[Therapeutic Drug Monitoring of Antiarrhythmic Drugs].

Naohiko Takahashi
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Abstract

Antiarrhythmic drugs (AADs) can exhibit lethal adverse effects including proarrhythmia. To avoid these adverse effects, therapeutic drug monitoring (TDM) provides a therapeutic benefit. Recently, the Japanese Circulation Society and Japan TDM Society collaborated to do publish "Guidelines for TDM of Cardiovascular Drugs". Class I AADs exert strong sodium channel-blocking effects. The initial dose should be set using a nomogram. When using a beta blocker, an electrocardiogram and heat rate monitoring are more useful than TDM. Pulmonary toxicity is frequently observed in patients treated with amiodarone. TDM of amiodarone and its active metabolite desethylamiodarone is available to assess the risk of pulmonary toxicity. The ther- apeutic range of bepridil is 250-800 ng/mL. Exceeding this range may result in abnormal QT prolongation and the development of torsade de pointes. Digitalis intoxication should be avoided. Its therapeutic range partially overlaps with its toxic range. In patients with congestive heart failure, the serum concentration of digoxin should be maintained at a lower range. In summary, regarding arrhythmia therapy using AADS, safety should be more important than efficacy. Appropriate TDM is recommended. [Review].

[抗心律失常药物的治疗药物监测]。
抗心律失常药物(AADs)可表现出致命的不良反应,包括心律失常原。为了避免这些不良反应,治疗药物监测(TDM)提供了治疗益处。最近,日本循环学会和日本TDM学会合作出版了《心血管药物TDM指南》。一类AADs具有很强的钠通道阻断作用。初始剂量应该用线图确定。当使用受体阻滞剂时,心电图和心率监测比TDM更有用。在胺碘酮治疗的患者中经常观察到肺毒性。胺碘酮及其活性代谢物去乙基胺碘酮的TDM可用于评估肺毒性风险。贝地尔的治疗范围为250 ~ 800 ng/mL。超过这个范围可能会导致异常的QT延长和扭转角的发展。应避免洋地黄中毒。其治疗范围与毒性范围部分重叠。对于充血性心力衰竭患者,地高辛的血药浓度应维持在较低的范围内。综上所述,对于使用AADS治疗心律失常,安全性应比有效性更重要。建议使用适当的TDM。(审查)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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