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Pharmacopsychiatry 2011; 44(06): 259-262
DOI: 10.1055/s-0031-1286281
Original Paper
Georg Thieme Verlag KG Stuttgart · New York

Therapeutic Drug Monitoring in Italian Psychiatry

A. Conca
1   Department of Psychiatry, Central Hospital of Bolzano, Bolzano, Italy
,
E. Schmidt
1   Department of Psychiatry, Central Hospital of Bolzano, Bolzano, Italy
,
M. Pastore
1   Department of Psychiatry, Central Hospital of Bolzano, Bolzano, Italy
,
C. Hiemke
2   Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Germany
,
D. Duffy
1   Department of Psychiatry, Central Hospital of Bolzano, Bolzano, Italy
,
G. Giupponi
1   Department of Psychiatry, Central Hospital of Bolzano, Bolzano, Italy
› Author Affiliations
Further Information

Publication History

received 08 January 2011
revised 05 March 2011

accepted 12 April 2011

Publication Date:
28 September 2011 (online)

Also available at
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Abstract

Introduction:

Therapeutic drug monitoring (TDM) aims to optimize pharmacotherapy treatment. Knowledge, availability and use of TDM for psychiatric patients, however, differ between countries. In this survey we analysed the practice in Italy of TDM for psychoactive drugs.

Methods:

A semi-structured questionnaire was sent out to 211 mental health centres (centro di salute mentale) and 10 university hospitals from each region in Italy.

Results:

Feedback was obtained from 44 centres. Information collected by the questionnaires indicated that in Italian psychiatry TDM is used for lithium, valproic acid and carbamazepine. With regard to clozapine, TDM was regarded as the blood cell counting which is obligatory when prescribing this drug. TDM was not employed for antidepressant or antipsychotic drug prescribing. Moreover, it appeared that only a few laboratories in Italy offer TDM services for psychiatric patients. Nevertheless, interest was expressed about receiving further information about TDM in psychiatry and participating in training programmes.

Discussion:

This nationwide survey revealed that in Italy, TDM of psychoactive drugs is restricted to only a few drugs. In response to interest expressed, mental health workers should be educated about TDM and more laboratories should be encouraged to establish TDM services for psychotropic drugs.

Key words

therapeutic drug monitoring - psychoactive drugs - plasma concentration - Italy - TDM service
 

  • References

  • 1 Abiodun OA. The role of laboratory medicine in psychiatry. East Afr Med J 1991; 68: 389-399
    PubMedGoogle Scholar
  • 2 Baumann P, Hiemke C, Ulrich S et al. The AGNP-TDM expert group consensus guidelines: therapeutic drug monitoring in psychiatry. Pharmacopsychiatry 2004; 37: 243-265
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 D’Arrigo C, Migliardi G, Santoro V et al. Determination of olanzapine in human plasma by reversed-phase high-performance liquid chromatography with ultraviolet detection. Ther Drug Monit 2006; 28: 388-393
    CrossrefPubMedGoogle Scholar
  • 4 DeVane CL, Stowe ZN, Donovan JL et al. Therapeutic drug monitoring of psychoactive drugs during pregnancy in the genomic era: challenges and opportunities. J Psychopharmacol 2006; 20: 54-59
    CrossrefPubMedGoogle Scholar
  • 5 Furlanut M, Benetello P, Spina E.. Pharmacokinetic optimisation of tricyclic antidepressant therapy. Clin Pharmacokinet 1993; 24: 301-318
    CrossrefPubMedGoogle Scholar
  • 6 Gatti G, Bonomi I, Marchiselli R et al. Improved enantioselective assay for the determination of fluoxetine and norfluoxetine enantiomers in human plasma by liquid chromatography. J Chromatogr B 2003; 784: 375-383
    CrossrefPubMedGoogle Scholar
  • 7 Gex-Fabry M, Balant-Gorgia AE, Balant LP. Therapeutic drug monitoring databases for postmarketing surveillance of drug-drug interactions. Drug Saf 2001; 24: 947-959
    CrossrefPubMedGoogle Scholar
  • 8 Heller S, Hiemke C, Stroba G et al. Assessment of storage and transport stability of new antidepressant and antipsychotic drugs for a nationwide TDM service. Ther Drug Monit 2004; 26: 459-461
    CrossrefPubMedGoogle Scholar
  • 9 Hiemke C, Baumann P, Bergemann N et al. AGNP consensus guidelines for therapeutic drug monitoring in psychiatry. Pharmacopsychiatry 2011; 44: 195-235
    Google Scholar
  • 10 Hiemke C, Dragicevic A, Gründer G et al. Therapeutic Drug Monitoring of New Antipsychotic Drugs. Ther Drug Monit 2004; 26: 156-160
    CrossrefPubMedGoogle Scholar
  • 11 Isacsson G, Bergman U, Wasserman D et al. The use of antidepressants and therapeutic drug monitoring by general practitioners and psychiatrists: findings from a questionnaire survey in two Swedish areas. Ann Clin Psychiatry 1996; 8: 153-160
    CrossrefPubMedGoogle Scholar
  • 12 Jaquenoud Sirot E, van der Velden JW, Rentsch K et al. Therapeutic drug monitoring and pharmacogenetic tests as tools in pharmacovigilance. Drug Saf 2006; 29: 735-768
    CrossrefPubMedGoogle Scholar
  • 13 Le Bloch Y, Woggon B, Weissenrieder H et al. Routine therapeutic drug monitoring in patients treated with 10–360 mg/day citalopram. Ther Drug Monit 2003; 5: 600-608
    PubMedGoogle Scholar
  • 14 Mandrioli R, Mercolini L, Raggi MA. Metabolism of benzodiazepine and non benzodiazepine anxiolytic-hypnotic drugs: an analytical point of view. Curr Med Chem 2010; 11: 815-829
    PubMedGoogle Scholar
  • 15 Mitchell PB. Therapeutic drug monitoring of psychotropic medications. Br J Clin 2001; 52: 45-54
    PubMedGoogle Scholar
  • 16 Munizza C, Tibaldi G, Bollini P et al. Prescription pattern of antidepressants in out-patient psychiatric practice. Psychol Med 1995; 25: 771-778
    CrossrefPubMedGoogle Scholar
  • 17 Musenga A, Saracino MA, Sani G et al. Antipsychotics and antiepileptic drugs in bipolar disorder: the importance of therapeutic drug monitoring. Curr Med Chem 2009; 16: 1463-1481
    CrossrefPubMedGoogle Scholar
  • 18 Nozawa M, Ohnuma T, Matsubara Y et al. The relationship between the response of clinical symptoms and plasma olanzapine concentration based on pharmacogenetics. The Drug Monit 2008; 30: 35-40
    PubMedGoogle Scholar
  • 19 Perry PJ, Zeilmann C, Arndt S. Tricyclic Antidepressants concentrations in plasma: An estimate of their sensitivity and specificity as a predictor of response. J Clin Psychopharmacol 1994; 14: 230-240
    PubMedGoogle Scholar
  • 20 Pfuhlmann B, Gerlach M, Burger R et al. Therapeutic drug monitoring of tricyclic antidepressants in everyday clinical practice. J Neural Transm Suppl 2007; 72: 287-296
    PubMedGoogle Scholar
  • 21 Prapotnik M, Waschgler R, König P et al. Therapeutic drug monitoring of trazodone: are there pharmacokinetic interactions involving citalopram and fluoxetine?. Int J Clin Pharmacol Ther 2004; 42: 120-124
    PubMedGoogle Scholar
  • 22 Preskorn SH, Burke MJ, Fast GA. Therapeutic drug monitoring. Principles and practice. Psychiatr Clin North Am 1993; 16: 611-645
    PubMedGoogle Scholar
  • 23 Preskorn SH, Fast GA. Therapeutic drug monitoring for antidepressants: efficacy, safety, and cost effectiveness. J Clin Psychiatry 1991; 52: 23-33
    PubMedGoogle Scholar
  • 24 Raggi MA. The therapeutic drug monitoring. Med Chem Rev – Online 2004; 1: 299-316
    PubMedGoogle Scholar
  • 25 Raggi MA. Therapeutic Drug Monitoring: chemical-clinical correlations of atypical antipsychotic drugs. Curr Med Chem 2002; 9: 1397-1409
    PubMedGoogle Scholar
  • 26 Raggi MA, Mandrioli R, Sabbioni C et al. Atypical antipsychotics: pharmacokinetics therapeutic drug monitoring and pharmacological interactions. Curr Med Chem 2004; 11: 279-296
    CrossrefPubMedGoogle Scholar
  • 27 Rougemont M, Ulrich S, Hiemke C et al. French summaries of product characteristics: content in relation to therapeutic monitoring of psychotropic drugs. Fundam Clin Pharm 2010; 24: 377-384
    CrossrefPubMedGoogle Scholar
  • 28 Ulrich S, Hiemke C, Laux G et al. Value and Actuality of the Prescription Information for Therapeutic Drug Monitoring of Psychopharmaceuticals: A Comparison with the Medico-Scientific Evidence. Pharmacopsychiatry 2007; 40: 121-127
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Weiss U, Marksteiner J, Kemmler G et al. Effects of age and sex on olanzapine plasma concentrations. J Clin Psychopharmacol 2005; 25 (06) 570-574
    CrossrefPubMedGoogle Scholar