Therapeutic drug monitoring of psychotropic medications

Mitchell, Philip B.

doi:10.1046/j.1365-2125.2000.00174.x

Cited by 77 publications

(45 citation statements)

References 93 publications

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“…Circulating drug concentrations were assayed to ensure levels equivalent to those used to obtain high and low human therapeutic ranges. 41 The mRNA from whole brain was analyzed by quantitative real-time PCR to determine the steady-state mRNA level of the mfat1 gene (murine FAT orthologue) and a control gene, Gapdh. Gapdh was chosen as the reference transcript because we found its expression remained constant across different experimental conditions (control, lithium and valproate).…”

Section: Resultsmentioning

confidence: 99%

Positional cloning, association analysis and expression studies provide convergent evidence that the cadherin gene FAT contains a bipolar disorder susceptibility allele

et al. 2006

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A susceptibility locus for bipolar disorder was previously localized to chromosome 4q35 by genetic linkage analysis. We have applied a positional cloning strategy, combined with association analysis and provide evidence that a cadherin gene, FAT, confers susceptibility to bipolar disorder in four independent cohorts (allelic P-values range from 0.003 to 0.024). In two case-control cohorts, association was identified among bipolar cases with a family history of psychiatric illness, whereas in two cohorts of parent-proband trios, association was identified among bipolar cases who had exhibited psychosis. Pooled analysis of the case-control cohort data further supported association (P = 0.0002, summary odds ratio = 2.31, 95% CI: 1.49-3.59). We localized the bipolar-associated region of the FAT gene to an interval that encodes an intracellular EVH1 domain, a domain that interacts with Ena/VASP proteins, as well as putative b-catenin binding sites. Expression of Fat, Catnb (b-catenin), and the three genes (Enah, Evl and Vasp) encoding the Ena/VASP proteins, were investigated in mice following administration of the mood-stabilizing drugs, lithium and valproate. Fat was shown to be significantly downregulated (P = 0.027), and Catnb and Enah were significantly upregulated (P = 0.0003 and 0.005, respectively), in response to therapeutic doses of lithium. Using a protein interaction map, the expression of genes encoding murine homologs of the FAT (ft)-interacting proteins was investigated. Of 14 interacting molecules that showed expression following microarray analysis (including several members of the Wnt signaling pathway), eight showed significantly altered expression in response to therapeutic doses of lithium (binomial P = 0.004). Together, these data provide convergent evidence that FAT and its protein partners may be components of a molecular pathway involved in susceptibility to bipolar disorder.

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Section: Resultsmentioning

confidence: 99%

Positional cloning, association analysis and expression studies provide convergent evidence that the cadherin gene FAT contains a bipolar disorder susceptibility allele

et al. 2006

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“…6 Possible mechanisms of this interaction include decreased renal blood flow secondary to prostaglandin inhibition and enhanced reabsorption of sodium (and thus lithium) secondary to prostaglandin inhibition. 6,7 Distal tubule diuretics, such as hydrochlorothiazide, have been reported to increase serum lithium concentrations by approximately 25%. 6 The purported mechanism of this interaction is the induction of natriuresis, which leads to a compensatory increase in the reabsorption of sodium (and thus lithium) in the proximal tubule.…”

Section: Drug Interactions With Lithiummentioning

confidence: 99%

“…6 The purported mechanism of this interaction is the induction of natriuresis, which leads to a compensatory increase in the reabsorption of sodium (and thus lithium) in the proximal tubule. 6,7 Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, and lisinopril, can increase serum lithium concentrations through volume depletion and reduction in glomerular filtration rate or a decrease in aldosterone levels that leads to sodium depletion and subsequent lithium retention. The onset of this interaction appears to be delayed (3-5 weeks), and elderly patients may be predisposed.…”

Section: Drug Interactions With Lithiummentioning

confidence: 99%

Therapeutic Drug Management of Lithium

Cates¹,

Sims²

2005

Am J Pharm Educ

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Lithium continues to be a mainstay in the treatment of bipolar disorder. Aside from understanding the basic pharmacokinetics of lithium and the factors that influence serum lithium concentrations, the student should understand the clinical usefulness of serum lithium concentrations, the reasons for obtaining them, and how to interpret them. Significant emphasis is placed on the student being able to apply the information to clinical scenarios and becoming an inquisitive problem solver. To that end, case studies are used to promote a deeper understanding of lecture material.

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“…Lithium levels must be monitored carefully during follow-up due to its narrow therapeutic index. (4). Drugs that alter renal function can increase the risk for chronic lithium toxicity (5,6).…”

Section: Introductionmentioning

confidence: 99%

Winter Sale on Lithium Levels: The Impact of Seasonality

Bakım

Karaahmet

Altınbaş

et al. 2013

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychophar

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Amaç: Lityum duygudurum bozukluklarının koruma tedavisinde etkili bir ilaç olarak tüm dünyada tanınmaktadır. Lityumun bipolar bozukluk profilaksisindeki etkinliği yetmişli yılların başından beri kanıtlanmıştır. Lityum bipolar bozuklukta akut duygudurum epizodları farmakoterapisi, döngülerin önlenmesi, önleyici tedavi ve intiharın önlenmesinde dayanak noktası olmuş ve olmaya devam etmektedir. Bazı ülkelerde lityum düzeylerinin mevsimsel değişiklikleri olduğu şeklinde yayınlar mevcuttur. Winter sale on lithium levels: the impact of seasonality Objective: Lithium is recognized worldwide as an effective prophylactic agent in mood disorders. Prophylactic efficacy of lithium in mood disorders has been established since the early seventies. Lithium has been and continues to be the mainstay of bipolar disorder (BD) pharmacotherapy for acute mood episodes, switch prevention, and suicide prevention. There are reports of seasonal variation in lithium levels from a few countries. Variability in the lithium level can lead to a lack of efficacy or to toxicity, making seasonal variation clinically relevant. We aimed to compare lithium levels of bipolar patients between summer and winter. Methods: Euthymic bipolar patients who were followed in the Raşit Tahsin Mood Clinic of the Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were recruited for the study, and lithium levels were measured in the second part of winter and summer (15 th of June to 1st of September and 15 th of January to 1 st of March). A prospective case sheet audit was performed for 32 BD patients for recording plasma lithium level, age and gender for one year. Bipolar patients whose treatment dosage of lithium was changed for any reason during the study follow-up were excluded. Situations of lithium use other than for bipolar disorder were excluded. The presence of concomitant diagnoses of mental retardation or drug dependence constituted exclusion criteria, as did medication non-compliance detected by persistently low lithium plasma levels. The use of antihypertensive drugs, nonsteroidal anti-inflammatory drugs, theophylline, some antibiotics, topiramate, and diuretics that could cause an increase in plasma concentrations of lithium, and of theophylline that could reduce lithium concentrations constituted exclusion criteria. Sodium levels were also monitored due to their propable effect on lithium levels. Lithium levels were compared using the paired sample t-test. Correlation analysis was done for the parameters that could affect lithium levels. Results: The mean age of the patients was 35.75±9.59 years, the mean age of onset was 21.97±6.17 and the mean duration of disorder was 13.90±9.41 year. 15 out of 32 patients were male. The overall average dose of lithium taken by the patients was 1190.6±249.0 mg/day. The mean lithium plasma level was 0.75±0.12 mEq/L in winter, and the mean lithium plasma level was 0.83±0.12 mEq/L in summer (p=0.003). The overall serum sodium levels were 139.1±2.2 mEq/L in summer and 137.1±2.3 mEq/L i...

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Therapeutic drug monitoring of psychotropic medications

Cited by 77 publications

References 93 publications

Positional cloning, association analysis and expression studies provide convergent evidence that the cadherin gene FAT contains a bipolar disorder susceptibility allele

Positional cloning, association analysis and expression studies provide convergent evidence that the cadherin gene FAT contains a bipolar disorder susceptibility allele

Therapeutic Drug Management of Lithium

Winter Sale on Lithium Levels: The Impact of Seasonality

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