PDF herunterladen
Pharmacopsychiatry 2018; 51(01/02): 63-68
DOI: 10.1055/s-0043-117891
Commentary
© Georg Thieme Verlag KG Stuttgart · New York

A Critical Commentary on the 2017 AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology

Jose de Leon
1   Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
2   Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain, and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 17. Juli 2017
revised 24. Juli 2017

accepted 31. Juli 2017

Publikationsdatum:
18. September 2017 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

In 2004, 2011, and 2017, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), a group of German-speaking psychiatric researchers and psychiatrists, published successive versions of therapeutic drug monitoring (TDM) expert group consensus guidelines. The 2017 version has as a major strength its encyclopedic nature, including 1358 references. The guideline has 3 major sections: 1) theoretical aspects of TDM, 2) drug concentration levels in blood to guide neuropsychopharmacotherapy, and 3) practical aspects of TDM in psychiatry and neurology. The writer hopes the time is right for a TDM guideline in psychiatry, which is indicated for: 1) psychiatric researchers ready to value how TDM can contribute to moving psychopharmacology forward, 2) flexible clinicians ready to improve their patient care by personalizing dosing, and 3) today’s psychiatry residents prepared as a new generation ready to be trained in TDM and willing to continue incorporating TDM as new psychiatric drugs are marketed.

Key words

cytochrome P-450 enzyme system/metabolism - drug interactions - drug monitoring - enzyme induction - enzyme inhibitors - pharmacokinetics - practice guideline - psychopharmacology - psychotropic drugs.
 

  • References

  • 1 Horvitz-Lennon M, Mattke S, Predmore Z. et al. The role of antipsychotic plasma levels in the treatment of schizophrenia. Am J Psychiatry 2017; 174: 421-426
    CrossrefPubMedGoogle Scholar
  • 2 Odom-White A, de Leon J. Clozapine levels and caffeine. J Clin Psychiatry 1996; 57: 175-176
    PubMedGoogle Scholar
  • 3 de Leon J. Pharmacogenetic tests in psychiatry: From fear to failure to hype. J Clin Psychopharmacol 2016; 36: 299-304
    CrossrefPubMedGoogle Scholar
  • 4 Ortega y Gasset J. The concept of the generation. In the modern theme. New York: Harper & Row; 1961: 11-18
    Google Scholar
  • 5 Pippenger CE. Therapeutic drug monitoring assay development to improve efficacy and safety. Epilepsy Res 2006; 68: 60-63
    CrossrefPubMedGoogle Scholar
  • 6 Trautner EM, Morris R, Noack CH. et al. The excretion and retention of ingested lithium and its effect on the ionic balance of man. Med J Aust 1955; 42: 280-291
    PubMedGoogle Scholar
  • 7 No authors listed Tricyclic antidepressants–blood level measurements and clinical outcome: An APA Task Force report. Task force on the use of laboratory tests in psychiatry. Am J Psychiatry. 1985; 142: 155-162
    CrossrefPubMedGoogle Scholar
  • 8 Spina E, Hiemke C, de Leon J. Assessing drug-drug interactions through therapeutic drug monitoring when administering oral second-generation antipsychotics. Expert Opin Drug Metab Toxicol 2016; 12: 407-422
    CrossrefPubMedGoogle Scholar
  • 9 Baumann P, Hiemke C, Ulrich S. et al. Arbeitsge-meinschaft fur neuropsychopharmakologie und pharmakopsychiatrie. The AGNP-TDM expert group consensus guidelines: Therapeutic drug monitoring in psychiatry. Pharmacopsychiatry 2004; 37: 243-265
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 10 Schäfer A, Hiemke C, Baumann P. Consensus guideline for therapeutic drug monitoring in psychiatry (2004): Bibliometric analysis of citations for the period 2004–2011. Nord J Psychiatry 2016; 70: 202-207
    CrossrefPubMedGoogle Scholar
  • 11 Hiemke C, Baumann P, Bergemann N. et al. AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: Update 2011. Pharmacopsychiatry 2011; 44: 195-235
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Hiemke C, Bergemann N, Clement HW. et al. Consensus guidelines for therapeutic drug monitoring in neuopsychopharmacology: update 2017. Pharmacopsychiatry 2018; 51: 9-62
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 13 Patsalos PN, Berry DJ, Bourgeois BF. et al. Antiepileptic drugs–best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008; 49: 1239-1276
    CrossrefPubMedGoogle Scholar
  • 14 de Leon J, De Las Cuevas C. The art of pharmacotherapy: Reflections on pharmacophobia. J Clin Psychopharmacol 2017; 37: 131-137
    CrossrefPubMedGoogle Scholar
  • 15 Ioannidis JPA. Hijacked evidence-based medicine: Stay the course and throw the pirates overboard. J Clin Epidemiol 2017; 84: 11-13
    CrossrefPubMedGoogle Scholar
  • 16 de Leon J. Evidence-based medicine versus personalized medicine: Are they enemies?. J Clin Psychopharmacol 2012; 32: 153-164
    CrossrefPubMedGoogle Scholar
  • 17 de Leon J. The crucial role of the therapeutic window in understanding the clinical relevance of the poor versus the ultrarapid metabolizer phenotypes in subjects taking drugs metabolized by CYP2D6 or CYP2C19. J Clin Psychopharmacol 2007; 27: 241-245
    CrossrefPubMedGoogle Scholar
  • 18 de Leon J. Translating pharmacogenetics to clinical practice: Do cytochrome P450 2D6 ultrarapid metabolizers need higher atomoxetine doses?. J Am Acad Child Adolesc Psychiatry 2015; 54: 532-544
    CrossrefPubMedGoogle Scholar
  • 19 Brown JT, Abdel-Rahman SM, van Haandel L. et al. Single dose, CYP2D6 genotype-stratified pharmacokinetic study of atomoxetine in children with ADHD. Clin Pharmacol Ther 2016; 99: 642-650
    CrossrefPubMedGoogle Scholar
  • 20 Subramanian S, Völlm BA, Huband N. Clozapine dose for schizophrenia. Cochrane Database Syst Rev 2017; 6 CD009555
    PubMedGoogle Scholar
  • 21 Spina E, de Leon J. Clinical applications of CYP genotyping in psychiatry. J Neural Transm (Vienna) 2015; 122: 5-28
    CrossrefPubMedGoogle Scholar
  • 22 Schoretsanitis G, Spina E, Hiemke C. et al. A systematic review and combined analysis of therapeutic drug monitoring studies for long-acting risperidone. Expert Review in Clinical Pharmacology 2017; DOI: 10.1080/17512433.2017.1345623.
    PubMedGoogle Scholar
  • 23 de Leon J. Highlights of drug package inserts and the website DailyMed: the need for further improvement in package inserts to help busy prescribers. J Clin Psychopharmacol 2011; 31: 263-265
    CrossrefPubMedGoogle Scholar
  • 24 de Leon J. False-negative studies may systematically contaminate the literature on the effects of inducers in neuropsychopharmacology. Part I: focus on epilepsy. J Clin Psychopharmacol 2014; 34: 177-183
    CrossrefPubMedGoogle Scholar
  • 25 de Leon J. False-negative studies may systematically contaminate the literature on the effects of inducers in neuropsychopharmacology: Part II: Focus on bipolar disorder. J Clin Psychopharmacol 2014; 34: 291-296
    CrossrefPubMedGoogle Scholar
  • 26 Meyer UA. Pharmacogenetics – five decades of therapeutic lessons from genetic diversity. Nat Rev Genet 2004; 5: 669-676
    CrossrefPubMedGoogle Scholar
  • 27 Fibiger HC. Psychiatry, the pharmaceutical industry, and the road to better therapeutics. Schizophr Bull 2012; 38: 649-650
    CrossrefPubMedGoogle Scholar
  • 28 Spina E, Pisani F, de Leon J. Clinically significant pharmacokinetic drug interactions of antiepileptic drugs with new antidepressants and new antipsychotics. Pharmacol Res 2016; 106: 72-86
    CrossrefPubMedGoogle Scholar
  • 29 Spina E, de Leon J. Potentially clinically relevant pharmacodynamics drug interactions between antiepileptic and psychotropic medications: An update. Curr Pharm Des 2018 in press
    PubMed
  • 30 de Leon J. The effects of antiepileptic inducers in neuropsychopharmacology, a neglected issue. Part I: A summary of the current state for clinicians. Rev Psiquiatr Salud Ment 2015; 8: 97-115
    CrossrefPubMedGoogle Scholar
  • 31 Jackson J, McCollum B, Ognibene J. et al. Three patients needing high doses of valproic acid to get therapeutic concentrations. Case Rep Psychiatry 2015; 2015: 542862
    PubMedGoogle Scholar
  • 32 O’Neill A, de Leon J. Two case reports of oral ulcers with lamotrigine several weeks after oxcarbazepine withdrawal. Bipolar Disord 2007; 9: 310-313
    CrossrefPubMedGoogle Scholar
  • 33 McGrane IR, Loveland JG, de Leon J. Possible oxcarbazepine inductive effects on aripiprazole metabolism: a case report. J Pharm Pract 2017; 1: 897190017710523 [Epub]
    PubMedGoogle Scholar
  • 34 de Leon J. The effects of antiepileptic inducers in neuropsychopharmacology, a neglected issue. Part II: Pharmacological issues and further understanding. Rev Psiquiatr Salud Ment 2015; 8: 167-188
    CrossrefPubMedGoogle Scholar
  • 35 Jackson J, McCollum B, O’Neill A. et al. A case report that suggested that the patient was very sensitive to induction and needed 1600 mg/d of lamotrigine to get therapeutic concentrations. J Clin Psychopharmacol 2015; 35: 745-747
    CrossrefPubMedGoogle Scholar
  • 36 Lana F, Martí-Bonany J, Fuster J. et al. Reduction in serum concentration of valproic acid secondary to the intake of ibuprofen as an example of valproic acid auto-induction metabolism. Actas Esp Psiquiatr 2016; 44: 136-144
    PubMedGoogle Scholar
  • 37 Crettol S, de Leon J, Hiemke C. et al. Pharmacogenomics in psychiatry: From therapeutic drug monitoring to genomic medicine. Clin Pharmacol Ther 2014; 95: 254-257
    CrossrefPubMedGoogle Scholar
  • 38 de Leon J. Training psychiatrists to think like pharmacologists. http://inhn.org/home/courses/jose-de-leon-training-psychiatrists-to-thinklike-pharmacologists.html
    PubMed
  • 39 Buclin T, Gotta V, Fuchs A. et al. Monitoring drug therapy. Br J Clin Pharmacol 2012; 73: 917-923
    CrossrefPubMedGoogle Scholar