Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany.
Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany.
Pharmacopsychiatry. 2018 Jan;51(1-02):9-62. doi: 10.1055/s-0043-116492. Epub 2017 Sep 14.
Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood to optimize pharmacotherapy. It considers the interindividual variability of pharmacokinetics and thus enables personalized pharmacotherapy. In psychiatry and neurology, patient populations that may particularly benefit from TDM are children and adolescents, pregnant women, elderly patients, individuals with intellectual disabilities, patients with substance abuse disorders, forensic psychiatric patients or patients with known or suspected pharmacokinetic abnormalities. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. However, the potential benefits of TDM to optimize pharmacotherapy can only be obtained if the method is adequately integrated in the clinical treatment process. To supply treating physicians and laboratories with valid information on TDM, the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued their first guidelines for TDM in psychiatry in 2004. After an update in 2011, it was time for the next update. Following the new guidelines holds the potential to improve neuropsychopharmacotherapy, accelerate the recovery of many patients, and reduce health care costs.
治疗药物监测(therapeutic drug monitoring,TDM)是定量和解释血液中药物浓度以优化药物治疗的方法。它考虑了药代动力学的个体间变异性,从而实现了个体化的药物治疗。在精神病学和神经病学中,可能特别受益于 TDM 的患者人群包括儿童和青少年、孕妇、老年患者、智力障碍患者、药物滥用障碍患者、法医精神病患者或已知或疑似药代动力学异常的患者。治疗剂量无反应、药物依从性不确定、耐受性不佳或药物代谢药物相互作用是 TDM 的典型指征。然而,如果该方法充分整合到临床治疗过程中,治疗药物监测优化药物治疗的潜在益处才能得以实现。为了向治疗医生和实验室提供关于 TDM 的有效信息,德国神经精神药理学和精神药理学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的 TDM 工作组于 2004 年发布了他们在精神病学领域的 TDM 第一份指南。在 2011 年更新后,现在是进行下一次更新的时候了。遵循新指南有可能改善神经精神药理学治疗,加速许多患者的康复,并降低医疗保健成本。