Hermann Monica, Waade Ragnhild Birkeland, Molden Espen
*Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo; and †Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
Ther Drug Monit. 2015 Aug;37(4):546-9. doi: 10.1097/FTD.0000000000000169.
Elderly patients are at increased risk for elevated serum concentrations from treatment with selective serotonin reuptake inhibitors (SSRIs). The aim of this study was to examine the use of therapeutic drug monitoring (TDM) of SSRIs in elderly compared with younger patients.
All serum concentration measurements of SSRIs (escitalopram, citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline) performed at our laboratory in 2011 were included. The use of TDM (relative frequency) in older versus younger patients was examined by comparing the use of TDM in patients aged 60 years or older with that in patients younger than 60 years and by evaluating the use of TDM relative to age (age groups in decennials). The number of patients with an SSRI dispensed by prescription in the same region and period (the Norwegian Prescription Database) was used as reference. Additionally, the number of samples above the upper limit of the recommended reference range in patients aged 60 years or older and patients younger than 60 years was evaluated.
TDM of an SSRI had been performed in 6333 patients. For all SSRIs, the use of TDM was significantly lower (8.2% versus 10.6% for citalopram, 10.0% versus 13.8% for escitalopram, 8.6% versus 17.0% for fluoxetine, 5.6% versus 10.3% for paroxetine, and 8.1% versus 15.0% for sertraline) in patients aged 60 years or older compared with those younger than 60 years (P < 0.001). There was a gradual decline in the use of TDM with increasing age, with a 3-fold difference between the youngest (10-19) and oldest (90+) patients (P < 0.0001). The percentage of samples above the upper limit of the recommended reference range was 2-fold higher in patients aged 60 years or older (6.7%) compared with patients younger than 60 (3.4%) years (P < 0.0001).
Clinical follow-up of patients with TDM of SSRIs is less frequent in older patients compared with younger patients. This is in contrast to the general guidelines for TDM where patients of advanced age are considered of particular importance to monitor closely.
老年患者使用选择性5-羟色胺再摄取抑制剂（SSRI）治疗时血清浓度升高的风险增加。本研究的目的是比较老年患者与年轻患者中SSRI治疗药物监测（TDM）的使用情况。
纳入2011年在我们实验室进行的所有SSRI（艾司西酞普兰、西酞普兰、氟西汀、氟伏沙明、帕罗西汀和舍曲林）血清浓度测量。通过比较60岁及以上患者与60岁以下患者的TDM使用情况，以及评估TDM相对于年龄（以十年为一组的年龄组）的使用情况，来研究老年患者与年轻患者中TDM的使用情况。同一地区和时期（挪威处方数据库）中通过处方配药的SSRI患者数量用作参考。此外，还评估了60岁及以上患者和60岁以下患者中高于推荐参考范围上限的样本数量。
对6333例患者进行了SSRI的TDM。对于所有SSRI，60岁及以上患者的TDM使用率显著低于60岁以下患者（西酞普兰为8.2%对10.6%，艾司西酞普兰为10.0%对13.8%，氟西汀为8.6%对17.0%，帕罗西汀为5.6%对10.3%，舍曲林为8.1%对15.0%）（P<0.001）。随着年龄增长，TDM的使用率逐渐下降，最年轻（10 - 19岁）和最年长（90岁以上）患者之间相差3倍（P<0.0001）。60岁及以上患者中高于推荐参考范围上限的样本百分比（6.7%）是60岁以下患者（3.4%）的2倍（P<0.0001）。
与年轻患者相比，老年患者中SSRI的TDM临床随访频率较低。这与TDM的一般指南相反，在该指南中，高龄患者被认为是特别需要密切监测的对象。
