DOCSLIB.ORG

AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Psychiatry: Update 2011

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Psychiatry: Update 2011 Review 195 AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Psychiatry: Update 2011 Authors C. Hiemke 1 , P. Baumann 2 , N. Bergemann3 , A. Conca 4 , O. Dietmaier 5 , K. Egberts 6 , M. Fric 7 , M. Gerlach 6 , C. Greiner 8 , G. Gründer 9 , E. Haen 10 , U. Havemann-Reinecke 11 , E. Jaquenoud Sirot 12 , H. Kirchherr 13 , G. Laux 7 , U. C. Lutz 14 , T. Messer 15 , M. J. Müller 16 , B. Pfuhlmann 17 , B. Rambeck 18 , P. Riederer 17 , B. Schoppek 19 , J. Stingl 20 , M. Uhr 21 , S. Ulrich 22 , R. Waschgler 23 , G. Zernig 24 Affi liations Affi liation addresses are listed at the end of the article Key words Abstract cologic agents have been introduced that are also ● ▶ consensus guidelines ▼ candidates for TDM. Therefore the TDM consen- ● ▶ drug analysis Therapeutic drug monitoring (TDM), i. e., the sus guidelines were updated and extended to 128 ▶ ● pharmacokinetics quantifi cation of serum or plasma concentra- neuropsychiatric drugs. 4 levels of recommenda- ● ▶ psychotropic drugs tions of medications for dose optimization, has tion for using TDM were defi ned ranging from ● ▶ reference ranges ● ▶ therapeutic drug monitoring proven a valuable tool for the patient-matched “strongly recommended” to “potentially useful”. ● ▶ therapeutic window psychopharmacotherapy. Uncertain drug adher- Evidence-based “therapeutic reference ranges” ence, suboptimal tolerability, non-response at and “dose related reference ranges” were elabo- therapeutic doses, or pharmacokinetic drug-drug rated after an extensive literature search and a interactions are typical situations when meas- structured internal review process. A “laboratory urement of medication concentrations is help- alert level” was introduced, i. e., a plasma level at ful. Patient populations that may predominantly or above which the laboratory should immedi- benefi t from TDM in psychiatry are children, ately inform the treating physician. Supportive pregnant women, elderly patients, individuals information such as cytochrome P450 substrate- with intelligence disabilities, forensic patients, and inhibitor properties of medications, nor- patients with known or suspected genetically mal ranges of ratios of concentrations of drug determined pharmacokinetic abnormalities or metabolite to parent drug and recommendations individuals with pharmacokinetically relevant for the interpretative services are given. Recom- comorbidities. However, the potential benefi ts mendations when to combine TDM with phar- of TDM for optimization of pharmacotherapy macogenetic tests are also provided. Following Downloaded by: Christoph Hiemke. Copyrighted material. can only be obtained if the method is adequately the guidelines will help to improve the outcomes integrated into the clinical treatment process. To of psychopharmacotherapy of many patients promote an appropriate use of TDM, the TDM especially in case of pharmacokinetic problems. expert group of the Arbeitsgemeinschaft für Thereby, one should never forget that TDM is an Bibliography Neuropsychopharmakologie und Pharmakopsy- interdisciplinary task that sometimes requires DOI http://dx.doi.org/ chiatrie (AGNP) issued guidelines for TDM in the respectful discussion of apparently discrep- 10.1055/s-0031-1286287 psychiatry in 2004. Since then, knowledge has ant data so that, ultimately, the patient can profi t Pharmacopsychiatry 2011; advanced signifi cantly, and new psychopharma- from such a joint eff ort. 44: 195–235 © Georg Thieme Verlag KG Stuttgart · New York than 5 decades [ 521 , 522 ] , growing evidence sug- ISSN 0176-3679 Introduction ▼ gests that improving the way the available medi- Correspondence In psychiatry, around 130 drugs are now availa- cations are administered may bring substantial C. Hiemke, PhD, Univ.-Prof. ble which have been detected and developed benefi t to patients [ 45 ] . Evidence-based guidelines Department of Psychiatry and during the last 60 years [ 54 ] . These drugs are for optimum treatment have been published dur- Psychotherapy eff ective and essential for the treatment of many ing the last decade [ 23 , 46 , 101 , 204 , 205 , 221 , 234 , University Medical Center, psychiatric disorders and symptoms. Despite 254 , 276 , 284 , 582 , 585 ,748]. Mainz enormous medical and economic benefi ts, how- A valuable tool for tailoring the dosage of the D-55101 Mainz ever, therapeutic outcomes are still far from prescribed medication(s) to the individual char- Germany Tel.: +49/6131/177 131 satis factory for many patients [ 5 , 6 , 396 , 661 ] . acteristics of a patient is therapeutic drug moni- Fax: +49/6131/176 789 Therefore, after having focused clinical research toring (TDM). The major reason to use TDM for [email protected] on the development of new drugs during more the guidance of psychopharmacotherapy is the Hiemke C et al. AGNP Consensus Guidelines for … Pharmacopsychiatry 2011; 44: 195–235 196 Review considerable interindividual variability in the pharmacokinetic aspects of monitoring drug plasma concentrations. The second properties of the patient [ 524 , 526 ] . At the very same dose, a part defi nes indications for TDM and gives reference drug plasma more than 20-fold interindividual variation in the medication’s concentrations for dose optimization. The third part describes steady state concentration in the body may result, as patients the best practice of the process of TDM, which starts with the diff er in their ability to absorb, distribute, metabolize and request and ends with the clinical decision to either continue or excrete drugs due to concurrent disease, age, concomitant medi- change the pre-TDM pharmacotherapy. cation or genetic peculiarities [ 61 , 94 , 310 , 311 , 334 , 335 , 374 ] . Aiming to optimise the practice of TDM the following topics Diff erent formulations of the same medication may also infl u- were addressed: ence the degree and temporal pattern of absorption and, hence, ▶ d e fi nition of indications to utilize TDM in psychiatry medication concentrations in the body. TDM uses the quantifi - ▶ d e fi nition of graded levels of recommendations to use TDM cation of drug concentrations in blood plasma or serum to titrate ▶ d e fi nition of therapeutic reference ranges (“therapeutic win- the dose of individual patients so that a drug concentration dows”) and dose-related reference ranges that laboratories associated with highest possible probability of response and can quote and clinicians can use to guide the psychopharma- tolerability and a low risk of toxicity can be obtained. Moreover, cotherapy TDM has the possible and widely unexploited potential to ▶ d e fi nition of alert levels for laboratories to warn the treating improve cost-eff ectiveness of psychopharmacotherapy [ 527 , 660 ] . physician when plasma concentrations are considered to be For a considerable number of psychopharmacologic compounds, too high and potentially harmful the quantifi cation of the medications’ plasma concentration has ▶ recommendations and help for interpretative services become clinical routine for dose adjustment. Clear evidence of ▶ recommendations concerning the combination of TDM with the benefi ts of TDM has been given for tricyclic antidepressants, pharmacogenetic tests a number of old and new antipsychotic drugs and for conven- tional mood stabilizing drugs [ 51 , 459 , 505 ] . For lithium, TDM has become a standard of care due to its narrow therapeutic Preparation of the Consensus Document range [ 133 , 395 ] . ▼ The benefi ts of TDM regarding the optimization of pharmaco- The updated consensus guidelines were prepared by the inter- therapy, however, can only be obtained if the method is ade- disciplinary TDM group of the AGNP consisting of clinical psy- quately integrated into the clinical treatment process. Current chiatrists, pharmacologists, biochemists, pharmacists and TDM use in psychiatric care is obviously suboptimal chemists from academic and non academic hospitals and insti- [ 134 , 700 , 742 ] . Similar to other medical disciplines, systematic tutions of Germany, Switzerland, Austria and Italy, who have studies have demonstrated that the inappropiate use of TDM is been involved for many years in the development and imple- widespread. Inappropriate TDM testing wastes laboratory mentation of TDM for psychotropic medications in everyday resources and also bears the risk that misleading results will clinical practice. The experts compiled information from the lit- adversely infl uence clinical decision making [ 122 ] . A study on erature and worked out the present best practice guidelines the clinical use of TDM for tricyclic antidepressants in psychiat- aiming at promoting the appropriate use of TDM in psychiatry. ric university hospital settings showed that between 25 and 40 % Because TDM is widely used in daily clinical practice for antide- of the requests for TDM were inappropriate and the interpreta- pressant, antipsychotic and mood stabilizing drugs, these 3 tion of the results led to about 20 % of inappropriate therapeutic pharmacologic classes are extensively represented in the present adjustments [ 700 , 742 ] . Other typical errors were absence of guidelines. Anxiolytic and hypnotic drugs, antidementia drugs, steady-state conditions and transcription errors on the request drugs for treatment of substance abuse related disorders and form [ 700,743 ] . Studies on TDM for antidepressant and mood other psychotropic drugs are also candidates for TDM and are Downloaded by: Christoph Hiemke. Copyrighted material. stabilizing drugs further specifi ed the information on the inap- thus covered in the present
Load more

Recommended publications
  • The In¯Uence of Medication on Erectile Function
    International Journal of Impotence Research (1997) 9, 17±26 ß 1997 Stockton Press All rights reserved 0955-9930/97 $12.00 The in¯uence of medication on erectile function W Meinhardt1, RF Kropman2, P Vermeij3, AAB Lycklama aÁ Nijeholt4 and J Zwartendijk4 1Department of Urology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; 2Department of Urology, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands; 3Pharmacy; and 4Department of Urology, Leiden University Hospital, P.O. Box 9600, 2300 RC Leiden, The Netherlands Keywords: impotence; side-effect; antipsychotic; antihypertensive; physiology; erectile function Introduction stopped their antihypertensive treatment over a ®ve year period, because of side-effects on sexual function.5 In the drug registration procedures sexual Several physiological mechanisms are involved in function is not a major issue. This means that erectile function. A negative in¯uence of prescrip- knowledge of the problem is mainly dependent on tion-drugs on these mechanisms will not always case reports and the lists from side effect registries.6±8 come to the attention of the clinician, whereas a Another way of looking at the problem is drug causing priapism will rarely escape the atten- combining available data on mechanisms of action tion. of drugs with the knowledge of the physiological When erectile function is in¯uenced in a negative mechanisms involved in erectile function. The way compensation may occur. For example, age- advantage of this approach is that remedies may related penile sensory disorders may be compen- evolve from it. sated for by extra stimulation.1 Diminished in¯ux of In this paper we will discuss the subject in the blood will lead to a slower onset of the erection, but following order: may be accepted.
    [Show full text]
  • Cardiovascular Adverse Reactions During Antidepressant Treatment
    International Journal of Neuropsychopharmacology, 2015, 1–9 doi:10.1093/ijnp/pyu080 Research Article research article Cardiovascular Adverse Reactions During Downloaded from https://academic.oup.com/ijnp/article-abstract/18/4/pyu080/664200 by guest on 02 December 2019 Antidepressant Treatment: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2010 Christoph Josef Spindelegger, MD; Konstantinos Papageorgiou, MD; Renate Grohmann, MD; Rolf Engel, MD; Waldemar Greil, MD; Anastasios Konstantinidis, MD; Marcus Willy Agelink, MD; Stefan Bleich, MD; Eckart Ruether, MD; Sermin Toto, MD; Siegfried Kasper, MD Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Drs Spindelegger, Papageorgiou, Konstantinidis, and Kasper); Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr-University of Bochum, Germany (Dr Agelink); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany (Drs Bleich and Toto); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Germany (Drs Grohmann, Engel, Greil, and Ruether) Correspondence: Siegfried Kasper, MD, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria ([email protected]) Abstract Background: Antidepressants (ADs) are known to have the potential to cause various cardiovascular adverse drug reactions (ADRs). The tricyclic antidepressants (TCAs) were first revealed to be a possible source of cardiovascular ADRs. In recent years, newer classes of ADs were also suggested to have a higher risk of cardiovascular adverse effects. In particular, the selective serotonin reuptake inhibitors (SSRIs) were suspected to have the potential to induce QTc interval prolongation, and therefore increase the risk of ventricular arrhythmia.
    [Show full text]
  • Pharmacokinetic Considerations in Antipsychotic Augmentation Strategies: How to Combine Risperidone with Low-Potency Antipsychotics
    Progress in Neuro-Psychopharmacology & Biological Psychiatry 76 (2017) 101–106 Contents lists available at ScienceDirect Progress in Neuro-Psychopharmacology & Biological Psychiatry journal homepage: www.elsevier.com/locate/pnp Pharmacokinetic considerations in antipsychotic augmentation strategies: How to combine risperidone with low-potency antipsychotics Michael Paulzen a,b,1, Georgios Schoretsanitis a,b,f,⁎,1, Benedikt Stegmann d,ChristophHiemkeg,h, Gerhard Gründer a,b,KoenR.J.Schruerse, Sebastian Walther f, Sarah E. Lammertz a,b,EkkehardHaenc,d a Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany b JARA – Translational Brain Medicine, Aachen, Germany c Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany d Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany e Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands f University Hospital of Psychiatry, Bern, Switzerland g Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Germany h Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany article info abstract Article history: Objectives: To investigate in vivo the effect of low-potency antipsychotics on metabolism of risperidone (RIS). Received 22 December 2016 Methods: A therapeutic drug monitoring database containing plasma concentrations of RIS and its metabolite 9-OH- Accepted 12 March 2017 RIS of 1584 patients was analyzed. Five groups were compared; a risperidone group (n = 842) and four co- med- Available online 14 March 2017 ication groups; a group co-medicated with chlorprothixene (n = 67), a group with levomepromazine (n = 32), a group with melperone (n = 46), a group with pipamperone (n = 63) and a group with prothipendyl (n = 24).
    [Show full text]
  • Neuroleptic Malignant Syndrome in a Patient
    Psychiatria Danubina, 2018; Vol. 30, Suppl. 7, pp 415-417 Conference paper © Medicinska naklada - Zagreb, Croatia NEUROLEPTIC MALIGNANT SYNDROME IN A PATIENT TREATED WITH CLOTIAPINE Clémentine Lantin, Miriam Franco, François-Xavier Dekeuleneer, Didier Chamart & Juan Martin Tecco Mental Health Unit, Centre Hospitalier Universitaire et Psychiatrique de Mons-Borinage (CHUP-MB), Mons, Belgium SUMMARY Background: Neuroleptic malignant syndrome (NMS), which is linked to the use of antipsychotic medication, is a potentially lethal neurological emergency. The interest of our study is that NMS induced by the use of clotiapine has never previously been described. Subjects and methods: We present the case of a 61-year old man whose sleep disorders were treated with clotiapine 40 mg/day. After 7 days of taking 40 mg clotiapine, the patient presented with a deterioration of his general health which had gradually taken hold, with altered consciousness accompanied by generalised muscle rigidity and hypersalivation. Laboratory blood tests revealed elevated levels of Creatine Phosphokinase (CPK) at 812 U/l. The patient was diagnosed with NMS and treated accordingly. Results: The mechanism that underlies the appearance of NMS remains largely unknown. Clotiapine is a second-generation antipsychotic, first released onto the market in the 1970s, and is available in a few countries, including Belgium. NMS is treated as a medical emergency due to the possibility of morbidity and death. The first step in the treatment of NMS consists in withholding the agent suspected of provoking the symptoms. Conclusions: NMS is difficult to diagnose due to a great variability in clinical presentations and the absence of specific tests and laboratory results.
    [Show full text]
  • Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued
    20558 Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DEPARMENT OF THE TREASURY Services, U.S. Customs Service, 1301 TABLE 1.ÐPHARMACEUTICAL APPEN- Constitution Avenue NW, Washington, DIX TO THE HTSUSÐContinued Customs Service D.C. 20229 at (202) 927±1060. CAS No. Pharmaceutical [T.D. 95±33] Dated: April 14, 1995. 52±78±8 ..................... NORETHANDROLONE. A. W. Tennant, 52±86±8 ..................... HALOPERIDOL. Pharmaceutical Tables 1 and 3 of the Director, Office of Laboratories and Scientific 52±88±0 ..................... ATROPINE METHONITRATE. HTSUS 52±90±4 ..................... CYSTEINE. Services. 53±03±2 ..................... PREDNISONE. 53±06±5 ..................... CORTISONE. AGENCY: Customs Service, Department TABLE 1.ÐPHARMACEUTICAL 53±10±1 ..................... HYDROXYDIONE SODIUM SUCCI- of the Treasury. NATE. APPENDIX TO THE HTSUS 53±16±7 ..................... ESTRONE. ACTION: Listing of the products found in 53±18±9 ..................... BIETASERPINE. Table 1 and Table 3 of the CAS No. Pharmaceutical 53±19±0 ..................... MITOTANE. 53±31±6 ..................... MEDIBAZINE. Pharmaceutical Appendix to the N/A ............................. ACTAGARDIN. 53±33±8 ..................... PARAMETHASONE. Harmonized Tariff Schedule of the N/A ............................. ARDACIN. 53±34±9 ..................... FLUPREDNISOLONE. N/A ............................. BICIROMAB. 53±39±4 ..................... OXANDROLONE. United States of America in Chemical N/A ............................. CELUCLORAL. 53±43±0
    [Show full text]
  • Stembook 2018.Pdf
    The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances FORMER DOCUMENT NUMBER: WHO/PHARM S/NOM 15 WHO/EMP/RHT/TSN/2018.1 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances. Geneva: World Health Organization; 2018 (WHO/EMP/RHT/TSN/2018.1). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data.
    [Show full text]
  • ARCI Uniform Classification Guidelines for Foreign Substances, Or Similar State Regulatory Guidelines, Shall Be Assigned Points As Follows
    DRUG TESTING STANDARDS AND PRACTICES PROGRAM. Uniform Classification Guidelines for Foreign Substances And Recommended Penalties Model Rule. January, 2019 (V.14.0) © ASSOCIATION OF RACING COMMISSIONERS INTERNATIONAL – 2019. Association of Racing Commissioners International 2365 Harrodsburg Road- B450 Lexington, Kentucky, USA www.arci.com Page 1 of 66 Preamble to the Uniform Classification Guidelines of Foreign Substances The Preamble to the Uniform Classification Guidelines was approved by the RCI Drug Testing and Quality Assurance Program Committee (now the Drug Testing Standards and Practices Program Committee) on August 26, 1991. Minor revisions to the Preamble were made by the Drug Classification subcommittee (now the Veterinary Pharmacologists Subcommittee) on September 3, 1991. "The Uniform Classification Guidelines printed on the following pages are intended to assist stewards, hearing officers and racing commissioners in evaluating the seriousness of alleged violations of medication and prohibited substance rules in racing jurisdictions. Practicing equine veterinarians, state veterinarians, and equine pharmacologists are available and should be consulted to explain the pharmacological effects of the drugs listed in each class prior to any decisions with respect to penalities to be imposed. The ranking of drugs is based on their pharmacology, their ability to influence the outcome of a race, whether or not they have legitimate therapeutic uses in the racing horse, or other evidence that they may be used improperly. These classes of drugs are intended only as guidelines and should be employed only to assist persons adjudicating facts and opinions in understanding the seriousness of the alleged offenses. The facts of each case are always different and there may be mitigating circumstances which should always be considered.
    [Show full text]
  • Newsletterno4 2013EC.Pdf
    prepared in collaboration with the WHO Collaborating Centre for International Drug Monitoring, Uppsala, Sweden TheThe aim aim of of the the N Newsletterewsletter is is to to No.No. 4, 3, 2013 2012 disseminatedisseminate information information on on the the safetysafety and and efficacy efficacy of of pharmaceuticalpharmaceutical products, products, based on communications received based onfrom communications our network of received "drug from our network of "drug information officers" and other TheThe WHO WHO Pharmaceuticals Pharmaceuticals Newsletter Newsletter provides provides you you wit withh informationsources such officers" as specialized and other sources such as specialized thethe latest latest information information on on the the safety safety of of medicines medicines a andnd bulletins and journals, as well as legallegal actions actions taken taken by by regulatory regulatory authorities authorities acros acrosss the the partnersbulletins in WHO. and journals, The information as well as partners in WHO. The information world.world. It It also also provides provides signals signals from from the the Uppsala Uppsala is produced in the form of résumés MonitoringMonitoring Centre's Centre's SIGNAL SIGNAL document. document inis English,produced full in thetexts form of which of résumés may in English,be obtained full texts on request of which from: may In addition to the usual features, this issue includes the be obtained on request from: summary of discussions from the tenth meeting of the Quality Assurance and Safety: The feature
    [Show full text]
  • Quantification of Neuroleptics in Human Plasma Or Serum by Liquid Chromatography-Tandem Mass Spectrometry for Clinical Research
    TECHNICAL NOTE 65134 Quantification of neuroleptics in human plasma or serum by liquid chromatography-tandem mass spectrometry for clinical research Authors Application benefits Claudio De Nardi, • Simple offline sample preparation by protein precipitation Thermo Fisher Scientific GmbH, • 28 neuroleptics in a single quantitative method Dreieich, Germany Sergio Indelicato, Introduction Thermo Fisher Scientific, An analytical method for clinical research, quantifying 28 neuroleptics Les Ulis, France in human plasma or serum, is reported. Analysis includes ziprasidone, paliperidone, flupenthixole, prothipendyl, aripiprazole, melperone, melperone, promethazine, levomepromazine, sulpiride, haloperidole, sertindole, perazine, zotepine, clozapine, risperidone, olanzapine, fluphenazine, Keywords dehydroaripiprazole, zuclopenthixole, pipamperone, norquetiapine, Neuroleptics, offline sample quetiapine, thioridazine, chlorprothixene, desmethylolanzapine, preparation, plasma, serum, mass chlorpromazine, and norclozapine. Plasma or serum samples are extracted spectrometry by offline internal standard addition and protein precipitation. Extracted samples are injected onto a Thermo Scientific™ Vanquish™ Flex Binary system connected to a Thermo Scientific™ TSQ Quantis™ triple quadrupole mass Goal spectrometer with heated electrospray ionization. Detection is performed by Implementation of an analytical selected reaction monitoring (SRM) using 25 deuterated internal standards. method for the quantification of Method performance was evaluated using the
    [Show full text]
  • High Prevalence of Prescription of Psychotropic Drugs for Older
    Arnold et al. BMC Pharmacology and Toxicology (2017) 18:76 DOI 10.1186/s40360-017-0183-0 RESEARCHARTICLE Open Access High prevalence of prescription of psychotropic drugs for older patients in a general hospital Inken Arnold1,2†, Kati Straube2,3,4†, Wolfgang Himmel3, Stephanie Heinemann3, Vivien Weiss3, Laura Heyden1,2,3, Eva Hummers-Pradier3 and Roland Nau1,2* Abstract Background: Many elderly patients receive psychotropic drugs. Treatment with psychotropic agents is associated with serious side effects including an increased risk of falls and fractures. Several psychotropic drugs are considered potentially inappropriate for treatment of the elderly. Methods: A retrospective chart review was conducted covering all patients aged ≥ 65 years who were admitted to Evangelisches Krankenhaus Göttingen-Weende between 01/01/2013 and 03/31/2013. Psychotropic drugs reviewed for included benzodiazepines, Z-drugs, antidepressants and neuroleptics, but not drugs for sedation during artificial ventilation or pre-medication before surgery. Potentially inappropriate drugs were identified according to the PRISCUS list. To assess which factors were associated with the administration of psychotropic drugs, univariate and multivariable logistic regression analyses were performed. Results: The charts of 2130 patients (1231 women) were analyzed. 53.9% of all patients received at least one psychotropic medication (29.5% benzodiazepines, 12.6% Z-drugs, 22.2% antidepressants, 11.9% neuroleptics). The mean number of psychotropic drugs prescribed per patient with at least one prescription was 1.6. Patients treated in the geriatric department most often received antidepressants (45.0%), neuroleptics (20.6%) and Z-drugs (27.5%). Benzodiazepines and Z-drugs were prescribed mostly as medication on demand (77.7% of benzodiazepines, 73.9% of Z-drugs).
    [Show full text]
  • Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017
    Review Thieme Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017 Authors C. Hiemke1, 2, N. Bergemann3, H. W. Clement4, A. Conca5, J. Deckert6, K. Domschke7, G. Eckermann8, K. Egberts9, M. Gerlach9, C. Greiner10, G. Gründer11, E. Haen12, U. Havemann-Reinecke13, G. Hefner14, R. Helmer15, G. Janssen16, E. Jaquenoud17, G. Laux18, T. Messer19, R. Mössner20, M. J. Müller21, M. Paulzen11, B. Pfuhlmann22, P. Riederer6, A. Saria23, B. Schoppek24, G. Schoretsanitis25, M. Schwarz26, M. Silva Gracia12, B. Stegmann12, W. Steimer27, J. C. Stingl10, M. Uhr28, S. Ulrich29, S. Unterecker6, R. Waschgler30, G. Zernig23, 31, G. Zurek32, P. Baumann33 Affiliations 19 Danuviuskliniken, Psychiatric Hospital, Pfaffenhofen, 1 Department of Psychiatry and Psychotherapy, University Germany Medical Center of Mainz, Mainz, Germany 20 Department of Psychiatry and Psychotherapy, University 2 Institute of Clinical Chemistry and Laboratory Medicine, of Tübingen, Tübingen, Germany University Medical Center of Mainz, Mainz, Germany 21 Psychiatric Hospitals Oberberggruppe, Berlin, Germany 3 Kitzberg Hospitals, Center for Psychosomatic Medicine 22 Psychiatric Hospital Weisser Hirsch, Dresden, Germany and Psychotherapy, Bad Mergentheim, Germany 23 Experimental Psychiatry Unit, Department of Psychiatry 4 Department of Child and Adolescent Psychiatry, 1, Medical University of Innsbruck, Innsbruck, Austria University of Freiburg, Freiburg, Germany 24 kbo-Isar-Amper Klinikum München-Ost, Psychiatric 5 Servizio Psichiatrico del Comprensorio
    [Show full text]
  • Drug/Substance Trade Name(S)
    A B C D E F G H I J K 1 Drug/Substance Trade Name(s) Drug Class Existing Penalty Class Special Notation T1:Doping/Endangerment Level T2: Mismanagement Level Comments Methylenedioxypyrovalerone is a stimulant of the cathinone class which acts as a 3,4-methylenedioxypyprovaleroneMDPV, “bath salts” norepinephrine-dopamine reuptake inhibitor. It was first developed in the 1960s by a team at 1 A Yes A A 2 Boehringer Ingelheim. No 3 Alfentanil Alfenta Narcotic used to control pain and keep patients asleep during surgery. 1 A Yes A No A Aminoxafen, Aminorex is a weight loss stimulant drug. It was withdrawn from the market after it was found Aminorex Aminoxaphen, Apiquel, to cause pulmonary hypertension. 1 A Yes A A 4 McN-742, Menocil No Amphetamine is a potent central nervous system stimulant that is used in the treatment of Amphetamine Speed, Upper 1 A Yes A A 5 attention deficit hyperactivity disorder, narcolepsy, and obesity. No Anileridine is a synthetic analgesic drug and is a member of the piperidine class of analgesic Anileridine Leritine 1 A Yes A A 6 agents developed by Merck & Co. in the 1950s. No Dopamine promoter used to treat loss of muscle movement control caused by Parkinson's Apomorphine Apokyn, Ixense 1 A Yes A A 7 disease. No Recreational drug with euphoriant and stimulant properties. The effects produced by BZP are comparable to those produced by amphetamine. It is often claimed that BZP was originally Benzylpiperazine BZP 1 A Yes A A synthesized as a potential antihelminthic (anti-parasitic) agent for use in farm animals.
    [Show full text]