Clinical Psychopharmacology Unit, Department of Neuroscience and Mental Health, Clinical Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, Milan, 20122, Italy.
Department of Psychosis Studies, King's College London, London, UK.
Clin Pharmacokinet. 2018 Dec;57(12):1493-1528. doi: 10.1007/s40262-018-0664-3.
Therapeutic drug monitoring studies have generally concentrated on controlling compliance and avoiding side effects by maintaining long-term exposure to minimally effective blood concentrations. The rationale for using therapeutic drug monitoring in relation to second-generation antipsychotics is still being discussed at least with regard to the real clinical utility, but there is evidence that it can improve efficacy, especially when patients do not respond or develop side effects using therapeutic doses. Furthermore, drug plasma concentration determinations can be of some utility in medico-legal problems. This review concentrates on the clinical pharmacokinetic data related to clozapine, risperidone, paliperidone, olanzapine, quetiapine, amisulpride, ziprasidone, aripiprazole, sertindole, asenapine, iloperidone, lurasidone, brexpiprazole and cariprazine and briefly considers the main aspects of their pharmacodynamics. Optimal plasma concentration ranges are proposed for clozapine, risperidone, paliperidone and olanzapine because the studies of quetiapine, amisulpride, asenapine, iloperidone and lurasidone provide only limited information and there is no direct evidence concerning ziprasidone, aripiprazole, sertindole, brexpiprazole and cariprazine: the few reported investigations need to be confirmed and extended.
治疗药物监测研究通常集中于通过维持最小有效血药浓度的长期暴露来控制依从性和避免副作用。在第二代抗精神病药物中使用治疗药物监测的基本原理仍在讨论中，至少在实际临床应用方面仍存在争议，但有证据表明，它可以提高疗效，尤其是当患者在使用治疗剂量时无反应或出现副作用时。此外，药物血浆浓度测定在医学法律问题中也有一定的作用。本综述集中于与氯氮平、利培酮、帕利哌酮、奥氮平、喹硫平、氨磺必利、齐拉西酮、阿立哌唑、司来吉兰、阿塞那平、依匹哌唑、鲁拉西酮、布瑞哌唑和卡利培嗪相关的临床药代动力学数据，并简要考虑了它们药效学的主要方面。由于对喹硫平、氨磺必利、阿塞那平、依匹哌唑和鲁拉西酮的研究仅提供了有限的信息，而对于齐拉西酮、阿立哌唑、司来吉兰、布瑞哌唑和卡利培嗪没有直接证据，因此提出了氯氮平、利培酮、帕利哌酮和奥氮平的最佳血浆浓度范围：少数报道的研究需要进一步证实和扩展。
