Atípusos antipszichotikumok és antidepresszív szerek terápiás gyógyszerszint-monitorozása: egy év tapasztalatai a Semmelweis Egyetemen

Abstract

INTRODUCTION: Pharmacotherapy supported by therapeutic drug monitoring (TDM) has a tradition in psy - chiatry. Novel diagnostic infrastructure based on mass spectrometry has been developed at Semmelweis University, allowing the renewal of psychiatric treatments supported by TDM. In a cooperation of the Department of Laboratory Medicine, and the Department of Psychiatry and Psychotherapy 13 drugs were assayed in a routine setting. Several drugs were determined with their pharmacologically active metabolites. METHODS: In 2019, 678 TDM tests were performed on samples taken from 465 patients receiving treatment at the Depart - ment of Psychiatry and Psychotherapy. No patient-related data were used for the presented evaluation. Analytical method performance was evaluated by method validation, using internal controls and participating in an inter - national external quality assessment scheme. The assay results were compared to reference ranges recommended in the leading international consensus guideline. RESULTS: Tests of clozapine, olanzapine and miscellaneous drugs comprised 35.8%, 34.9% and 29.3% of all orders, res - pec tively. A high proportion of results was outside the limits of the therapeutic ranges. Similarly, several concentra tion ratios of metabolites and parent drugs were outside the reference ranges. CONCLUSIONS: The reference ranges related to drug and metabolite concentrations are useful indicators but do not pre - sent therapeutic goals or a basis for clinical decisions by themselves. The interpretation of TDM results should be based on the condition of the patient, the clinical goals and the therapeutic context (e.g. the coadministration of other drugs), handled as an element of more complex decision making, and should serve the individualization of therapy.