Jan 16, 2008

Clinical utility of drug measurement and pharmacokinetics: therapeutic drug monitoring in psychiatry

European Journal of Clinical Pharmacology
Christoph Hiemke


Based on the assumption that a relationship between blood levels and clinical effects (therapeutic effects, adverse events and toxicity) can be defined and considering that after equal doses plasma concentrations vary markedly between individual patients, therapeutic drug monitoring (TDM) can assist to personalize dose adjustment. Taken together, drug levels and a knowledge of the pharmacological profile of the administered drugs can enable the optimal dosage to be tailored according to the need of the individual patient. Therapeutic drug monitoring has been established for a limited number of drugs. In psychiatry, it has a 40-year-long history, which started with nortriptyline. Evidence has accumulated which shows that TDM is a valid tool for the optimization of psychopharmacotherapy. When used adequately, TDM is helpful for many patients and in many situations. Combined with pharmacogenetic tests, the metabolic status of a patient can be well characterized. Several new observations have been made during routine TDM that have stimulated clinical pharmacological research, such as investigations on inherited differences in drug metabolism that are closely linked to TDM in psychiatry. The contributions of individual forms of cyto...Continue Reading

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  • Citations21


Mentioned in this Paper

Metabolic Process, Cellular
Drug Development
Drug Measurement
Cytochrome P450
Clinical Pharmacology Discipline
Nortriptyline Assay
Brain Diseases, Metabolic, Inborn
Adverse Event
Metabolic Pathway

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