title: Determination of blood concentration levels of psychotropic medications in Rwandan patients.
abstract: OBJECTIVE
  In Rwanda, no therapeutic monitoring of psychotropic drugs is done. This results in difficult treatment optimisation and exposition to a high risk of toxicity and drug ineffectiveness for patients under treatment. This study aimed to determine blood concentration levels of psychotropic drugs in Rwandan patients and identify problems associated with the lack of therapeutic drug monitoring (TDM) of these drugs.
  
  
  METHODS
  The analysis was performed on 1 ml of serum sample using prazepam as internal standard. Regarding the step of sample preparation, we used a liquid-liquid extraction with a mixture of organic solvents: diethyl ether/dichloromethane/hexane/n-amyl alcohol (50/30/20/0.5:V/V). A Waters Alliance 2695 was used for analysis. The chromatography was run on a Symmetry C8 column and as mobile phase acetonitrile and phosphate buffer (pH 3.8) were used.
  
  
  RESULTS
  Concerning the results, serum samples from 128 patients were analysed. Twenty-one different psychotropic drugs belonging to various pharmacological classes were detected and quantified. Analytical results were put into three categories based upon therapeutic reference ranges (TRR) of various drugs: subtherapeutic, therapeutic and supratherapeutic. For a total of 237 analyses, results within TRR represented 46% while 47 and 8% of results were, respectively, below and above TRR.
  
  
  CONCLUSIONS
  It was therefore concluded that patients under psychotropic treatment in Rwanda are exposed to both the risk of drug ineffectiveness and the risk of toxicity (54%) with only 46% of results within the TRR. Consequently, TDM is needed to optimise psychotropic treatment in Rwandan patients.
authors.affiliation: Laboratory of Clinical, Forensic, Environmental and Industrial Toxicology, CHU-Liege , Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Hahirwa
authors.forename: C
authors.initials: C
authors.lastname: Charlier
authors.forename: C
authors.initials: C
authors.lastname: Karangwa
authors.forename: R
authors.initials: R
authors.lastname: Denooz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000097:blood*; D012016:Reference Values; D012432:Rwanda; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Drug ineffectiveness; Drug toxicity; Psychotropic drugs; Rwandan patients