Gerlach Manfred, Rothenhöfer Silke, Mehler-Wex Claudia, Fegert Joerg M, Schulz Eberhard, Wewetzer Christoph, Warnke Andreas
Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie der Universität Würzburg.
Z Kinder Jugendpsychiatr Psychother. 2006 Jan;34(1):5-13. doi: 10.1024/1422-4917.34.1.5.
The therapy of children and adolescents with psychotropic drugs differs from that of adults. Due to the differences in the pharmacokinetic behaviour of the drugs used that are dependent on a child's, respectively an adolescent's stage of development, the same dosages as recommended for adults cannot be used. Moreover, many of the drugs used have not been approved for use in children and adolescents. Thus the criteria which guarantee their efficacy and safety for use in adults do not apply for their use in children and adolescents. Therefore therapeutic drug monitoring (TDM) is a general indication for the administration of psychotropic drugs in children and adolescents. TDM enables the clinician to adjust the dosage of a drug according to the characteristics of the individual patient. It is also a valid tool to increase the safety of therapy and optimise therapy with psychotropic drugs. However, standardized studies are also needed to find therapeutic ranges of plasma concentrations for children and adolescents. Such studies will deliver new insights into the pharmacokinetic and pharmacodynamic behaviour of drugs used in child and adolescent psychiatry. The present contribution begins with a brief description of the strategy of TDM in psychiatry, followed by a discussion of the characteristics of pharmacotherapy in child and adolescent psychiatry and the reasons for the general indication of TDM in children and adolescents. Finally, recommendations are given for the routine performance of TDM. For a detailed treatment of TDM in psychiatry, the interested reader is referred to the AG-NP-TDM Expert Group Consensus Guidelines published earlier (Baumann et al., 2004).
儿童和青少年使用精神药物的治疗方法与成人不同。由于所使用药物的药代动力学行为因儿童或青少年的发育阶段而异，因此不能使用与成人推荐剂量相同的剂量。此外，许多所使用的药物尚未被批准用于儿童和青少年。因此，保证其在成人中使用的有效性和安全性的标准并不适用于其在儿童和青少年中的使用。因此，治疗药物监测（TDM）是儿童和青少年使用精神药物的一般指征。TDM使临床医生能够根据个体患者的特征调整药物剂量。它也是提高精神药物治疗安全性和优化治疗的有效工具。然而，还需要进行标准化研究以确定儿童和青少年的血浆浓度治疗范围。此类研究将为儿童和青少年精神病学中使用的药物的药代动力学和药效学行为提供新的见解。本文首先简要描述了精神病学中TDM的策略，随后讨论了儿童和青少年精神病学中药物治疗的特点以及儿童和青少年TDM一般指征的原因。最后，给出了TDM常规操作的建议。对于精神病学中TDM的详细论述，感兴趣的读者可参考早期发表的AG-NP-TDM专家组共识指南（鲍曼等人，2004年）。
