頁籤選單縮合
題名 | 精神分裂症患者使用Clozapine之副作用=Adverse Effects of Clozapine in the Treatment of Schizophrenia |
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作者 | 林清華; 余伍洋; 徐秋蓬; 洪明潤; 陳素媖; 楊寬弘; | 書刊名 | 臺灣精神醫學 |
卷期 | 13:3 1999.09[民88.09] |
頁次 | 頁33-42 |
分類號 | 418.21 |
關鍵詞 | 姿勢性低血壓; EKG之QT段延長; EEG異常; Clozapine; Orthostatic hypotension; QT prolongation in EKG; EEG abnormality; |
語文 | 中文(Chinese) |
中文摘要 | 目的:clozapine自1993年起在本院使用,分析其常見之副作用、效果及預測因子。 方法:符合頑固型精神分裂症標準且使用clozapine治療之病人共107人,收集病人服藥前 之肝功能、腎功能、血壓、腋溫、體重、心電圖、腦電圖、及簡短精神量表(BPRS);並至 少服用三個月後重做一次上述之檢查。至少服用三個月後以UKU副作用量表測量副作用及 量立臥姿之血壓差。服藥的十八週內每週測一次血液常規,之後改每月測一次,並以BPRS 變化量表示臨床反應。結果:發生leukocytopenia只有一個案,無顆粒性白血球減少之個案; 用藥第一個月內發生白血球增加及發燒為短暫現象。服藥後常見之副作用有流口水、鎮靜、 便秘;常見之錐體外副作用為手抖;體動明顯增加。心臟血管系統之影響有心跳增加、收縮 壓降低;EKG之變化為QT段延長,但仍屬正常範圍。分析服藥時間與副作用之相關性顯 示:肝功能、腎功能、體重、心臟血管系統、心電圖、流口水、鎮靜、及便秘等副作用無顯 著相關;分析副作用與劑量之關:GOT變化與藥物劑量呈負相關,但所有GOT值位於正常 值範圍;clozapine劑量愈高愈易引起姿勢性低血壓及腦電圖異常。Clozapine臨床反應與使 用時間、劑量、體重增加、發病年齡、性別、及EEG異常無關。結論:clozapine引起之副 作用很多,主要為白血球變化、發燒、心跳增加、收縮壓降低、姿勢性低血壓、心電圖之QT 段延長、異常腦波、流口水、鎮靜、及便秘等副作用,大部分副作用在服藥早期即發生,三 個月後變化不明顯。高劑量無法增加臨床效果,但卻增加姿勢性低血壓之危險及腦電圖異常 變化。 |
英文摘要 | Objective: The purpose of this study was to determine the frequency of adverse effects of clozapine and the predictors of clinical response. Methods: Data were collected from the charts of 107 schizophrenic patients met the criteria of DSM-IV and of treament-refractoriness treated during the period from Apr, 1997 to Nov, 1997. Baseline levels of various clinical parameters were established using values obtained at examinations before the start of clozapine use, and included liver function, renal function, BP, axillary BT, BW, EKG, EEG, and BPRS. These clinical parameters were rechecked 3 months later. Results: Agranulocytosis was not observed in this series and only one case of leukocytopenia was observed. Both leukocytosis and fever were transient in this patient. A statistically significant increase in BW and HR and a significant decrease in systolic BP were observed. A significant QT prolongation was observed on EKG. Sialorrhea and sedation were occurring in 38.0% and 30.4% of patients, respectively. There was no significant difference in the incidence of adverse effects with treatment duration. Conclusion: In this series, the major adverse effects of clozapine were: leukocytopenia, leukocytosis, fever, body weight gain, HR increase , systolic BP decrease, orthostatic hypotension, and QT prolongation in EKG. There were no significant changes in adverse effects with treatment duration. The duration of treatment, dosage, BW gain, onset, sex, and presence of EEG abnormalities were not predictive of the clinical response. Higher dosage could not improve clinical response, but increased the risks of EEG abnormality and orthostatic hypotension. (Full Text in Chinese) |
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