治療憂鬱症另類藥物－Escitalopram之優點

Advantages of Escitalopram as an Alternative Treatment for Depression

林淑芬(Shu-Fen Lin) ； 柯素蕙(Shu-Hui Ko) ； 張信男(Shin-Nan Chang)

《北市醫學雜誌》 4卷1期 (2007/01) Pp. 30-36

https://doi.org/10.6200/TCMJ.2007.4.1.04

摘要

現今憂鬱症的治療及控制，仍以藥物使用為主軸；大部份抗憂鬱劑於三維立體化學結構式中，可發現鏡像異構物(enantiomers)，其鏡像體間有著不同的生化特性，進而影響到藥物動力學及藥物藥效學。分離光學鏡像異構物是一個快速研發的方向，找出一個較優越的活性鏡像體，此不僅可以提高原來消旋混合物(racemic mixture)的療效，並可降低劑量，減少副作用及藥物交互作用的發生；且可延續先前消旋混合體的治療經驗，使藥物治療的發揮更臻完善。而是否出現有利益的單一鏡像體，完全視藥物而論。例如fluoxetine也似大部分的SSRI存在對掌中心，然在實驗中發現活性鏡像體，卻會引起心臟毒性；而Escitalopram則是消旋性異構物相對於藥品活性研究下的成功產物。Escitalopram保留了其他抗憂鬱劑的優點，包括服藥方便、療效確定，同時也呈現此藥獨特的作用機轉，提高療效與提供更佳耐受性，尤其適合長期用藥；且劑量調整方便，初始劑量即為有效劑量，快速達成症狀緩解，副作用小於同強度之SSRI製劑，為憂鬱症藥物治療上提供了另一種選擇。

關鍵字

鏡像異構物 ； 消旋混合物 ； 抗憂鬱劑 ； Escitalopram

並列摘要

Nowadays the treatment and control over depression diseases are still mainly based on pharmaceutical use. Enantiomers that can be found in three-dimensional chemical structures of most antidepressants have differently biochemical properties which will affect the pharmacokinetics and pharmacodynamics. Separation of the enantiomers is a fast development way to identify a more superior active enantiomer, which not only improves the efficacy of a racemic mixture but also reduces dosage, side effects and prevents the occurrences of drug interaction. In addition, it can continue previous experience of treatment with a racemic mixture, perfectly maximizing medical treatment effects. Whether or not a single beneficial enantiomer appears completely depends on medicine. For example, Fluoxetine, which is similar to most SSRIs, has a chiral center, although the active enantiomers found in experiments will cause heart toxicity. However escitalopram are successful products produced from a study on a racemic mixture versus medical activity. Escitalopram reserves the advantages of other antidepressants, including convenience administration, confirmed efficacy, and shows the medical unique mechanism of action, boosts efficacy, as well as provides better tolerability. Especially, it is ideal for a long period of use. Its dosing is convenient, and the initial dose is the effective dose, which can achieve symptomatic remission, with side effects minor than those of SSRIs in terms of severity, ultimately provides an alternative medical treatment for depression patients.

並列關鍵字

enantiomers ； racemic mixture ； antidepressants ； Escitalopram