ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121026.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121027.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121028.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121029.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Retention of patients in methadone treatment was studied in a cohort of 238 heroin addicts who entered maintenance programmes between February 1986 and August 1987. All subjects had been assessed at a centralised unit and referred to one of two other units for maintenance. Of the ten client characteristics that we analysed, three ‐ a history of imprisonment, a history of dependence on barbiturates or benzodiazepines and employment status at entry ‐ were included with “clinic” and maximum dose of methadone in the Cox regression models. Allowing for the other four variables, the maximum daily dose of methadone dispensed during the study period was a highly significant predictor of retention (P<0.00001). With maximum dose stratified into three levels<60 mg, 60‐79 mg, 80 + mg ‐ and with the lowest stratum used as the baseline, the relative risk (RR)of leaving treatment was halved (RR 0.47, 95% confidence interval [C1] 0.33‐0.67) for subjects receiving 60‐79 mg, and halved again (RR0.21,95% Cl 0.12‐0.38) for those who received 80 + mg. Clinic dosage policies contribute significantly to retention in methadone maintenance treatment. Clinics need to develop dosage policies in negotiation with individual patients.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121030.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo review the potential problems and their management associated with the use of anticonvulsant drugs during pregnancy.Data sourcesStudies published between 1968 and 1990 assessing the effect of pregnancy on the pharmacokinetics of anticonvulsant drugs, the teratogenicity of anticonvulsants, breast feeding and anticonvulsants and use of the oral contraceptive pill in patients taking anticonvulsant medication, were reviewed.Results of data synthesisIn general, plasma levels fall during pregnancy and rise during the puerperium. A number of factors including possible reduced absorption, increased volume of distribution, reduced protein binding, increased clearance and noncompliance, contribute to this fall in plasma concentration. All anticonvulsants are potentially teratogenic. The incidence of fetal malformations is higher In patients treated with multiple anticonvulsant drugs and on higher dosages with higher plasma levels. Anticonvulsants are excreted in low concentrations in breast milk. All anticonvulsants except valproic acid have been associated with failure of the oral contraceptive pill. This is due to liver enzyme induction of these drugs.ConclusionAs plasma levels of anticonvulsants fall during pregnancy, concentrations should be monitored regularly. Due to the fall in protein binding, marginally low total plasma levels of highly protein bound drugs may not reflect reduced unbound levels, and hence an increase in dosage may not be reqUired. In order to reduce teratogenicity, one should aim to use a single anticonvulsant drug and the lowest dosage able to achieve seizure control. In general, breast feeding Is not contraindicated.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121031.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121032.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121033.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121035.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121036.x

出版商:Wiley    

年代:1991

数据来源: WILEY