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目的比较合用西咪替丁前后抗结核药物异烟肼和利福平对血浆氯氮平浓度的影响。方法先将25例伴肺结核的精神分裂症患者在维持原来氯氮平剂量治疗>2周的基础上,给予异烟肼(0.3 g,qd,po)和利福平(0.45g,qd,po)治疗6周,将6周末采用高效液相色谱(HPLC)法测定氯氮平血药浓度作为基础浓度;再合用西咪替丁(0.4 g,b id),并维持6周。分别于合用西咪替丁后第2和6周末测定血浆氯氮平浓度,并与基础浓度作比较。结果异烟肼+利福平治疗6周后,氯氮平浓度为(82.4±37.4)ng.mL-1,加用西咪替丁后,第2和6周末氯氮平血药浓度分别为(107.6±53.6)和(135.5±65.7)ng.mL-1,平均升幅分别为30.3%和64.4%。治疗前与第2周末的氯氮平血浓度间差异无显著性(P>0.05),治疗前与第6周末比较差异有极显著性(P<0.01)。结论西咪替丁可部分提高血浆氯氮平浓度,有利于精神分裂症伴肺结核患者的精神症状的稳定。
Objective To compare the effects of isoniazid and rifampicin before and after the combination of cimetidine on plasma clozapine concentration. Methods 25 patients with schizophrenia with pulmonary tuberculosis were treated with isoniazid (0.3 g, qd, po) and rifampicin (0.45 g, qd, po ) For 6 weeks. The plasma concentration of clozapine was determined by HPLC at 6 weeks as the baseline concentration. Cimetidine (0.4 g, b id) was also added for 6 weeks. Plasma clozapine concentrations were measured at the 2nd and 6th weekend after co-administration of cimetidine, respectively, and compared with baseline concentrations. Results After isoniazid + rifampin treatment for 6 weeks, the concentration of clozapine was (82.4 ± 37.4) ng.mL-1. After adding cimetidine, the serum concentrations of clozapine at the 2nd and 6th weekend were (107.6 ± 53.6) and (135.5 ± 65.7) ng.mL-1, respectively. The average increase was 30.3% and 64.4% respectively. There was no significant difference between the blood levels of clozapine before treatment and the end of the second week (P> 0.05). There was significant difference between before treatment and the end of the sixth week (P <0.01). Conclusion Cimetidine can partially increase the plasma clozapine concentration, which is beneficial to the stabilization of mental symptoms in patients with schizophrenia and pulmonary tuberculosis.