治疗方案的变化和肝硬化对酒精戒断综合征治疗期间苯二氮䓬类药物暴露量的影响。
Effect of variations in treatment regimen and liver cirrhosis on exposure to benzodiazepines during treatment of alcohol withdrawal syndrome.
作者信息
Gershkovich Pavel, Wasan Kishor M, Ribeyre Charles, Ibrahim Fady, McNeill John H
机构信息
School of Pharmacy, University of Nottingham, University Park, Nottingham, UK;
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada;
出版信息
Drugs Context. 2015 Aug 7;4:212287. doi: 10.7573/dic.212287. eCollection 2015.
PURPOSE
Benzodiazepines (BDZs) are the drugs of choice to prevent the symptoms of alcohol withdrawal syndrome (AWS). Various treatment protocols are published and have been shown to be effective in both office-managed and facility-managed treatment of AWS. The aim of this scientific commentary is to demonstrate the differences in the expected exposure to BDZs during AWS treatment using different treatment regimens available in the literature, in patients with or without alcoholic liver cirrhosis.
METHODS
Diazepam and lorazepam AWS protocols were examined and reviewed in the literature, and blood plasma levels were examined and compared, respectively.
RESULTS
Considerable variation in the blood levels with the different dosing schedules was found. Because the drugs are metabolized differently, we have also shown that liver disease affects the blood levels of diazepam, but not of lorazepam.
CONCLUSIONS
Differences in treatment regimens, the choice of BDZ, as well as the presence of liver cirrhosis can substantially alter the exposure of patients to drugs used for AWS treatment. Outpatient treatment of AWS has been shown to be relatively safe and effective for the treatment of AWS but patients should be carefully monitored.
目的
苯二氮䓬类药物（BDZs）是预防酒精戒断综合征（AWS）症状的首选药物。已发表了各种治疗方案，并且这些方案已被证明在门诊管理和住院管理的AWS治疗中均有效。本科学评论的目的是展示在有或无酒精性肝硬化的患者中，使用文献中可用的不同治疗方案治疗AWS期间，预期的BDZs暴露量的差异。
方法
在文献中检查和回顾了地西泮和劳拉西泮治疗AWS的方案，并分别检查和比较了血浆水平。
结果
发现不同给药方案的血药水平存在相当大的差异。由于这些药物的代谢方式不同，我们还表明肝病会影响地西泮的血药水平，但不影响劳拉西泮的血药水平。
结论
治疗方案的差异、BDZ的选择以及肝硬化的存在会显著改变患者接受AWS治疗所用药物的暴露量。门诊治疗AWS已被证明对治疗AWS相对安全有效，但应对患者进行仔细监测。
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