Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017

Hiemke, Christoph; Bergemann, Niels; Clement, Hans-Willi; Conca, Andreas; Deckert, Jürgen; Domschke, Katharina; Eckermann, Gabriel; Egberts, Karin; Gerlach, Manfred; Greiner, Christine; Gründer, Gerd; Haen, Ekkehard; Havemann-Reinecke, Ursula; Hefner, Gudrun; Helmer, Renate; Janssen, G. M. E.; Jaquenoud, Eveline; Laux, Gerd; Messer, Thomas; Mößner, Rainald; Müller, Matthias J.; Paulzen, Michael; Pfuhlmann, Bruno; Riederer, Peter; Saria, Alois; Schoppek, Bernd; Schoretsanitis, Georgios; Schwarz, Markus J.; Gracia, Margarethe Silva; Stegmann, Benedikt; Steimer, Werner; Stingl, Julia; Uhr, M.; Ulrich, S.; Unterecker, Stefan; Waschgler, Roland; Zernig, Gerald; Zurek, G; Baumann, Pierre

doi:10.1055/s-0037-1600991

Cited by 170 publications

(249 citation statements)

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“…The mean (median) difference in the PM median concentrations between the databases was −5% (0%), and the mean or different (eg, N-desmethylclomipramine) pharmacodynamic properties than their respective parent compounds, or they may be pharmacologically inactive (eg, N-desmethylcitalopram). 34 For those drugs with similar properties, the sum of the concentrations of parent drug and active metabolite can be used for interpretation. Even non-active metabolites are important from a pharmacokinetic perspective, because the metabolite-to-parent drug ratio (MPR) can be used for differentiating between acute and chronic intake.…”

Section: Comparison To Literature Reference Concentrationsmentioning

confidence: 99%

“…45 MPR sometimes allows identification of abnormal metabolism caused by pharmacokinetic interactions or genetic abnormalities, 49 especially when compared with established ratios from therapeutic drug monitoring. 34 As has been pointed out earlier, the PM concentrations of drugs of abuse, such as parenterally administered strong opioids 12,50,51 and stimulants, 52 are of limited value in assessing the cause of death because individual tolerance, route of administration, and poly-drug abuse are more important factors in these cases. However, MPR can be decisive in interpreting the role of drugs in abuser deaths.…”

Section: Comparison To Literature Reference Concentrationsmentioning

confidence: 99%

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Summary statistics for drug concentrations in post‐mortem femoral blood representing all causes of death

Ketola

Ojanperä

2019

Drug Testing and Analysis

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Concentration distributions for 183 drugs and metabolites frequently found in post‐mortem (PM) femoral venous blood were statistically characterized based on an extensive database of 122 234 autopsy cases investigated during an 18‐year period in a centralized laboratory. The cases represented all causes of death, with fatal drug poisonings accounting for 8%. The proportion of males was 74% with a median age of 58 years compared with 26% females with a median age of 64 years. In 36% of these cases, blood alcohol concentration was higher than or equal to 0.2‰, the median being 1.6‰. The mean, median, and upper percentile (90th, 95th, 97.5th) drug concentrations were established, as the median PM concentrations give an idea of the “normal” PM concentration level, and the upper percentile concentrations indicate possible overdose levels. A correspondence was found between subsets of the present and the previously published PM drug concentrations from another laboratory that grouped cases according to the cause of death. Our results add to the knowledge for evidence‐based interpretation of drug‐related deaths.

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Section: Comparison To Literature Reference Concentrationsmentioning

confidence: 99%

Section: Comparison To Literature Reference Concentrationsmentioning

confidence: 99%

Summary statistics for drug concentrations in post‐mortem femoral blood representing all causes of death

Ketola

Ojanperä

2019

Drug Testing and Analysis

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“…Other factors influencing medication response include ensuring the correct diagnosis is made, appropriate dose titration, patient acceptance/understanding of illness, influence of stigma on taking medications, Therapeutic drug monitoring is one objective method to help maximize the effectiveness and reduce adverse events for certain psychiatric medications (eg, clozapine, lithium, and nortriptyline). 17 However, the evidence to support therapeutic drug monitoring is limited or absent for a majority of psychiatric medications. The use of pharmacogenomic testing has begun to be applied to psychiatry in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas

Caudle

Gammal

Karnes

et al. 2019

J Am Coll Clin Pharm

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Clinical pharmacists have been incorporating precision medicine into practice for decades. Drug selection and dosing based on patient‐specific clinical factors such as age, weight, renal function, drug interactions, plasma drug concentrations, and diet are expected as part of routine clinical practice. Newer concepts of precision medicine such as pharmacogenomics have recently been implemented into clinical care, while other concepts such as epigenetics and pharmacomicrobiomics still predominantly exist in the research area but clinical translation is expected in the future. The purpose of this paper is to describe current and emerging aspects of precision medicine as it relates to clinical pharmacy across a variety of specialty areas of practice, with perspectives from the American College of Clinical Pharmacy Practice and Research Network membership.

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“…As a matter of fact, the only SGAP in which TDM was widely studied was clozapine, a very effective drug, which has a relatively narrow therapeutic window (Spina & de Leon, 2015). In spite of the recommendations to use clozapine TDM for routine clinical practice (Hiemke et al, 2018), many psychiatrist clinicians do not use clozapine TDM because they are no longer familiar with TDM, although they may be willing to use clozapineTDM in unusual situations in which there is risk of toxicity (Ruan et al, 2017) or no obvious response with typical doses (Hiemke et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…A group of experts from German-speaking countries, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), developed a guideline for TDM with a first version in 2004 (Baumann et al, 2004) and a second version in 2011 (Hiemke et al, 2011). The third version developed in 2017 and published in 2018 (Hiemke et al, 2018) probably signals the maturation of the science of TDM in psychiatry (de Leon, 2018).…”

Section: Introductionmentioning

confidence: 99%

Quantitative determination of risperidone, paliperidone and olanzapine in human serum by liquid chromatography–tandem mass spectrometry coupled with on‐line solid‐phase extraction

Ruan

Guo

Zhou

et al. 2018

Biomedical Chromatography

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A recent guideline recommends therapeutic drug monitoring for risperidone, paliperidone and olanzapine, which are frequently used second-generation antipsychotics. We developed a simple high-performance liquid chromatography-tandem mass spectrometry coupled with an online solid-phase extraction method that can be used to measure risperidone, paliperidone and olanzapine using small (40 μL) samples. The analytes were extracted from serum samples automatically pre-concentrated and purified by C (5 μm, 2.1 × 30 mm) solid-phase extraction cartridges, then chromatographed on an Xbidge™ C column (3.5 μm, 100 × 2.1 mm) thermostatted at 30°C with a mobile phase consisting of 70% acetonitrile and 30% ammonium hydroxide 1% solution at an isocratic flow rate of 0.3 mL/min, and detected with tandem mass spectrometry. The assay was validated in the concentration range from 2.5 to 160 ng/mL. Intra- and inter-day precision for all analytes was between 1.1 and 8.2%; method accuracy was between 6.6 and 7.6%. The risperidone and paliperidone assay was compared with a high-performance liquid chromatography-ultraviolet assay currently used in our hospital for risperidone and paliperidone therapeutic drug monitoring, and the results of weighted Deming regression analysis showed good agreement. For the olanzapine assay, we compared 20 samples in separate re-assays on different days; all the relative errors were within the 20% recommended limit.

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Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017

Cited by 170 publications

References 0 publications

Summary statistics for drug concentrations in post‐mortem femoral blood representing all causes of death

Summary statistics for drug concentrations in post‐mortem femoral blood representing all causes of death

PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas

Quantitative determination of risperidone, paliperidone and olanzapine in human serum by liquid chromatography–tandem mass spectrometry coupled with on‐line solid‐phase extraction

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