Study On Clinical Treatment Based On Quetiapine Individualized Drug Metabolism Information

ObjectiveIn this study,the quetiapine fumarate dose,plasma concentration,efficacy,and drug abuse were investigated in patients with acute schizophrenia with different metabolic types by examining the quinopine-related metabolic types and monitoring plasma concentrations.The relationship between the responses is to provide a reference for the individualized drug selection of patients with acute schizophrenia in a rapid and effective manner.Objects and methodsInpatients with acute schizophrenia who met the inclusion criteria were treated with a single oral quetiapine as a treatment method for a total of 30 days.During the treatment period,drug doses were titrated and the peak level of steady-state plasma concentrations of quetiapine was monitored dynamically.Regular assessment of positive and negative symptoms scale,treatment emergente symptom scale,and monitoring of liver function,renal function,blood lipids,prolactin and other biochemical indicators.Result1.A total of 20 patients were included in the study and 19 were completed.Among them CYP3A5 weak metabolism,CYP2D6 intermediate metabolism type 5 cases,CYP3A5 weak metabolism,CYP2D6 fast metabolic type 6 cases,CYP3A5 intermediate metabolism,CYP2D6 weak metabolic type 1 case,CYP3A5 intermediate metabolism,CYP2D6 intermediate metabolism type 1 case,CYP3A5 intermediate metabolism,CYP2D6 Fast metabolism type was 2 cases,CYP3A5 fast metabolism,CYP2D6 intermediate metabolism type 2 cases,CYP3A5 fast metabolism,CYP2D6 fast metabolism type 2 cases.All the biochemical indicators such as electrocardiogram,liver function and renal function performed on the 1st and 2nd day of all patients were normal.2.The peak of steady-state plasma concentration of quetiapine was 306.7-511.3 ng/mL for the first time when the terminal effective group(n=11)was markedly effective during treatment(the PANSS reduction rate was ?30%).Among them,the male was 324-543ng/m L.mL,female:282-450 ng/mL.The effective plasma concentration range for the effective 30-day treatment group ranged from 358.5-629.5 ng/mL,with 467.6-666.8 ng/mLfor males and 282.1-449.5 ng/mL for females.3.The first markedly effective(PANSS reduction rate equal to 30%)time was later than the peak steady state plasma concentration for the effective concentration time.The onset time of CYP3A5 weak metabolism and CYP2D6 intermediate metabolism type was delayed by 5 days compared with the markedly effective plasma concentration.The onset time of CYP3A5 weak metabolism and CYP2D6 fast metabolic type was delayed by about10 days compared with the markedly effective plasma concentration.4.There were 8 adverse reactions during the study period in 8 patients,including 4abnormal liver function abnormalities,3 occurrences of borderline hypertriglyceridemia,2occurrences of tachycardia,and abnormal elevation of headache,troponin-I,and muscles.Abnormal increase of acid kinase isoenzyme and abnormal increase of creatine kinase occurred once.The adverse reactions corresponding to the minimum blood concentration of319.7ng/m L,the maximum value of 846.9ng/mL,corresponding to the drug dose of400mg/day-700mg/day.Conclusion1.Quetiapine treatment of acute schizophrenia at the onset of steady-state plasma concentrations peaked at 306.7-511.3 ng/mL.2.The onset time of quetiapine in the treatment of acute schizophrenia was later than the peak of marked blood concentration.At present,it is found that this delay time is different between the two metabolic types of CYP3A5 weak metabolism,CYP2D6 intermediate metabolism and CYP3A5 weak metabolism,and CYP2D6 fast metabolism.3.There was no significant correlation between the adverse reactions occurring within30 days of oral administration of quetiapine and its blood drug concentration and drug dose.4.The initial drug dose titration during the clinical application of quetiapine can be performed exactly as described in its pharmaceutical instructions.