背景:对于精神分裂症患者,氯氮平(CLZ)联合氯硝西泮(CLNAZ)是可行的治疗选择之一。我们成功地将CLZ和CLNAZ的剂量降低到多药物滥用患者的安全范围。据我们所知,这是这个问题的第一种情况。由于没有减少CLZ或CLNAZ的相关指南,我们希望通过分享这一案例,为类似多药滥用患者的防治提供参考。
方法:本病例报告描述一名46岁男性,有24年精神分裂症病史。他的主要临床表现是幻听,迫害妄想,和情绪不稳定。2012年,患者因肺结核开始服用利福平,并逐渐过度使用CLZ和CLNAZ。入院前,他每天服用1,275毫克CLZ,每晚服用26毫克CLNAZ。在治疗药物监测(TDM)和药物遗传学测试的帮助下,我们逐渐减少了他每日的CLZ和CLNAZ剂量,并为他制定了更合理的给药方案.在出院时,患者每天服用CLZ450毫克,每晚服用CLNAZ2毫克,没有明显的精神病症状.
结论:在精神分裂症的药物维持治疗过程中,有必要采取TDM策略来减少和治疗多种处方药的滥用。
BACKGROUND: For patients with schizophrenia, clozapine (CLZ) in combination with clonazepam (CLNAZ) is one of the viable therapeutic options. We successfully reduced the doses of CLZ and CLNAZ to the safe range of a polydrug abuse patient. As far as we know, this is the first
case of this problem. As there are no relevant guidelines to reduce CLZ or CLNAZ, we hope to share this
case to provide a reference for the prevention and treatment of similar patients with multidrug abuse.
METHODS: This
case report describes a 46-year-old male with a 24-year history of schizophrenia. His main clinical manifestations are auditory hallucinations, persecutory delusion, and emotional instability. In 2012, the patient started taking rifampicin due to tuberculosis and gradually overused CLZ and CLNAZ. Before admission, he took 1,275 mg of CLZ every day and 26 mg of CLNAZ every night. With the help of Therapeutic Drug Monitoring (TDM) and pharmacogenetic testing, we gradually reduced his daily dose of CLZ and CLNAZ and formulated a more reasonable dosing schedule for him. At the time of discharge, the patient took CLZ 450 mg per day and CLNAZ 2 mg per night, with no obvious symptoms of psychosis.
CONCLUSIONS: In the process of drug maintenance treatment of schizophrenia, it is necessary to adopt TDM strategy to reduce and treat the abuse of multiple prescription drugs.