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Miroshnichenko I.I.

Mental Health Research Center

Baymeeva N.V.

Mental Health Research Center

Platova A.I.

Mental Health Reseroch center

Kaleda V.G.

Mental Health Research Centre

Therapeutic drug monitoring of antipsychotic drugs in routine psychiatric practice

Authors:

Miroshnichenko I.I., Baymeeva N.V., Platova A.I., Kaleda V.G.

More about the authors

Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(5): 145‑152

DOI: 10.17116/jnevro2023123051145

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Table of contents

THERAPEUTIC DRUG MONITORING OF ANTIPSYCHOTIC DRUGS IN ROUTINE PSYCHIATRIC PRACTICE
THERAPEUTIC DRUG MONITORING OF ANTIPSYCHOTIC DRUGS IN ROUTINE PSYCHIATRIC PRACTICE

To cite this article:

Miroshnichenko II, Baymeeva NV, Platova AI, Kaleda VG. Therapeutic drug monitoring of antipsychotic drugs in routine psychiatric practice. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(5):145‑152. (In Russ.)
https://doi.org/10.17116/jnevro2023123051145

Подписка 2026 Журнал неврологии и психиатрии им. С.С. Корсакова (S.S. Korsakov Journal of Neurology and Psychiatry)
МСФ на ЯМ
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Abstract:

OBJECTIVE

To evaluate the relationship between daily doses of antipsychotic drugs, their serum concentrations, and characteristics of patients treated for schizophrenia or schizophreniform disorder in day-to-day clinical practice.

MATERIAL AND METHODS

A total of 187 patients were included in the study, 77 (41.1%) patients were on monotherapy, and 110 (58.9%) patients received two or more antipsychotics. Patients age was 27.8±8.1 years, and their body weight was 79.8±15.6 kg. The sample was represented mainly by young men (93.0%). The proportion of smokers was 37.4%. The appropriate HPLC-MS/MS method was used for the simultaneous analysis of 8 antipsychotics and its active metabolites. Serum concentrations of the drugs aripiprazole (ARI), chlorpromazine (CPZ), haloperidol (HAL), zuclopenthixol (ZUC), clozapine (CLO), risperidone (RIS), quetiapine (QUE), olanzapine (OLA), norclozapine (N-desmethylclozapine, NOR), 9-hydroxyrisperidone (9-OH-RIS), dehydroaripiprazole (DGA) were measured. The serum concentration/dose ratio (C/D) was employed as the primary outcome measure, as doses were not kept constant during the study. The active antipsychotic fraction (drug+active metabolite, active moiety — AM) was also evaluated for RIS and ARI. In addition, the metabolite/parent ratio (MPR) was evaluated for RIS and ARI.

RESULTS

A total of 265 biological samples were obtained, 421 and 203 measurements of the concentration of drugs and their metabolites were carried out, respectively. Overall, 48% of antipsychotics levels were in the expected therapeutic ranges, 30% were below therapeutic ranges, and 22% were above them. A total of 55 patients underwent dose adjustments or drug changes due to ineffectiveness or side-effects. It has been found that smoking reduces the level of C/D for CLO (p<0.01, Mann—Whitney test). We have established that comedication with CLO significantly increases the C/D ratio of QUE (p<0.05, Mann—Whitney test). We have not revealed any influence of weight and age of the subjects on the C/D. The dose-concentration regression relationships are formalized for all AP.

CONCLUSION

Therapeutical drug monitoring (TDM) is an essential tool to personalize antipsychotic therapy. Careful analysis of TDM data can contribute significantly to the study of the impact of individual patient characteristics on systemic exposure to these drugs.

Keywords:

serum concentration
pharmacokinetics
concentration-dose ratio
active metabolite
active moiety

Authors:

Miroshnichenko I.I.

Mental Health Research Center

Baymeeva N.V.

Mental Health Research Center

Platova A.I.

Mental Health Reseroch center

Kaleda V.G.

Mental Health Research Centre

Received:

29.08.2022

Accepted:

15.12.2022

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