#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Therapeutic drug monitoring in psychiatry


Authors: Eva Češková 1,2;  Petr Šilhán 2
Authors‘ workplace: Psychiatrická klinika LF MU a FN Brno 1;  Oddělení psychiatrické FN Ostrava 2
Published in: Čas. Lék. čes. 2023; 162: 148-151
Category: Review Article

Overview

In medicine, there are two main methods of improving the healthcare provided: perfecting (optimizing) the existing ones and seeking new treatment procedures. Despite of tremendous development in the central nervous system research, current treatment of severe mental illnesses, such as schizophrenia and depressive disorder, is suboptimal. Nowadays, optimization of treatment in psychiatry includes therapeutic drug monitoring (TDM) and pharmacogenomic testing, which examines genetic variation involved in medication metabolism and drug action. The TDM enables to determine drug concentrations in blood and adjust the dose accordingly if clinical effects correlate better with drug blood levels than drug doses.

The first international guidelines for TDM in neuropsychopharmacology were published in 2004 and regularly updated. The recent update provides therapeutic reference ranges for a majority of commonly prescribed psychiatric medications and gives example of patients regularly treated in clinical practice profiting from TDM (using antipsychotics and changing their smoking habits). TDM in psychiatry is an underused tool, given its ability to optimize treatment, as well as to improve treatment effectiveness.

Keywords:

effectiveness – Therapeutic drug monitoring – adherence – therapy optimization – pharmacogenomic testing


Sources
  1. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry 2016; 3: 171–178.
  2. Češková E. The need to improve current psychopharmacotherapy before developing new drugs. Expert Opin Pharmacother 2014; 15: 1969–1973.
  3. Preskorn SH. Tricyclic antidepressants: the whys and hows of therapeutic drug monitoring. J Clin Psychiatry 1989; 50 (Suppl.): 34–42.
  4. Baumann P, Hiemke C, Ulrich S et al. The AGNP-TDM expert group consensus guidelines: therapeutic drug monitoring in psychiatry. Pharmacopsychiatry 2004; 37: 243–265.
  5. Hiemke C, Baumann P, Bergemann N et al. AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: update 2011. Pharmacopsychiatry 2011; 44: 195–235.
  6. Hiemke C, Bergemann N, Clement HW et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry 2018; 51: 9–62.
  7. Češková E, Šilhán P, Kacířová I a kol. Terapeutické monitorování léčiv v psychiatrii. Doporučení postupy psychiatrické péče Psychiatrické společnosti ČLS JEP. Dostupné na: https://postupy-pece.psychiatrie.cz/lecba/monitorovani-lecby-psychofarmaky/terapeuticke-monitorovani-leciv-v-psychiatrii
  8. Köhler GI, Bode-Böger SM, Busse Ret al. Drug-drug interactions in medical patients: Effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther 2000; 38: 504–513.
  9. Seymour RM, Routledge PA. Important drug-drug interactions in the elderly. Drugs Aging 1998; 12: 485–494.
  10. Prokeš M, Suchopár J. Lékové interakce v psychiatrii – teorie a praxe. Psychiatrie pro praxi 2015; 16: 51–55.
  11. Grundmann M, Kacířová I. Význam TDM, fenotypizace a genotypizace pro správné dávkování léčiv. Časopis lékařů českých 2010; 149: 482–487.
  12. Palomo T, Archer T, Kostrzewa RM, Beninger RJ. Comorbidity of substance abuse with other psychiatric disorders. Neurotox Res 2007; 12: 17–27.
  13. Češková E, Sušilová L, Ustohal L. Volba farmakoterapie u nemocných se schizofrenií a abúzem návykových látek. Psychiatrie pro praxi 2017; 18: 26–28.
  14. de Leon J, Diaz FJ. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 2005; 76: 135–157.
  15. Mayerová M, Ustohal L, Jarkovský J et al. Influence of dose, gender, and cigarette smoking on clozapine plasma concentrations. Neuropsychiatr Dis Treat 2018; 14: 1535–1543.
  16. Schmith VD, Foss JF. Effects of inflammation on pharmacokinetics/pharmacodynamics: Increasing recognition of its contribution to variability in response. Clin Pharmacol Ther 2008; 83: 809–811.
  17. de Leon J, Schoretsanitis G, Smith RL. An international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levels. Pharmacopsychiatry 2022; 55: 73–86.
  18. Moschny N, Hefner G, Grohmann R et al. Therapeutic drug monitoring of second-and third-generation antipsychotic drugs – influence of smoking behavior and inflammation on pharmacokinetic. Pharmaceuticals 2021; 14: 514.
  19. Knöchel C, Hefner G, Stiehl T, Schmidbauer W. Elevated clozapine blood concentrations after second COVID-19 vaccination with Spikevax (COVID-19 vaccine Moderna). J Clin Psychopharmacol 2022; 42: 317–320.
  20. Šilhán P, Urinovská R, Kacířova I et al. what does antidepressant drug level monitoring reveal about outpatient treatment and patient adherence? Pharmacopsychiatry 2019; 52: 78–83.
  21. Bousman CA, Bengesser SA, Aitchison KJ et al. Review and consensus on pharmacogenomic testing in psychiatry. Pharmacopsychiatry 2021; 54: 5–17.
  22. Bradley P, Shiekh M, Mehra V et al. Improved efficacy with targeted pharmacogenetic-guided treatment of patients with depression and anxiety: a randomized clinical trial demonstrating clinical utility. J Psychiatr Res 2018; 96: 100–107.
  23. Dauphin-Ducharme P, Yang K, Arroyo-Currás N et al. Electrochemical aptamer-based sensors for improved therapeutic drug monitoring and high-precision, feedback-controlled drug delivery. ACS Sens 2019; 4: 2832–2837.
  24. Capiau S, Veenhof H, Koster RA et al. Official international association for therapeutic drug monitoring and clinical toxicology guideline: development and validation of dried blood spot-based methods for therapeutic drug monitoring. Ther Drug Monit 2019; 41: 409–430.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#