Chen Xiao, Zhang Yue, Yin Di, Jin Ying-Wei, He Su-Mei, Zhang Cun, Wang Dong-Dong
School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China.
School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China.
Drug Des Devel Ther. 2025 Sep 9;19:8051-8067. doi: 10.2147/DDDT.S538856. eCollection 2025.
Quetiapine has been used for treating patients with depression; however, drug-drug interactions (DDIs) deeply limit its individualized administration. This study explored DDIs and initial dose recommendation of quetiapine in depression patients based on real-world data.
Sixty-four real-world depression patients were used to investigate the effects of drug combinations on quetiapine using a non-linear mixed effect model (NONMEM).
In the final model, paroxetine and fluvoxamine were included as covariates, which significantly affected the clearance rate of quetiapine, with ratios of about 1.00:0.54:0.48:0.26 in patients with depression who were not accompanied by paroxetine or fluvoxamine, patients with depression who were accompanied by paroxetine, patients with depression who were accompanied by fluvoxamine, and patients with depression who were accompanied by paroxetine and fluvoxamine. Furthermore, the initial dose optimizations of quetiapine were 20 and 16 mg/kg/day for depression patients not accompanied by paroxetine or fluvoxamine who weighted 40-80, and 80-120 kg, respectively. The initial dose of quetiapine was 8 mg/kg/day for depression patients accompanied by paroxetine who weighted 40-120 kg. The initial dose of quetiapine was 8 mg/kg/day for depression patients accompanied by fluvoxamine, who weighted 40-120 kg. The initial dose optimization of quetiapine was 4 mg/kg/day for depression patients accompanied by paroxetine and fluvoxamine who weighted 40-120 kg.
Our study explored DDIs and initial dose recommendation of quetiapine in depression patients from the real world, and the initial dose optimization of quetiapine was recommended based on the interaction with paroxetine or fluvoxamine.
喹硫平已被用于治疗抑郁症患者；然而，药物相互作用（DDIs）严重限制了其个体化给药。本研究基于真实世界数据探讨了抑郁症患者中喹硫平的药物相互作用及初始剂量推荐。
采用非线性混合效应模型（NONMEM），对64例真实世界中的抑郁症患者进行研究，以考察药物组合对喹硫平的影响。
在最终模型中，帕罗西汀和氟伏沙明作为协变量被纳入，它们显著影响喹硫平的清除率，在未伴有帕罗西汀或氟伏沙明的抑郁症患者、伴有帕罗西汀的抑郁症患者、伴有氟伏沙明的抑郁症患者以及伴有帕罗西汀和氟伏沙明的抑郁症患者中，其比值约为1.00:0.54:0.48:0.26。此外，对于体重40 - 80千克和80 - 120千克、未伴有帕罗西汀或氟伏沙明的抑郁症患者，喹硫平的初始剂量优化分别为20毫克/千克/天和16毫克/千克/天。对于体重40 - 120千克、伴有帕罗西汀的抑郁症患者，喹硫平的初始剂量为8毫克/千克/天。对于体重40 - 120千克、伴有氟伏沙明的抑郁症患者，喹硫平的初始剂量为8毫克/千克/天。对于体重40 - 120千克、伴有帕罗西汀和氟伏沙明的抑郁症患者，喹硫平的初始剂量优化为4毫克/千克/天。
我们的研究从真实世界探讨了抑郁症患者中喹硫平的药物相互作用及初始剂量推荐，并根据与帕罗西汀或氟伏沙明的相互作用推荐了喹硫平的初始剂量优化方案。
