Apr 12, 2008

Therapeutic drug monitoring in neuropsychopharmacology: does it hold its promises?

European Archives of Psychiatry and Clinical Neuroscience
C Hiemke

Abstract

To produce its characteristic effects, a drug must be present in appropriate concentrations at its sites of action. The latter is not only a function of the dose administered, but also of the extent and rate of drug absorption, distribution, tissue binding, biotransformation, and excretion, which can vary markedly between individual patients due to differences in gender, age, morbidity, smoking or eating habits, differential expression of drug metabolising enzymes or drug transporters or other factors. Therefore drug concentrations in blood resulting after a given dose differ by tenfold or more between individual patients. For psychoactive drugs, animal studies have shown that plasma concentrations of psychotropic drugs correlate well with concentrations in the target organ, the brain. In the brain of patients treated with antipsychotic or antidepressant drugs clear-cut relationships were found between plasma concentrations of the drug and occupancy of dopamine receptors or serotonin uptake sites by positron emission tomography (PET). Monitoring concentrations of psychoactive drugs in plasma of patients, so called therapeutic drug monitoring (TDM), is therefore useful to adjust dosages for optimal "receptor" blockade. TDM is we...Continue Reading

  • References49
  • Citations20

References

  • References49
  • Citations20

Citations

Mentioned in this Paper

Metabolic Process, Cellular
Morbidity Aspects
Anticonvulsants
Positron-Emission Tomography
Enzymes, antithrombotic
Brain
Psychiatric Inpatient
5-hydroxytryptamine Uptake
Antipsychotic Agents
Body Excretions

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