22 Using TDM to improve efficacy and safety outcomes of antipsychotic treatment

Introduction The application of therapeutic drug monitoring (TDM), i. e. the quantification of drug levels in a human matrix, can be helpful in numerous challenging clinical scenarios, such as lack of therapeutic response, relapse, or adverse drug reactions (ADRs) related to antipsychotic treatment.

Methods A selective review of invariably observational studies and case reports that highlight the value of TDM as clinical routine tool for clinicians prescribing antipsychotic medications.

Results Increasing literature demonstrates the usefulness of TDM in the appropriate dose selection for antipsychotics. Specific patient subgroups treated with antipsychotics, such as elderly, patients receiving polypharmacy, women under oral contraception and pregnant women may essentially benefit from the regular use of TDM. Moreover, TDM can be instrumental in the prevention of ADRs, with strength of evidence highly depending on data availability. For example, a dominant amount of evidence is available for clozapine compared to other antipsychotics. On the other hand, TDM evidence is practically absent for clinical scenarios such as transition between different formulations of antipsychotics, which have been less investigated, particularly for second-generation antipsychotics.

Conclusions TDM can be useful for: 1) monitoring drug compliance, 2) evolution of the relationship between the drug blood concentration and antipsychotic effect, 3) potential drug-interaction susceptibility and ultimately for identification of the therapeutic window for clinical efficacy of antipsychotic agents. The presentation will provide examples of condensed clinical decision-making scenarios to assist clinicians who routinely prescribe antipsychotics, to successfully apply TDM in routine clinical practice in order to optimize antipsychotic efficacy and safety.

Publication History

Article published online:
30 April 2020