Therapeutic Drug Monitoring of Antipsychotics: Innovations in the 2024 Consensus Guidelines

Over the past decades, starting in the late 1980s, advancements in molecular imaging (i.e. PET) have dramatically changed the landscape of schizophrenia treatment with antipsychotics. These technologies have shed light on the interplay between drug target engagement and clinical outcomes, leading to the establishment of a receptor occupancy-based therapeutic range for antipsychotics. However, the role and significance of Therapeutic Drug Monitoring (TDM) remain controversial, with many clinicians underestimating their importance. Moreover, TDM has faced challenges such as unclear reporting of drug-specific therapeutic reference ranges in the literature.

In response to these challenges, the current AGNP guidelines are being updated to refine the methodologies for determining therapeutic reference ranges. This presentation will highlight the effective application of these revised methodologies to antipsychotics, including olanzapine and aripiprazole, and how it has led to the update of their therapeutic reference ranges.

The most robust method for establishing therapeutic reference ranges involves a comprehensive systematic review of prospective data. However, such data, especially studies on concentration-response relationships, are rare. For many psychotropic drugs, the correlation between drug concentration and therapeutic response remains unclear. In these instances, valid reference ranges can be determined using retrospective data, ideally incorporating pharmacodynamic informations in combination with molecular imaging data.

The integration of pharmacological insights into clinical practice is essential for rational and effective treatments of mental health disorders. The updated guideline will be an important resource for clinicians, facilitating the application of the latest developments in patient care.

Publication History

Article published online:
12 March 2024