精神疾病患者之鋰鹽血中濃度監測：每日兩次和睡前與每日三次服用方式之血中濃度比較

TDM of Lithium in Psychiatric Disorders patients: BID/HS vs. TID oral administration in plasma levels

郭建宏(Chien-Hung Kuo)

指導教授 ： 詹道明

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00092

摘要

鋰鹽被認為是治療急性躁狂和長期預防雙相情感疾病的第一線療法，亦用在其他疾病的治療，如：精神病合併有攻擊性，重鬱症和精神分裂症。其治療指數狹窄，所以必須施行治療藥物監測來調整劑量。精神疾病患者其一般使用鋰鹽的正常劑量為每次300毫克，每天三次，口服使用。當達不到治療濃度時，臨床上總是建議增加劑量，但有些病人會有副作用的抱怨。有些醫生則會改以每天兩次和就寢前服用的給藥模式投予病患。本研究設計採取病歷回溯性方式，於郭綜合醫院蒐集自2004年至2009年間有執行鋰鹽血中濃度監測之研究對象，其就醫病歷記錄、用藥記錄等，並將資料分組與分析比較。在與每日三次的給藥模式（0.260 ± 0.228毫當量/公升）比較下，我們證實每天兩次與就寢前服用的給藥模式（0.664 ± 0.261毫當量/公升）可大幅增加鋰鹽濃度達 0.404 ± 0.192毫當量/公升（t＝7.566，df＝12，p＜0.001），而採取每天兩次與就寢前服用的方式，除了能更理想地顯示出病患的鋰鹽血中濃度，亦可避免因增加劑量而造成的副作用。

關鍵字

鋰鹽 ； 每天兩次和就寢前 ； 治療藥物監測

並列摘要

Lithium is considered a first-line therapy for treatment of acute mania and long-term prophylaxis of bipolar affective disorder (BAD). It is also used in other conditions, such as schizoaffective disorder, major depressive disorder and schizophrenia. Lithium has a narrow therapeutic index, therapeutic drug monitoring (TDM) is essential in assisting in the management of the dosage. The usual lithium dose for patients with psychiatric disorders is 300 mg three times a day (TID) orally. When not reaching the therapeutic concentrations, clinically always recommended to increase the dose. At this time, some patients have complained of side-effects. Some doctors take twice a day (BID) and bedtime (HS) modes administration. A retrospective chart review of all patients who received TDM for lithium carbonate between January 2004 and October 2009 was done at Kuo General Hospital in Tainan, Taiwan. We confirmed that BID/HS (0.664 ± 0.261 mEql/L) was a significant increase in lithium concentration 0.404 ± 0.192 mEq/L (t = 7.566, df = 12, p < 0.001) compared with the TID (0.260 ± 0.228 mEq/L). The BID/HS administration method can ideally show a patient’s lithium concentration and can avoid side-effects caused by a higher dose.

並列關鍵字

Lithium ； BID/HS ； TDM

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