Levron J C, Ropert R
Encephale. 1987 Mar-Apr;13(2):83-7.
Precise pharmacokinetic data of long-acting neuroleptics: apparent half life (T 1/2), time of peak plasma concentration (Tmax), bioavailability, has been a major contribution to determine optimal dosage of the drug. If the aim of the depot neuroleptic is to obtain a stable plasma concentration of the neuroleptic after I.M. injection of the ester form equivalent to that following oral administration, it is logical to obtain the same pharmacological effect; this is true for haloperidol decanoate. Mean value of T 1/2 of clopenthixol decanoate and haloperidol decanoate are 19 and 21 days, respectively, they thereby justify monthly administration. Flupenthixol decanoate and fluphenazine enanthate should be injected with dosing intervals of 3 and 1 weeks, respectively in respect with their half-lives: 17 and 4 days. Fluphenazine decanoate have a half-life of 14 days, however, the longer time the treatment, the longer the apparent half-life, suggesting to reduce the dose or to enlarge the dosing interval. Optimal dose has been determined from the bioavailability of the oral formulation and the interval between two injections, it averages 15, 20 times the oral daily dose for haloperidol decanoate. A lower conversion factor is frequently used (0.5 to 5 times) for other depot-neuroleptics such as pipotiazine palmitate, fluphenazine enanthate or decanoate; these low factors are not entirely explainable by the low bioavailability of the oral forms and produces more lower plasma concentration than after oral administration.
表观半衰期(T1/2)、血浆浓度峰值时间(Tmax)、生物利用度,对确定药物的最佳剂量起到了重要作用。如果长效抗精神病药物的目标是在肌肉注射酯型药物后获得与口服给药后相当的稳定血浆浓度,那么获得相同的药理效应是合理的;氟哌啶醇癸酸酯就是如此。癸酸氯氮平和癸酸氟哌啶醇的T1/2平均值分别为19天和21天,因此证明每月给药是合理的。癸酸氟奋乃静和庚酸氟奋乃静应分别根据其半衰期(17天和4天)以3周和1周的给药间隔进行注射。癸酸氟奋乃静的半衰期为14天,然而,治疗时间越长,表观半衰期越长,这表明应减少剂量或延长给药间隔。最佳剂量是根据口服制剂的生物利用度和两次注射之间的间隔确定的,癸酸氟哌啶醇的最佳剂量平均为口服日剂量的15至20倍。对于其他长效抗精神病药物,如棕榈酸哌泊噻嗪、庚酸氟奋乃静或癸酸氟奋乃静,通常使用较低的换算系数(0.5至5倍);这些低系数不能完全用口服剂型的低生物利用度来解释,并且会使血浆浓度比口服给药后更低。