Greek translation of a summary of the 2017 update of the consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology

The quantification and pharmacological interpretation of drug concentrations in blood (serum or plasma) is widely known as therapeutic drug monitoring (TDM). In clinical practice, TDM is an established precision tool that provides the fundamental prerequisites for personalized treatment. Specifically, in neurology and psychiatry, TDM can be used as part of the process of prescription of medications in specific patient subgroups, including children and adolescents, pregnant women, elderly patients, patients with intellectual disabilities, patients with substance abuse disorders, individuals with pharmacokinetic idiosyncrasies and forensic patients. Clinicians may consider TDM in the case of lack of clinical response to therapeutic doses of medication, assessment of drug adherence, tolerability and drug-drug interactions. This is the Greek translation of a short summary of the updated consensus guidelines compiled by the TDM task force of the Arbeitsgemeinschaft fur Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP). It includes therapeutic reference ranges, laboratory alert levels, recommendation levels for prescribing TDM for dosage optimization without specific indications, conversion factors, factors for calculation of dosage-related drug concentrations and metabolite-to-parent ratios

Systematic review and meta-analysis on the therapeutic reference range for escitalopram : Blood concentrations, clinical effects and serotonin transporter occupancy

Introduction: A titration within a certain therapeutic reference range presupposes a relationship between the blood concentration and the therapeutic effect of a drug. However, this has not been systematically investigated for escitalopram. Furthermore, the recommended reference range disagrees with mean steady state concentrations (11-21 ng/ml) that are expected under the approved dose range (10-20 mg/day). This work systematically investigated the relationships between escitalopram dose, blood levels, clinical effects, and serotonin transporter occupancy.Methods: Following our previously published methodology, relevant articles were systematically searched and reviewed for escitalopram.Results: Of 1,032 articles screened, a total of 30 studies met the eligibility criteria. The included studies investigated escitalopram blood levels in relationship to clinical effects (9 studies) or moderating factors on escitalopram metabolism (12 studies) or serotonin transporter occupancy (9 studies). Overall, the evidence for an escitalopram concentration/effect relationship is low (level C).Conclusion: Based on our findings, we propose a target range of 20-40 ng/ml for antidepressant efficacy of escitalopram. In maintenance treatment, therapeutic response is expected, when titrating patients above the lower limit. The lower concentration threshold is strongly supported by findings from neuroimaging studies. The upper limit for escitaloprams reference range rather reflects a therapeutic maximum than a tolerability threshold, since the incidence of side effects in general is low. Concentrations above 40 ng/ml should not necessarily result in dose reductions in case of good clinical efficacy and tolerability. Dose-related escitalopram concentrations in different trials were more than twice the expected concentrations from guideline reports

Therapeutic drugmonitoring in neuropsychopharmacology. Summary of the consensus guidelines 2017 of the TDM task force of the AGNP

Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood serum or plasma to optimize pharmacological therapy. TDM is an instrument with which the high interindividual variability of pharmacokinetics of patients can be identified and therefore enables apersonalized pharmacotherapy. In September 2017 the TDM task force of the Working Group for Neuropsychopharmacology and Pharmacopsychiatry (AGNP) published an update of the consensus guidelines on TDM published in 2011. This article summarizes the essential statements for the clinical practice in psychiatry and neurology

TDM in psychiatry and neurology: A comprehensive summary of the consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology, update 2017; a tool for clinicians

Objectives: Therapeutic drug monitoring (TDM) combines the quantification of drug concentrations in blood, pharmacological interpretation and treatment guidance. TDM introduces a precision medicine tool in times of increasing awareness of the need for personalized treatment. In neurology and psychiatry, TDM can guide pharmacotherapy for patient subgroups such as children, adolescents, pregnant women, elderly patients, patients with intellectual disabilities, patients with substance use disorders, individuals with pharmacokinetic peculiarities and forensic patients. Clear indications for TDM include lack of clinical response in the therapeutic dose range, assessment of drug adherence, tolerability issues and drug-drug interactions.Methods: Based upon existing literature, recommended therapeutic reference ranges, laboratory alert levels, and levels of recommendation to use TDM for dosage optimization without specific indications, conversion factors, factors for calculation of dose-related drug concentrations and metabolite-to-parent ratios were calculated.Results: This summary of the updated consensus guidelines by the TDM task force of the Arbeitsgemeinschaft fur Neuropsychopharmakologie und Pharmakopsychiatrie offers the practical and theoretical knowledge for the integration of TDM as part of pharmacotherapy with neuropsychiatric agents into clinical routine.Conclusions: The present guidelines for TDM application for neuropsychiatric agents aim to assist clinicians in enhancing safety and efficacy of treatment