Affiliation:
1. Mental health research center
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.
Publisher
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology
Reference34 articles.
1. Baymeeva NV, Zastrozhin MS, Sychev DA, Kaleda VG, Miroshnichenko II Results of Therapeutic drug monitoring of haloperidol in patients with alcoholic psychosis and schizophrenia. Psikhiatriya. 2019;17(2):23-28. (In Russ.). https://doi.org/10.30629/2618-6667-2019-17-2-23-28
2. Miroshnichenko II Monitoring of the antipsychotic therapy effectiveness. Psikhiatriya. 2022;20(4):128-138. (In Russ.). https://doi.org/10.30629/2618-6667-2022-20-4-128-138
3. Miroshnichenko II, Fedotov YuA, Gorshkova EV, Ivashchenko AA Chromatomass spectrometry in pharmacokinetic studies. Kachestvennaya Klinicheskaya Praktika. 2008;(3):29-36. (In Russ.).
4. Potanin S.S. Rol' terapevticheskogo lekarstvennogo monitoringa antipsihotikov v individualizacii terapii obostreniya pristupoobrazno-progredientnoj shizofrenii: dis. kand. med. Nauk. Moskva, 2015. (In Russ.).
5. Potanin SS, Burminsky DS, Morozova MA, Platova AI, Baimeeva NV, Miroshnichenko II. Wide individual variability in antipsychotic concentrations in patients with exacerbation of schizophrenia in routine practice. Social'naya i klinicheskaya psihiatriya. 2017;27(3), 73-80. (In Russ.).