Analysis of the characteristics and influencing factors of mirtazapine steady-state trough concentration and concentration-to-dose ratio
- VernacularTitle:米氮平稳态谷浓度及剂量校正血药浓度的特征与影响因素分析
- Author:
Ze ZHANG
1
;
Mengqiang ZHAO
2
;
Ruiyan YU
3
;
Yiyuan WANG
3
;
Yuanyuan ZHAO
2
;
Jing YU
2
;
Chunhua ZHOU
3
Author Information
1. Dept. of Pharmacy，Luquan Branch，the Second Hospital of Hebei Medical University，Shijiazhuang 050200，China
2. Dept. of Clinical Pharmacy，the First Hospital of Hebei Medical University，Shijiazhuang 050031，China;Hebei Technology Innovation Center of Artificial Intelligence for Clinical Pharmacy，Shijiazhuang 050031，China
3. Dept. of Clinical Pharmacy，the First Hospital of Hebei Medical University，Shijiazhuang 050031，China
- Publication Type:Journal Article
- Keywords:
mirtazapine;
steady-state trough concentration
- From:
China Pharmacy
2026;37(6):776-781
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To analyze the distribution characteristics of mirtazapine steady-state trough concentration and concentration-to-dose ratio （ C / D ）， and to investigate the influence of clinical and genetic factors on C / D . METHODS A retrospective study was conducted on hospitalized patients with depression who received mirtazapine treatment and underwent therapeutic drug monitoring at the First Hospital of Hebei Medical University from May 2022 to May 2025. The collected data included patients’ gender， age， body mass index， daily dose， steady-state trough concentration， smoking status， history of liver disease， drug type， concomitant medications， and CYP2D6 metabolic phenotype. The C / D was calculated. Spearman rank correlation was used to analyze the relationship between mirtazapine steady-state trough concentration and daily dose. Univariate analysis and multiple linear regression model were employed to screen the factors potentially influencing the C / D of mirtazapine. RESULTS A total of 226 patients were included. The daily dose of mirtazapine was 25.00 （24.82， 30.00） mg/d， the steady-state trough concentration was 44.46 （20.00， 70.00） ng/mL， and the C / D was 1.83 （1.00， 2.00） （ng·d）/（mL·mg）. Steady-state trough concentrations were within the reference range （30-80 ng/mL） in 121 patients （53.54%）， below the lower limit in 80 patients （35.40%）， and above the upper limit in 25 patients （11.06%）. A positive correlation was observed between mirtazapine steady-state trough concentration and daily dose （coefficient of determination was 0.320 8， P ＜0.001）. Gender， smoking status， and CYP2D6 metabolic phenotype were significantly associated with the mirtazapine C / D （ P ＜0.05）. CONCLUSIONS Significant interindividual variability exists in mirtazapine steady-state trough concentrations. Gender， smoking status， and CYP2D6 metabolic phenotype are identified as independent influencing factors for the mirtazapine C / D ， with higher C / D ratios observed in females， non-smokers， and intermediate metabolizers.
