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Consensus Guideline Based Therapeutic Drug Monitoring (TDM) in Psychiatry and Neurology

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Therapeutic drug monitoring (TDM) is a valuable tool for tailoring the dosage of the prescribed medication(s) to the individual pharmacokinetic characteristics of a patient. In psychiatry and neurology, however, proven evidence that TDM should be used for treatment with the multiple neuropsychiatric medications is restricted to few compounds. Well-designed clinical trials on medical and economic benefits of TDM are rare. The use of TDM is limited in most countries to few antiepileptics, especially carbamazepine, phenobarbital and phenytoin, some mood stabilizers, especially lithium and valproic acid, some antidepressants, especially tricyclic antidepressants and some antipsychotics, primarily clozapine because these drugs have a narrow therapeutic index. On the other hand, specific indications and distinct problems can make TDM most useful for individualized pharmacotherapy with almost any neuropsychiatric drug. Potential benefits of TDM can, however, only be reaped if the method is adequately integrated into the clinical treatment process. The TDM expert group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued consensus guidelines for the best practice of TDM in psychiatry and neurology. A first version was published in 2004. These guidelines were extended in 2011 and are actually updated (see: www.agnp.de). Exemplified by single cases it is shown here how to use TDM consensus guidelines for problem solving in psychiatry and neurology. Studies on depressed patients give evidence for tricyclic antidepressants, venlafaxine and citalopram that TDM could become a standard of care in psychiatry and neurology. There is potential to accelerate improvement. Reducing phases of suffering will not only have medical benefits for the patients but also an impact on costs for the health system which needs to be clarified by controlled studies.
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Keywords: Compliance control; guidelines; individualized pharmacotherapy; plasma concentration; therapeutic drug monitoring

Document Type: Research Article

Publication date: 01 May 2016

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  • The aim of Current Drug Delivery is to publish peer-reviewed articles, short communications, short and in-depth reviews in the rapidly developing field of drug delivery. Modern drug research aims to build in delivery properties of a drug at the design phase, however in many cases this ideal cannot be met and the development of delivery systems becomes as important as the development as the drugs themselves.

    The journal aims to cover the latest outstanding developments in drug and vaccine delivery employing physical, physico-chemical and chemical methods. The drugs include a wide range of bioactive compounds from simple pharmaceuticals to peptides, proteins, nucleotides, nucleosides and sugars. The journal will also report progress in the fields of transport routes and mechanisms including efflux proteins and multi-drug resistance.

    The journal is essential for all pharmaceutical scientists involved in drug design, development and delivery.
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