Guideline for the use of therapeutic drug monitoring of antipsychotics to individualize the selection of therapy in the treatment of exacerbation of schizophrenia

Abstract

Significant individual variability in the concentration of antipsychotics (AP) and its impact on both the efficacy and safety of therapy has been shown in many studies. In this regard, the use of therapeutic drug monitoring (TDM) of AP seems to be a clinically relevant method for the individualization of psychopharmacotherapy in the treatment of exacerbations of schizophrenia. The purpose of this work was to develop recommendations on the use of TDM AP for the individualization of therapy for exacerbation of schizophrenia. Materials and methods. To develop recommendations, a literature search was performed on the Medline, Google Scolar and Elibrary databases and the materials of the dissertation of Potanin S.S. "The role of therapeutic drug monitoring of antipsychotics in the individualization of therapy for exacerbations of paroxysmal-progredient schizophrenia" were used. Results. The conducted literature search made it possible to classify AP according to the degree of expediency of TDM, to determine the optimal therapeutic concentrations for each drug, indications for TDM, and to develop a structured decision-making algorithm depending on the results obtained. The main indications for TDM AP in the treatment of exacerbation of schizophrenia are signs of impaired drug compliance, insufficient efficacy of therapy, pronounced dose-dependent side effects, and the addition of concomitant therapy that can significantly affect the concentration of AP. According to the results obtained, TDM is strongly recommended for clozapine, olanzapine and amisulpride, recommended for risperidone, paliperidone, aripiprazole, quetiapine, haloperidol, ziprasidone, perphenazine, sertindole, trifluoperazine, sulpiride and chlorpromazine, for other antipsychotics TDM may be useful in selected cases. A detailed decision-making algorithm is presented in the form of a table and is based on both the clinical situation and the results of TDM AP. Conclusion. Thus, TDM AP seems to be one of the most relevant and potentially close to the introduction into everyday practice methods of individualization of therapy for exacerbation of schizophrenia.