Pharmacopsychiatry
DOI: 10.1055/s-0043-116492
Review
© Georg Thieme Verlag KG Stuttgart · New York

Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017

C. Hiemke1, 2, N. Bergemann3, H. W. Clement4, A. Conca5, J. Deckert6, K. Domschke7, G. Eckermann8, K. Egberts9, M. Gerlach9, C. Greiner10, G. Gründer11, E. Haen12, U. Havemann-Reinecke13, G. Hefner14, R. Helmer15, G. Janssen16, E. Jaquenoud17, G. Laux18, T. Messer19, R. Mössner20, M. J. Müller21, M. Paulzen11, B. Pfuhlmann22, P. Riederer6, A. Saria23, B. Schoppek24, G. Schoretsanitis25, M. Schwarz26, M. Silva Gracia12, B. Stegmann12, W. Steimer27, J. C. Stingl10, M. Uhr28, S. Ulrich29, S. Unterecker6, R. Waschgler30, G. Zernig23, 31, G. Zurek32, P. Baumann33
  • 1Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany
  • 2Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
  • 3Psychotherapeutic Center Bad Mergentheim, Bad Mergentheim, Germany
  • 4Department of Child and Adolescent Psychiatry, University of Freiburg, Freiburg, Germany
  • 5Servizio Psichiatrico del Comprensorio Sanitario di Bolzano, Bolzano, Italy
  • 6Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Würzburg, Germany
  • 7Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  • 8Psychiatric Hospital, Kaufbeuren, Germany
  • 9Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
  • 10Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
  • 11Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, and JARA – Translational Brain Medicine, Aachen, Germany
  • 12Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
  • 13Department of Psychiatry and Psychosomatics, University of Göttingen, Göttingen, Germany
  • 14Psychiatric Hospital, Vitos Klinik, Eichberg, Eltville, Germany
  • 15Center of Epilepsy, Bielefeld, Germany
  • 16Medical Laboratory Stein, Limbach Group, Mönchengladbach, Germany
  • 17Psychiatric Hospital, Königsfelden, Brugg, Aargau, Switzerland
  • 18Institute of Psychological Medicine, Haag in Oberbayern, Germany
  • 19Danuviuskliniken, Psychiatric Hospital, Pfaffenhofen, Germany
  • 20Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
  • 21Psychiatric Hospitals Oberberggruppe, Berlin, Germany
  • 22Psychiatric Hospital Weisser Hirsch, Dresden, Germany
  • 23Experimental Psychiatry Unit, Department of Psychiatry 1, Medical University of Innsbruck, Innsbruck, Austria
  • 24kbo-Isar-Amper Klinikum München-Ost, Psychiatric Hospital, Munich-Haar, Germany
  • 25Department of Psychiatry, University of Bern, Bern, Switzerland
  • 26Department of Laboratory Medicine, Ludwig Maximilian University, Munich, Germany
  • 27Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
  • 28Max Planck Institute of Psychiatry, Munich, Germany
  • 29Aristo Pharma GmbH, Berlin, Germany
  • 30Psychiatric Hospital, Feldkirch, Austria
  • 31Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria
  • 32Medical Laboratory Bremen, Bremen, Germany
  • 33Department of Psychiatry, University of Lausanne, Prilly-Lausanne, Switzerland
Further Information

Publication History

received  15 May 2017
revised  + 08 July 2017

accepted 10 July 2017

Publication Date:
14 September 2017 (eFirst)

Abstract

Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood to optimize pharmacotherapy. It considers the interindividual variability of pharmacokinetics and thus enables personalized pharmacotherapy. In psychiatry and neurology, patient populations that may particularly benefit from TDM are children and adolescents, pregnant women, elderly patients, individuals with intellectual disabilities, patients with substance abuse disorders, forensic psychiatric patients or patients with known or suspected pharmacokinetic abnormalities. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. However, the potential benefits of TDM to optimize pharmacotherapy can only be obtained if the method is adequately integrated in the clinical treatment process. To supply treating physicians and laboratories with valid information on TDM, the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued their first guidelines for TDM in psychiatry in 2004. After an update in 2011, it was time for the next update. Following the new guidelines holds the potential to improve neuropsychopharmacotherapy, accelerate the recovery of many patients, and reduce health care costs.