Focus on Psychosis: Consensus Statement It is illegal to post this copyrighted PDF on any website. CME Background Articles are selected for credit designation based on an Blood Levels to Optimize assessment of the educational needs of CME participants, Antipsychotic Treatment in with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Clinical Practice: Activities are planned using a process that links identified needs with desired results. A Joint Consensus Statement of To obtain credit, read the article, correctly answer the questions in the Posttest, and complete the Evaluation. A the American Society of Clinical $10 processing fee will apply. Psychopharmacology and the CME Objective After studying this article, you should be able to: Therapeutic Drug Monitoring Task • Use therapeutic drug monitoring with appropriate indications as part of the clinical decision-making Force of the Arbeitsgemeinschaft process to help optimize the efficacy and safety of antipsychotics für Neuropsychopharmakologie und Accreditation Statement Pharmakopsychiatrie The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Georgios Schoretsanitis, MD, PhDa,*; Council for Continuing Medical Education John M. Kane, MDa,b; Christoph U. Correll, MDa,b,c; Stephen to provide continuing medical education for d e physicians. R. Marder, MD ; Leslie Citrome, MD, MPH ; John W. Newcomer, MDf; Delbert G. Robinson, MDa,b; Donald C. Credit Designation Goff, MDg; Deanna L. Kelly, PhDh; The CME Institute of Physicians Postgraduate Press, Inc., i j designates this journal-based CME activity for a maximum Oliver Freudenreich, MD ; Daria Piacentino, MD, PhD ; of 1 AMA PRA Category 1 Credit™. Physicians should claim Michael Paulzen, MDk; Andreas Conca, MDl; only the credit commensurate with the extent of their Gerald Zernig, MDm; Ekkehard Haen, MD, PhDn; participation in the activity. Pierre Baumann, PhDo; Christoph Hiemke, PhDp; Note: The American Academy of Physician Assistants (AAPA) q accepts certificates of participation for educational activities and Gerhard Gründer, MD ; for the American Society of certified for AMA PRA Category 1 Credit™ from organizations Clinical Psychopharmacology and the Therapeutic Drug accredited by ACCME or a recognized state medical society. Monitoring Task Force of the Arbeitsgemeinschaft für Physician assistants may receive a maximum of 1 hour of Neuropsychopharmakologie und Pharmakopsychiatrier Category I credit for completing this program. Release, Expiration, and Review Dates This educational activity was published in May 2020 and ABSTRACT is eligible for AMA PRA Category 1 Credit™ through June 30, Objective: The quantification of antipsychotic levels in blood, 2022. The latest review of this material was April 2020. also known as therapeutic drug monitoring (TDM), is a potentially useful tool of modern personalized therapy that can be applied to Financial Disclosure augment antipsychotic use and dosing decisions. The application All individuals in a position to influence the content of this activity were asked to complete a statement regarding of TDM for antipsychotics can be helpful in numerous challenging all relevant personal financial relationships between clinical scenarios, such as lack of therapeutic response, relapse, or themselves or their spouse/partner and any commercial adverse drug reactions (ADRs) related to antipsychotic treatment. interest. The CME Institute has resolved any conflicts of The benefits of TDM may be particularly evident in the treatment of interest that were identified. In the past year, Marlene P. highly vulnerable patient subgroups, such as children, adolescents, Freeman, MD, Editor in Chief, has received research funding pregnant women, and the elderly. The main aim of this article is to from JayMac and Sage; has been a member of the advisory aid clinicians who routinely prescribe antipsychotics to successfully boards for Otsuka, Alkermes, and Sunovion; has been a apply TDM in routine clinical practice in order to help optimize the member of the Independent Data Safety and Monitoring efficacy and safety of those antipsychotics. Committee for Janssen; has been a member of the Steering Participants: Participants were clinicians and researchers, Committee for Educational Activities for Medscape; and, members of the American Society of Clinical Psychopharmacology, as a Massachusetts General Hospital (MGH) employee, and the Therapeutic Drug Monitoring Task Force of the works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Arbeitsgemeinschaft für Neuropsychopharmakologie und You are prohibited from making this publicly PDF available. You Sunovion, and works with the MGH Clinical Trials Network Pharmakopsychiatrie (Association of Neuropsychopharmacology and Institute, which receives research funding from multiple and Pharmacopsychiatry). pharmaceutical companies and the National Institute Evidence: TDM literature on antipsychotics was critically reviewed of Mental Health. No member of the CME Institute staff to provide a condensed clinical decision-making algorithm with reported any relevant personal financial relationships. therapeutic reference ranges for blood antipsychotic levels, within Faculty financial disclosure appears at the end of the which patients are most likely to respond and tolerate treatment, article. although TDM is not equally recommended/supported for all antipsychotics. For reprints or permissions, contact [email protected]. ♦ © 2020 Copyright Physicians Postgraduate Press, Inc. J Clin Psychiatry 81:3, May/June 2020 e1 Schoretsanitis et al ConsensusIt is illegal Process: A preliminary to post draft was prepared this and copyrighted PDF on any website. circulated to the writing group members. Consensus was achieved Clinical Points in all cases, and resulting recommendations focused on following There is an urgent need for improvement of treatment areas: steady-state and sampling time, levels of recommendations, ■ response and safety for antipsychotic treatment. indications, therapeutic reference ranges and laboratory alert levels, practical issues, and interpretation, as well as limitations. ■ Measuring blood levels of antipsychotics, also known as therapeutic drug monitoring (TDM), in several patient Conclusions: The utilization of TDM as a tool for problem solving subgroups and under appropriate indications can in antipsychotic treatment offers a unique method to improve efficiently guide clinicians in clinical routine. safety and efficacy. This consensus statement summarizes essential information on the routine use of TDM for antipsychotics and ■ This work provides a framework for the implementation of encourages clinicians to perform TDM with the appropriate TDM as part of antipsychotic treatment. indications as part of the clinical decision-making process. J Clin Psychiatry 2020;81(3):19cs13169 To cite: Schoretsanitis G, Kane JM, Correll CU, et al. Blood levels to optimize antipsychotic treatment in clinical practice: a joint consensus easurement of drug levels in blood provides statement of the American Society of Clinical Psychopharmacology and valuable insight in several areas of medicine the Therapeutic Drug Monitoring Task Force of the Arbeitsgemeinschaft M für Neuropsychopharmakologie und Pharmakopsychiatrie. J Clin Psychiatry. including oncology, immunology, infectious diseases, 2020;81(3):19cs13169. clinical toxicology, pediatrics, and psychiatry. Specifically, To share: https://doi.org/10.4088/JCP.19cs13169 in psychopharmacotherapy there is an established role for © Copyright 2020 Physicians Postgraduate Press, Inc. therapeutic drug monitoring (TDM) for antidepressants aDepartment of Psychiatry, The Zucker Hillside Hospital, Northwell Health, and mood stabilizers, such as lithium, valproate, and Glen Oaks, and Center for Psychiatric Neuroscience, Feinstein Institute for 1,2 Medical Research, Manhasset, New York carbamazepine. Additionally, the quantification of bDepartment of Psychiatry and Molecular Medicine, Donald and Barbara antipsychotic levels in blood allows tailoring the dosage Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York of drugs based on patients’ individual pharmacokinetic cCharité Universitätsmedizin, Department of Child and Adolescent patterns.3,4 Implementation of precision medicine tools Psychiatry, Berlin, Germany dPsychiatry and Biobehavioral Sciences, University of California Los like TDM in the pharmacologic treatment of patients with Angeles, David Geffen School of Medicine, Los Angeles, California severe mental disorders may help overcome suboptimal eDepartment of Psychiatry and Behavioral Sciences, New York Medical efficacy and/or tolerability related to antipsychotic College, Valhalla, New York treatment.5 TDM may be particularly valuable in the fThriving Mind South Florida Behavioral Health Network, Miami, Florida; and Department of Psychiatry, Washington University School of Medicine, management of specific subgroups, such as children and St Louis, Missouri adolescents, pregnant women, and the elderly, as well gDepartment of Psychiatry, NYU Langone Medical Center, New York, and as patients with intellectual disabilities, patients with Nathan Kline Institute, Orangeburg, New York substance use disorders, and forensic patients.6 Regardless hDepartment of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland of patient profiles, specific