Psychotropic drugs therapeutic drug monitoring

Hendset, M. et al. 2006. The complexity of active metabolites in therapeutic drug monitoring of psychotropic drugs. Pharmacopsychiatry. 39 121. 

TABLE 4.2 Indications for Therapeutic Drug Monitoring of Psychotropic Drugs... 

Gex-Fabry, M., Balant-Gorgia, A.E., and Balant, L.P. (1997) Therapeutic drug monitoring databases for postmarketing surveillance of drug-drug interactions evaluation of a paired approach for psychotropic medication. Ther Drug Monit 19 1-10. 

Mitchell, P.B. (2000) Therapeutic drug monitoring of psychotropic medications. Br ] Clin Pharmacol 49 303-312. 

Another use of the laboratory is for therapeutic drug monitoring (TDM) of psychotropics with defined optimal ranges, narrow therapeutic indices, or both. Although TDM is not essential for many psychotropics, it is for others, including lithium, several TCAs, valproate, and carbamazepine. It may also be helpful to optimize the use of certain antipsychotics (e.g., haloperidol, clozapine) ( 7). 

Plasma levels of various psychotropics differ widely among individuals on the same dose due to differences in their rates of metabolism. Therefore, the clinician must adjust each patient s dosage to achieve maximal benefit with minimal side effects. Therapeutic drug monitoring can be used to address these issues ... 

Choong E, Rudaz S, Kottelat A et al (2009) Therapeutic drug monitoring of seven psychotropic drugs and four metabolites in human plasma by HPLC-MS. J Pharm Biomed Anal 50 1000-1008... 

Therapeutic drug monitoring of psychotropic drugs has clinical utility for the following reasons ... 

Psychotropic drugs Nortriptyline Therapeutic drug monitoring recommended may require dose increase or change to alternate psychotropic drug. 

Antidepressant drugs A major class of psychotropic drugs with diverse chemical configurations including the monoamine oxidase inhibitors (MAOIs), the heterocyclic drugs (composed of mono-, di-, tri-, and hetero-cyclics), the serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline, trazodone, and venlafaxine), and bupropion are more recent innovations. Antidepressants usually must be taken for several weeks to have the desired effect and they often have a low therapeutic index, so they must be closely monitored. 

Baumarm P et al (2004) Therapeutic monitoring of psychotropic drugs an outline of the AGNP-TDM expert group consensus guideline. Ther Drug Monit 26 167-170... 

---