接受选择性5-羟色胺再摄取抑制剂治疗的患者的氯氮平和去甲氯氮平的血清水平。
Serum levels of clozapine and norclozapine in patients treated with selective serotonin reuptake inhibitors.
作者信息
Centorrino F, Baldessarini R J, Frankenburg F R, Kando J, Volpicelli S A, Flood J G
机构信息
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
出版信息
Am J Psychiatry. 1996 Jun;153(6):820-2. doi: 10.1176/ajp.153.6.820.
OBJECTIVE
The selective serotonin reuptake inhibitor (SSRI) fluoxetine can increase serum levels of clozapine and norclozapine, but effects of other SSRIs are unknown. Thus, the authors evaluated interactions of clozapine with fluoxetine, paroxetine, and sertraline.
METHOD
Serum clozapine and norclozapine concentrations were assayed in 80 psychiatric patients, matched for age and clozapine dose, given clozapine (mean dose = 279 mg/day) alone or with fluoxetine (mean dose = 39.3 mg/day), paroxetine (mean = 31.2 mg/day), or sertraline (mean = 92.5 mg/ day). Each patient's dose of clozapine was stable for at least a month before serum sampling.
RESULTS
Concentrations of clozapine plus norclozapine averaged 43% higher, and the risk of levels higher than 1000 ng/ml was 10-fold greater (25%), in the patients taking SSRIs, with minor differences between patients taking the individual SSRIs.
CONCLUSIONS
SSRIs can increase circulating concentrations of clozapine and norclozapine, sometimes to potentially toxic levels.
目的
选择性5-羟色胺再摄取抑制剂（SSRI）氟西汀可提高氯氮平和去甲氯氮平的血清水平，但其他SSRI的作用尚不清楚。因此，作者评估了氯氮平与氟西汀、帕罗西汀和舍曲林之间的相互作用。
方法
对80例年龄和氯氮平剂量相匹配的精神科患者测定血清氯氮平和去甲氯氮平浓度，这些患者单独服用氯氮平（平均剂量=279毫克/天）或与氟西汀（平均剂量=39.3毫克/天）、帕罗西汀（平均=31.2毫克/天）或舍曲林（平均=92.5毫克/天）合用。在采集血清样本前，每位患者的氯氮平剂量至少稳定一个月。
结果
服用SSRI的患者中，氯氮平加去甲氯氮平的浓度平均高出43%，高于1000纳克/毫升的水平风险高出10倍（25%），服用不同SSRI的患者之间差异较小。
结论
SSRI可提高氯氮平和去甲氯氮平的循环浓度，有时会达到潜在的中毒水平。
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