The Correlation Study Between The Plasma Concentration Of Paroxetine And The Treatment Effect,Adverse Reaction In Depression

Objective:Therapeutic drug monitoring starts in the latter half of the 20th century, with the use of analysis technology development, advanced equipment, drug sector develop a service aiming at during the drug treatment, by timing quantitative collection of patients with serum, plasma and other body fluids (such as urine and saliva) With modern analysis, testing and digital technology. Taking the measure of the concentration of the drug and its metabolites that is aiming to explore the drug in vivo biological conversion process. The relationship between drug concentration and efficacy and toxicity can assist professor to adjust the individualized drug therapy. Recently, there are a lot of researches about antidepressant therapeutic drug monitoring. Paroxetine belongs to SSRI drugs. There is little research about TDM. This study was to examine the correlation between the Paroxetine plasma concentration and the dose, the clinical efficacy and the side effects in patients with depression.Methods:This paper selected 44 patients who had been diagnosed depression in our hospital from April 2015 to January 2016. These patients took a fixed dose of Paroxetine (Day 1-4 10mg/d, the fifth day — weekend-6 20mg/d) treatment for 8 weeks.We assessed the HAMD, HAMA, MADRS, VAS, SF-36 and TESS scale to evaluate the clinical efficacy and adverse reactions at baseline. Then we used Ultra High-Performance Liquid Chromatograph (UHPLC) to detect the blood concentration of Paroxetine at 0,1,2,4and8weeks respectively. We used full analysis set (FAS)and per-protocal population(PP) to analyze the clinical curative effect.We used per-protocal population to analyze the relationship between plasma concentrations of Paroxetine and the clinical efficacy.T test and correlation analysis were used to statistical analysis.Results:1.Compared with the baseline, HAMD, HAMA, MADRS, SF-36 and VAS scale scores have very significant statistical significance (P<0.001)after treatment 1,2, 4 and8weeks;The plasma concentration range of Paroxetine, there was no correlation (P>0.05)between the plasma concentration of Paroxetine.There was significant statistical significance (P<0.01)in the clinical cure rate and the effective rate of treatment in the early onset group and the early without onset group (8).2.Patients after taking the paroxetine for (2.2-57.8) ng/ml, which is the blood drug concentration range. Comparedin the patients who is the early onset blood drug concentration and early not onset blood drug concentration, their difference does not have statistical significance (P>0.05). Patients at 1 and 2 weeks of blood serum concentrations were significantly positively correlated with the HAMD reduction rate of first and 2 weeks (P<0.01),and negatively correlated with the VAS score at first and 2 weeks (P<0.01). Taking paroxetine after 8 weeks of treatment obtained clinical cure patients than did not achieve clinical cure patients 1,2 weeks to higher blood drug concentration, the difference is statistically significant (P<0.05); but taking paroxetine treatment 8 weeks after treatment patients and did not achieve the effective treatment of patients 1,2 weeks blood drug concentration difference does not have statistical significance (P<0.05).Conclusion:1.Paroxetine can effectively improve the symptoms of depression, and improve the life quality, but it is not obvious to improve the patient’s pain symptoms. Paroxetine’s common adverse reactions is loss appetite/anorexia, nausea, vomiting, dry mouth, constipation, dizziness and fainting, diarrhea, drowsiness, sweating and so on. But there was no significant correlation between plasma concentration and adverse reaction.2.Paroxetine’s blood concentration and HAMD reduction ratio between is correlated; higher paroxetine in plasma concentration of patients with better curative effect. Suggesting that early (1 week,2 weeks) paroxetine blood drug concentration can be predicted with 8 weeks of clinical cure rate. And find the treatment of 1 and 2 weeks of the early onset of paroxetine lowest concentration values were 11.68ng/ml and 14.600ng/ml.