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In general terms, tdm of psychotropics is not useful. The reasons for
doing it need to be carefully documented, the reference ranges identified
and validated and easy assay methods need to be found. I am not sure, with
the exception of nortryptiline and ami that these criteria are applicable
to psychotropics. Early work on Tricyclics, TC, was done by Braithwaite
(Braithwaite et al, lancet 1972, 1297) and asberg (asberg et al, BMJ, 1971,
3, 331). Stephen Curry did some work with CPZ ( Curry et al, 1972, clin
pharmacology ther, 13, 931), but subsequently tdm of these agents has not
proved worthwhile. Of the recent drugs, there is evidence that clozapine
is useful, but I woud steer clear of csf and free levels.
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You should be able to get some key references if you browse thru' recent
issues of Clinical Pharmacokinetics (last 2-3 years). You might also be
able to conduct a literature search on Medline, which is now available
free of cost to all in the US.
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On the question of TDM of psychotropic drugs, you can read the following
reviews:
EA Balant-Gorgia, LP Balant
Therapeutic drug monitoring - Relevance during the drug treatment of
psychiatric disorders.
CNS Drugs 1995, 4 (6) : 432-453.
Eilers R.
Therapeutic drug monitoring for the treatment of psychiatric disorders.
Clinical use and cost effectiveness.
Clin Pharmacokinet 1995, 29 (6) : 442-450.
---------------
Gilles Paintaud
Laboratoire de Pharmacologie et Toxicologie, Hopital Bretonneau, F-37044
Tours Cedex, France.
Tel. +33 (0) 247 47 60 08. Fax. +33 (0) 247 47 60 11
paintaud.aaa.med.univ-tours.fr
--------------
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Further to my recent message on the usefulness or otherwise for tricyclics
and antipsychotics on TDM, there is a book from Contemporary Issues in
Clinical Biochemistry- Ed Brian Widdop, Churchill Livingstone, 1985 which
will give you some information. Also TDM Vol 16 1994, page 1 will give you
information of tricylics.
Graham Mould
Guildford Clinical Pharmacology
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A very useful reference in regard to TDM of antipsychotics is "Clinical
Use of Neuroleptic Plasma Levels" published by the American Psychiatric
Association in 1993, ed: Marder SR, Davis JM, and Janicak PG. The APA
also published another similar on around the same time in regards to
treatment-resistant depression. Unfortunately I forget the name and
editor. It had a few chapters devoted to TDM of tricyclics. Very
Useful. You might contact the APA for more info. Hope this helps.
Peter L. Bonate, Ph.D.
Hoechst Marion Roussel
Clinical Pharmacokinetics
P.O. Box 9627 (F4-M3112)
Kansas City, MO 64134
fax: 816-966-6999
phone: 816-966-3723
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Hello.
We do TDM on different psychotropics, including nortriptyline, lithium,
zuclophentixole etc.
It is a very different area, primarily because there are no really good
therapeutic intervals and also no clearcut PD models to use - yet
Also, the population PK data are not that good, especially not for our
population.
It is an interesting area, though, because of the side effects, the prizes
(especially the new antipsychotics are extremely expensive) etc.
We are running a project in cooperaiton with the Dpt. of psychiatry in
order to evaluate our relatively newly opened PK SERVICE UNIT. here, we
analyze almost all antipsychotics used at the Dpt. (haloperidol,
perphenazine and zuclopenthixole) + nortriptyline, amitriptyline and
lithium.
We do Bayesian Forecasting on Li, Nor, and Zuclo, but only in the project.
There are a lot of practical problems involved, e.g. getting the necessary
information about the patient (dosage regimens, demographical data etc.),
and also data handling in a routine set-up is rather difficult. We are
working on it, though.
Please feel free to contact me for further discussions on this topic, which
we find very interesting - and no doubt with a future in it.
Thomas Senderovitz, MD.
Bispebjerg Hospital, University of Copenhagen
Clinical Pharmacology Unit
DK-2400 Copenhagen, Denmark
E-mail: senderovitz.aaa.dadlnet.dk
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Dear Thomas,
We also do a lot of monitoring of psychopharmacological drugs:
all tricyclics, all SSRI's, all antipsychotics (including all atypical
antipsychotics), Li, etc. I would like to join a discussion about
population PK parameters, PD, etc.
dr. D.J. Touw, PharmD, PhD.
University Hospital Vrije Universiteit
Amsterdam
Netherlands
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Dear D.J. Touw and others interested in this topic.
To DJ Touw: Could you mail me your e-mail adress?
I find this area very interesting.
First of all:
Are the therapeutic intervals of antipsychotics of any use?
Do any one have good population PK data?
The next do discuss is the PD of antipsychotics. What are the relevant PD
dta? Use of medicine against side effects?
I still find there's a lot to be done. And one of the problems is that
there are no really user-friendly programs in the Bayesian Froecasting
"area" yet - they are simply not applicable to daily routine use, at least
not in our setting. The USC Pack is a very good alternative, and I'm
looking forward to the Windows edition, but the problem is also the
population PK data for these drugs (if there are any).
I would very much like to hear opinions on this topic as well as references
to good data.
All the best,
Thomas Senderovitz, MD.
Clinical Pharmacology unit
Bispebjerg Hospital
University of Copenhagen
E-mail: senderovitz.-a-.dadlnet.dk
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