Therapeutic drug monitoring of non-tricyclic antidepressant drugs.
Therapeutic drug monitoring (TDM) of many of the tricyclic antidepressants (TCAs) has been demonstrated to be of clear clinical value. This article reviews studies of TDM for the selective serotonin reuptake inhibitors (SSRIs) and other non-tricyclic antidepressants such as venlafaxine, nefazodone, trazodone, mianserin and bupropion. No definitive therapeutic concentrations have been demonstrated for these agents, nor have levels indicative of toxicity been reported. The major benefit of TDM for these agents would appear to be in the assessment of the apparently treatment-refractory depressed patient, to determine whether such lack of response is related to inadequate levels that would suggest either poor compliance, ultra-rapid metabolism, or drug interactions leading to induction of metabolising enzymes. Potential future applications of TDM, in conjunction with genotyping of cytochrome P450 enzymes and pharmacogenomic evaluations, are discussed.
Mitchell
Philip B
PB
School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, Australia. phil.mitchell@unsw.edu.au
D018687:Antidepressive Agents, Second-Generation / Q000494:pharmacology*; D000929:Antidepressive Agents, Tricyclic / Q000494:pharmacology; D016642:Bupropion / Q000494:pharmacology; D003511:Cyclohexanols / Q000494:pharmacology; D003577:Cytochrome P-450 Enzyme System / Q000737:chemistry; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D008803:Mianserin / Q000494:pharmacology; D010879:Piperazines; D017367:Selective Serotonin Reuptake Inhibitors / Q000493:pharmacokinetics*; D014196:Trazodone / Q000494:pharmacology; D014230:Triazoles / Q000494:pharmacology; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D016642:Bupropion; D003511:Cyclohexanols; D003577:Cytochrome P-450 Enzyme System; D008803:Mianserin; D010879:Piperazines; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone; D014230:Triazoles; D000069470:Venlafaxine Hydrochloride; C051752:nefazodone