Outliers on the dose-response curve: how to minimize this problem using therapeutic drug monitoring, an underutilized tool in psychiatry.
This column continues the discussion of outliers on the dose-response curve begun in earlier columns. It focuses on therapeutic drug monitoring (TDM) as an underutilized tool in psychiatry to minimize this problem. The scientific rationale for dose adjustment based on TDM is presented and its efficiency is contrasted with dose adjustment based on clinical assessment of response. In current practice, the use of TDM with psychiatric drugs is generally restricted to drugs with narrow therapeutic windows or drugs imported into psychiatry from neurology where TDM is more commonly used. Examples of each of these types of drugs are cited.
Preskorn
Sheldon H
SH
Department of Psychiatry, University of Kansas School of Medicine-Wichita, and Chief Science Officer and Medical Director, Clinical Research Institute, Wichita, Kansas, USA.
D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D001711:Biotransformation / Q000235:genetics; D003511:Cyclohexanols / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D003865:Major Depressive Disorder / Q000097:blood / Q000188:drug therapy / Q000235:genetics / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D004351:Drug Resistance; D006801:Humans; D001523:Mental Disorders / Q000097:blood / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology; D008657:Metabolic Clearance Rate / Q000235:genetics; D010597:Pharmacogenetics; D010641:Phenotype; D011619:Psychotropic Drugs / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D011619:Psychotropic Drugs; D000069470:Venlafaxine Hydrochloride; D019389:Cytochrome P-450 CYP2D6