Pharmacopsychiatry 2022; 55(03): 172-173
DOI: 10.1055/s-0042-1747666
Abstracts | XIVth Symposium of the Task Force Therapeutic Drug Monitoring of the AGNP

The therapeutic reference range for olanzapine revised – how to combine old and new findings

K. Wesner
1   Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
C. Hiemke
2   University Medical Center of Mainz, Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, Mainz, Germany
,
N. Bergemann
3   AMEOS Clinic for Psychiatry, Psychotherapy and Psychosomatics, Bad Salzuflen, Germany
,
M. Gerlach
4   Division of Clinical Neurochemistry, Department of Psychiatry and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
,
U. Havemann-Reinecke
5   Department of Psychiatry and Psychosomatics, University of Göttingen, Göttingen, Germany
,
X.M. Lense
1   Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
T.G. Riemer
6   Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, Charité – Medical University of Berlin, Free University of Berlin, Humboldt University of Berlin, Berlin, Germany
,
G. Schoretsanitis
7   University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
,
M. Uhr
8   Clinical Laboratory, Max Planck Institute of Psychiatry, Munich, Germany
,
G. Zernig
9   Experimental Psychiatry Unit, Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, and Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria
,
G. Gründer
1   Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
X.M. Hart
1   Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Introduction Therapeutic Drug Monitoring (TDM) for olanzapine (OLZ) is highly recommended in current guidelines for dose titration within a blood concentration range of 20 to 80 ng/mL [1]. A range between 10 and 40 ng/mL has been recently discussed for long-acting injectable OLZ [2]. A relationship between OLZ concentration and clinical response is the basis for a valid reference range. A clear relationship however could not yet be demonstrated in the current literature [3] .

The present systematic review discusses literature on the relationship between OLZ blood levels (OLZ BL), clinical outcomes and dopamine receptor occupancy in terms of the therapeutic reference range for OLZ.

Methods For study selection and quality assessment, we followed our review protocol published previously [4]. Four electronic databases were systematically searched for relevant articles. The mean OLZ concentration was computed from eligible studies. 65% and 80% effective concentrations (EC65; EC80) were extracted from neuroimaging studies.

Results 34 studies met the eligibility criteria. The mean OLZ BL was 31 ng/mL (CI 95: 27-36 ng/mL). Four studies found a positive relationship between OLZ BL and response after oral intake (Level C1; low). Five studies consistently report higher clinical efficacy with OLZ BL>20 ng/mL. No correlation between OLZ BL and occurrence of extrapyramidal or other side effects was found. EC65-80 ranged between 24-43 ng/mL.

Conclusion Our work strongly suggests an optimal target range of 20-40 ng/mL for oral OLZ with increasing efficacy above the lower threshold.



Publication History

Article published online:
16 May 2022

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