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用于治疗注意力缺陷/多动障碍的苯丙胺类药物的临床药代动力学

The Clinical Pharmacokinetics of Amphetamines Utilized in the Treatment of Attention-Deficit/Hyperactivity Disorder.

作者信息

Markowitz John S, Patrick Kennerly S

机构信息

1 Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida , Gainesville, Florida.

2 Center for Pharmacogenomics, University of Florida , Gainesville, Florida.

出版信息

J Child Adolesc Psychopharmacol. 2017 Oct;27(8):678-689. doi: 10.1089/cap.2017.0071. Epub 2017 Sep 14.

Abstract

Amphetamine (AMP), an indirectly acting psychostimulant approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults, is among the most long-standing therapeutic agents in all of clinical psychopharmacology. This review focuses on AMP absorption, metabolism, and elimination brought to bear on comparative pharmacokinetics in its various formulations. A comprehensive search of the published literature was conducted using MEDLINE (PubMed) and Google Scholar databases through April 2017 to retrieve all pertinent in vitro and human studies for review and synthesis. Additionally, Food and Drug Administration (FDA) databases were accessed for otherwise unavailable data when possible. Initially available as racemic (dl)-AMP, this drug was later supplanted by enantiopure (d)-AMPH or enantioenriched (75:25 dl)-AMP formulations; although racemic AMP returned as an approved drug to treat ADHD in 2014. Presently, there are several immediate-release (IR) formulations available, including d-AMP, dl-AMP, and mixed amphetamine salts, which are neither racemic nor the pure d-enantiomer (i.e., a 3:1 mixture of d-AMP and l-AMP). Furthermore, new modified-release AMP formulations, including an oral suspension and an orally disintegrating tablet, are now available. A lysine-bonded prodrug form of d-AMP also serves as a treatment option. Oral AMP is rapidly absorbed, with high absolute bioavailability, followed by extensive metabolism involving multiple enzymes. Some metabolic pathways exhibit stereoselective biotransformations favoring the l-isomer substrate. Drug exposure exhibits dose-proportional pharmacokinetics. Body weight is a fundamental determinant of differences in observed AMP plasma concentrations. IR formulations typically provide a T from 2 to 3 hours. In replicated studies, children exhibit a shorter plasma T (∼7 hours) relative to adults (∼10 to 12 hours). There are few documented pharmacokinetic drug interactions of clinical significance beyond influences of drug-induced alteration of urinary pH. The array of AMP formulations addressed in this review offer flexibility in dosing, drug onset, and offset to assist in individualized pharmacotherapy of ADHD.

摘要

苯丙胺(AMP)是一种间接作用的精神兴奋剂,被批准用于治疗儿童、青少年和成人的注意力缺陷多动障碍(ADHD),是临床精神药理学中使用时间最久的治疗药物之一。本综述聚焦于不同剂型的AMP在比较药代动力学方面的吸收、代谢和消除情况。通过使用MEDLINE(PubMed)和谷歌学术数据库,对截至2017年4月的已发表文献进行了全面检索,以获取所有相关的体外研究和人体研究,用于综述和综合分析。此外,如有可能,还访问了美国食品药品监督管理局(FDA)数据库以获取其他无法获取的数据。该药物最初是以消旋(dl)-AMP形式上市,后来被对映体纯的(d)-AMPH或对映体富集(75:25 dl)-AMP剂型所取代;不过消旋AMP在2014年又作为一种获批药物回归用于治疗ADHD。目前,有几种速释(IR)剂型可供使用,包括d-AMP、dl-AMP和混合苯丙胺盐,它们既不是消旋体也不是纯d-对映体(即d-AMP和l-AMP的3:1混合物)。此外,现在还有新的缓释AMP剂型,包括口服混悬液和口腔崩解片。d-AMP的赖氨酸结合前药形式也是一种治疗选择。口服AMP吸收迅速,绝对生物利用度高,随后会经历涉及多种酶的广泛代谢。一些代谢途径表现出有利于l-异构体底物的立体选择性生物转化。药物暴露呈现出剂量比例药代动力学特征。体重是观察到的AMP血浆浓度差异的一个基本决定因素。IR剂型的血浆达峰时间(T)通常为2至3小时。在重复研究中,儿童的血浆达峰时间(约7小时)相对于成人(约10至12小时)较短。除了药物引起的尿液pH值改变的影响外,几乎没有记录在案的具有临床意义的药代动力学药物相互作用。本综述中涉及的一系列AMP剂型在给药剂量、起效时间和药效消退方面提供了灵活性,有助于ADHD的个体化药物治疗。

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