Cooper T B
Clin Pharmacokinet. 1978 Jan-Feb;3(1):14-38. doi: 10.2165/00003088-197803010-00002.
Psychotic patients treated with identical doses of antipsychotic drugs have been shown to have great interindividual differences in their steady state plasma concentration. Therefore, monitoring treatment by dosage adjustment alone is of little value. If antipsychotic blood levels can be related to clinical response then their routine measurement may well result in well defined guidelines to individualised optimal dosage. Despite the considerable effort expended in this field and the many interesting testable hypotheses generated, little substantive evidence for an acceptable plasma level monitoring guide has been reported to date. Work on metabolite level profiles, intra- and extracellular drug concentration differences, more detailed clinical rating scales, and improved experimental design, all show great promise for the future. Investigation of the pharmacokinetics and the elucidation of the often complex metabolic pathways of individual antipsychotic drugs are generating the data base required for the rational pharmacotherapy of these most severely ill patients. Until more data are available, routine monitoring of antipsychotic drug plasma levels remains of research interest.
接受相同剂量抗精神病药物治疗的精神病患者，其稳态血浆浓度存在很大的个体差异。因此，仅通过调整剂量来监测治疗效果价值不大。如果抗精神病药物的血药浓度与临床反应相关，那么常规检测血药浓度很可能会产生明确的个体化最佳剂量指南。尽管在该领域付出了巨大努力并提出了许多有趣的可检验假设，但迄今为止，几乎没有关于可接受的血浆水平监测指南的实质性证据报道。关于代谢物水平谱、细胞内和细胞外药物浓度差异、更详细的临床评分量表以及改进的实验设计等方面的研究，都为未来展现了巨大的前景。对各抗精神病药物的药代动力学研究以及对其通常复杂代谢途径的阐明，正在为这些重症患者的合理药物治疗生成所需的数据库。在获得更多数据之前，抗精神病药物血浆水平的常规监测仍属于研究范畴。
