Therapeutic monitoring of escitalopram by dexamethasone suppression test.
Introduction. Depression is associated with a dysfunction of regulation of the hypothalamic-pituitary-adrenal, HPA, which is reflected in the alteration of the dexamethasone suppression test, DST. Escitalopram and other SSRIs decrease the HPA axis response to the DST, being the aim of this study val...
| Publicado en: | Actas Espanolas de Psiquiatria Vol. 40; no. 5; pp. 275 - 281 |
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| Autores principales: | , , , , , |
| Formato: | Artículo |
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Maria Lopez-Ibor
sep/oct2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=lth&AN=87688071&site=ehost-live header: @attributes: shortDbName: lth uiTerm: 87688071 longDbName: MedicLatina uiTag: AN controlInfo: bkinfo: jinfo: jid: 11399287 IVZ jtl: Actas Espanolas de Psiquiatria issn: 11399287 maglogo: N pubinfo: dt: sep/oct2012 vid: 40 iid: 5 pid: 80014 pub: Maria Lopez-Ibor artinfo: ui: 87688071 ppf: 275 ppct: 6 formats: fmt: @attributes: type: P size: 151KB tig: atl: Therapeutic monitoring of escitalopram by dexamethasone suppression test. aug: au: Lozano-Ortiz, Roberto Marin-Lacasa, Reyes Pascual-Garcia, Asuncion Santacruz-Abion, Maria J. Sebastian-Perez, Francisca Orea-Ramón, Beatriz affil: Hospital Real y Provincial Ntra. Sra. De Gracia Servicio Farmacia Hospital Real y Provincial Ntra. Sra. De Gracia. Servicio Psiquiatría su: Mental depression Therapeutics Escitalopram Pituitary-adrenal function tests Serotoninergic mechanisms Serotonin Phenotypes sug: subj: Mental depression Therapeutics Escitalopram Pituitary-adrenal function tests Serotoninergic mechanisms Serotonin Phenotypes keyword: Cortisol CYP450 DST-test Genotype Phenotype polymorphisms Cortisol CYP450 DST-test Escitalopram Fenotipo Genotipo Polimorfismo ab: Introduction. Depression is associated with a dysfunction of regulation of the hypothalamic-pituitary-adrenal, HPA, which is reflected in the alteration of the dexamethasone suppression test, DST. Escitalopram and other SSRIs decrease the HPA axis response to the DST, being the aim of this study validate the DST as a surrogate marker of central serotonergic activity in the treatment with escitalopram and its application to the calculation of the dosage regimens. Methodology. Prospective observational study on 29 patients, upon whom was performed the DST-test with 0.25 mg of Dexamethasone and subsequent genetic analysis of CYP2C19 by Progenika PHARMAchip test. Results. The range of plasma cortisol levels post-DTS associated with each phenotypic group were: PM phenotype=0.6 to 1.7 mcg/dl, IM phenotype= 1.2 to 3.5 mcg/dl and EM phenotype = 4.8 to 13.2 mcg/dl, being carried out the dose titration and correspondng, respectively, the following dose regimens: 3-4 mg/day, 5-8 mg/day and 10-31 mg/day. Coclusiones. It has been shown that the DST test can be used as a surrogate marker of drug response to escitalopram and as a tool for dose adjustment, providing significant data on different phenotypes of CYP2C19 metabolizers. Introducción. La depresión está asociada a una disfunción de la regulación del eje hipotálamo-pituitario-adrenal, HPA, que se refleja en la alteración del test de supresión con Dexametasona, DST. Escitalopram y otros ISRS disminuyen la respuesta del eje HPA en el DST, siendo el objetivo del presente trabajo la validación del DST como marcador subrogado de la actividad serotoninergica central en los tratamientos con escitalopram y su aplicación al cálculo de sus regimenes nosológicos. Metodología. Estudio prospectivo observacional sobre 29 pacientes, a los que se realizo el DST con 0,25 mg de Dexametasona y posterior análisis genético del CYP2C19 mediante test PHARMAchip de Progenika. Resultados. El rango de valores de cortisol plasmático post-DTS asociados a cada grupo fenotipico fueron: fenotipo PM=0,6-1,7 mcg/dl, fenotipo IM=1,2-3,5 mcg/dl y para el fenotipo EM=4,8-13,2 mcg/dl, realizándose el ajuste nosológico y correspondiéndoles, respectivamente, las siguiente dosis: 3-4 mg/ día, 5-8 mg/día y 10-31 mg/día. Conclusiones. Se ha comprobado que el DST test puede utilizarse como marcador subrogado de la respuesta farmacológica al escitalopram y como instrumento para su ajuste nosológico, proporcionando datos significativos sobre distintos fenotipos metabolizadores del CYP2C19. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: Y custom: Copyright of Actas Espanolas de Psiquiatria is the property of Maria Lopez-Ibor and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. item: Actas Espanolas de Psiquiatria holder: Maria Lopez-Ibor dt: @attributes: year: 2012 holdings: @attributes: islocal: N |
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