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Pharmaceutisch weekblad

, Volume 1, Issue 1, pp 129–149 | Cite as

De bepaling van het farmacon-metaboliserend vermogen bij de mens

  • M. Danhof
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Conclusies

De activiteit van het ‘mixed function oxidase’ systeem in de lever blijkt afhankelijk te zijn van een groot aantal factoren. Als gevolg daarvan kunnen de steady-state plasmaconcentraties die worden bereikt na toediening van een geneesmiddel in vaste dosering van persoon tot persoon zeer sterk uiteenlopen.

Het is daarom gewenst dat de dosering, met name van farmaca met een geringe therapeutische breedte, wordt geÏndividualiseerd. Vooralsnog zijn evenwel nog geen methoden beschikbaar waarmee het farmacon-metaboliserend vermogen van een individu in absolute zin kan worden vastgesteld. Daardoor is het alleen mogelijk de dosering te individualiseren door plasmaconcentraties van het desbetreffende geneesmiddel zelf te bepalen.

De meest ideale methode om de dosering te individualiseren is wellicht die waarbij na een eenmalige dosering de halfwaardetijd van het desbetreffende geneesmiddel bij een bepaalde patiënt wordt bepaald. Aannemend dat het verdelingsvolume redelijk constant is, kan dan met behulp van formule (1) de hoogte van de dosering alsmede het doseringsinterval worden berekend die nodig zijn om de gewenste steady-state plasmaconcentratie te bereiken.

Overigens dienen dit soort gegevens met zorg te worden geÏnterpreteerd, omdat van sommige farmaca bekend is dat ze hun eigen omzetting versnellen, als gevolg waarvan de berekende steady-state plasmaconcentraties niet worden bereikt. Dit is onder andere het geval door carbamazepine en andere anti-epileptica (Rawlins e.a. 1975). Het verdient in het algemeen aanbeveling te controleren of de berekende steady-state plasmaconcentraties inderdaad worden bereikt.

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© Bohn, Scheltema & Holkema 1979

Authors and Affiliations

  • M. Danhof
    • 1
  1. 1.Sylvius LaboratoriaLeiden

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