Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Department of Clinical Pharmacology, CAP, Marseille, France.
Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
Expert Opin Drug Metab Toxicol. 2022 Jul-Aug;18(7-8):507-518. doi: 10.1080/17425255.2022.2113378. Epub 2022 Aug 22.
The effects of antipsychotic drugs are dose-dependent, which is particularly true for their efficacy, each antipsychotic having a specific dose-response curve. This may justify individualizing doses for these agents.
We review the pharmacokinetic profiles of seven oral antipsychotics: haloperidol, risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole. Their main indications are psychotic and affective disorders. They are prescribed in a very large population which may have comorbidities. Hence, we analyze the impact of the latter on the pharmacokinetic profiles of these antipsychotics, focusing on renal and hepatic impairment. Reviews and clinical trials were discussed based on a systematic literature search (PubMed) ranging from 1995 to 2022.
Factors liable to impact antipsychotic dosage are numerous and their subsequent effects often hard to predict, due to multilevel interactions and compensatory phenomena. In clinical practice, physicians must be aware of these potential effects, but base their decisions on monitoring antipsychotic plasma levels.
抗精神病药物的作用与剂量有关，这在其疗效上尤为明显，每种抗精神病药物都有特定的剂量反应曲线。这可能证明这些药物的剂量个体化是合理的。
我们回顾了七种口服抗精神病药物的药代动力学特征：氟哌啶醇、利培酮、奥氮平、氯氮平、喹硫平、齐拉西酮和阿立哌唑。它们的主要适应症是精神病和情感障碍。这些药物在可能有合并症的大量人群中使用。因此，我们分析了后者对这些抗精神病药物药代动力学特征的影响，重点关注肾功能和肝功能损害。根据 1995 年至 2022 年的系统文献检索（PubMed），对综述和临床试验进行了讨论。
可能影响抗精神病药物剂量的因素很多，由于多层次的相互作用和代偿现象，其后续影响往往难以预测。在临床实践中，医生必须意识到这些潜在的影响，但要根据监测抗精神病药物血浆水平来做出决策。
