克罗米帕明治疗强迫症患者的个性化药物。

IF 1.3 4区 医学 Q3 PSYCHIATRY Journal of Psychiatric Practice Pub Date : 2023-11-01 DOI:10.1097/PRA.0000000000000750
Sheldon H Preskorn, Ryan Rode
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引用次数: 0

摘要

克罗米帕明(CIMI)是治疗对选择性血清素转运抑制剂(如舍曲林)试验无效的强迫症患者的有效方法。这里介绍的案例说明了CIMI在特定患者中的药效学和药代动力学知识如何用于个性化治疗,以优化疗效的可能性(即最大获益风险比)。本专栏中描述的方法考虑到:(1)由于细胞色素P450 2D6酶活性的遗传缺陷,患者清除CIMI及其主要代谢产物去甲多胺的能力减弱,以及(2)患者将CIMI广泛转化为去甲多丁胺的能力。这种转化削弱了抑制血清素转运蛋白的能力,血清素转运蛋白很可能是CIMI治疗强迫症疗效的机制。
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Personalized Medicine in the Treatment of a Patient With Obsessive-Compulsive Disorder With Clomipramine.

Clomipramine (CIMI) is an effective treatment for obsessive-compulsive disorder in patients who have failed to respond to trials of selective serotonin transport inhibitors (eg, sertraline). The case presented here illustrates how knowledge of the pharmacodynamics and pharmacokinetics of CIMI in a specific patient can be used to personalize treatment to optimize the likelihood of efficacy (ie, maximum benefit to risk ratio). The approach described in this column considered: (1) the patient's diminished ability to clear CIMI and its major metabolite, desmethlyclomipramine due to a genetic deficiency in cytochrome P450 2D6 enzyme activity, and (2) the patient's ability to extensively convert CIMI to desmethlyclomipramine. That conversion impairs the ability to inhibit the serotonin transporter, the mechanism that is most likely responsible for the efficacy of CIMI in obsessive-compulsive disorder.

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来源期刊
CiteScore
2.30
自引率
10.50%
发文量
159
审稿时长
>12 weeks
期刊介绍: Journal of Psychiatric Practice® seizes the day with its emphasis on the three Rs — readability, reliability, and relevance. Featuring an eye-catching style, the journal combines clinically applicable reviews, case studies, and articles on treatment advances with practical and informative tips for treating patients. Mental health professionals will want access to this review journal — for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. Journal of Psychiatric Practice combines clinically applicable reviews, case studies, and articles on treatment advances with informative "how to" tips for surviving in a managed care environment.
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