在临床毒理学抗体Fab片段:一些应用程序。

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弗拉纳根RJ,琼斯

在临床毒理学抗体Fab片段:一些应用程序。

药物Saf。2004; 27(14): 1115 - 33所示。

PubMed ID

15554746 (在PubMed

]

文摘

本文提供了当前信息的使用antigen-binding片段(Fab)裂解治疗与地高辛中毒和其他强大的抗体,低质量公式毒物,如秋水仙碱和三环类抗抑郁药。Anti-digoxin Fab片段已成功应用多年的管理与地高辛中毒,严重洋地黄毒苷,以及一系列的其他结构相关的化合物,包括心脏毒素从夹竹桃和Thevetia sp。(夹竹桃)和以sp。(蟾蜍)。然而,他们主要使用仍将地高辛中毒。克分子数相等的剂量的anti-digoxin Fab片段完全绑定地高辛体内。Fab片段(mg)的近似剂量的80倍地高辛的身体负担(毫克)。如果摄入剂量和血浆地高辛/洋地黄毒苷浓度,在成人380毫克的anti-digoxin Fab片段应该给。老年病人的剂量或肾功能损害患者应该类似于那些正常的肾功能。Fab片段的血浆半衰期12-20小时,但这可以延长患者的肾功能损害。分析血清超滤液使用一种免疫测定显示没有矩阵偏差仍是最准确的方法来测量自由地高辛anti-digoxin Fab片段的存在。抗体片段在稀释后15 - 30分钟静脉注射与血浆蛋白的解决方案,至少250毫升0.9% (w / v)氯化钠,或去离子水,除了婴儿的注入可以减少体积。 Factors limiting the efficacy of Fab fragments are the dose, the duration of the infusion and any delay in administration. Guidelines for Fab fragment administration in children include (i) dilution to a final Fab concentration of 10 g/L in either 5% (w/v) dextrose or 0.9% (w/v) sodium chloride; (ii) infusion through a 0.22 microm filter; (iii) administration of the total dose over a minimum of 30 minutes; and (iv) avoiding coadministration of other drugs and/or electrolyte solutions. Fab fragments are generally well tolerated. Adverse effects attributable to Fab treatment include hypokalaemia and exacerbation of congestive cardiac failure; renal function could be impaired in some patients. Fab fragment preparations for treating acute colchicine and tricyclic antidepressant poisoning have been developed, but are not available commercially. Colchicine poisoning is rare in Western countries, and pharmacological management together with supportive care is usually effective even in severe tricyclic antidepressant overdosage. Attempts have been made to produce anti-paraquat antibodies capable of enhancing paraquat elimination from the lung, but thus far all such attempts have proved unsuccessful.

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