Egberts Karin, Fekete Stefanie, Häge Alexander, Hiemke Christoph, Scherf-Clavel Maike, Taurines Regina, Unterecker Stefan, Gerlach Manfred, Romanos Marcel
Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Zentrum für Psychische Gesundheit, Universitätsklinikum Würzburg.
Arbeitsgruppe "Therapeutisches Drug-Monitoring" der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) e. V.
Z Kinder Jugendpsychiatr Psychother. 2021 Mar;50(2):133-152. doi: 10.1024/1422-4917/a000845.
Therapeutic drug monitoring to optimize psychopharmacotherapy in children and adolescents - Update and guidelines for practice Despite the improved evidence base, many uncertainties remain in child and adolescent psychiatric pharmacotherapy about the efficacy and tolerability of drugs, which are often prescribed off-label or in combination therapy in this age group. Because medium- to long-term use is unavoidable in many cases, clinicians should minimize adverse drug reactions as far as possible and tailor an effective dosage to the individual characteristics of the patient. Not only are children and adolescents particularly vulnerable to certain adverse drug effects, they are also exposed to iatrogenic risks from dosing or application errors, which can lead to under- or overdosing with correspondingly negative effects on the success of the therapy. In addition to determining a strict indication, it is therefore essential to establish precise dosage and systematic monitoring of the safety of the psychopharmacotherapy. This article introduces therapeutic drug monitoring as a useful clinical tool and describes how its correct application in practice can improve the efficacy as well as the safety and tolerability of psychotropic therapy in children and adolescents for the immediate benefit of patients. Psychopharmacotherapy, adverse drug reactions, pharmacovigilance, therapeutic drug monitoring, quality assurance.
优化儿童和青少年心理药物治疗的治疗药物监测——实践更新与指南 尽管有了更多的循证依据，但在儿童和青少年精神科药物治疗中，关于药物的疗效和耐受性仍存在许多不确定性，在这个年龄组中，药物常常是超说明书用药或联合用药。由于在许多情况下中长期用药不可避免，临床医生应尽可能减少药物不良反应，并根据患者的个体特征调整有效的剂量。儿童和青少年不仅特别容易受到某些药物不良反应的影响，还会面临因给药或用药错误导致的医源性风险，这可能会导致用药不足或过量，从而对治疗效果产生相应的负面影响。因此，除了确定严格的适应症外，还必须确定精确的剂量并对心理药物治疗的安全性进行系统监测。本文介绍了治疗药物监测这一有用的临床工具，并描述了其在实践中的正确应用如何能够提高儿童和青少年精神药物治疗的疗效以及安全性和耐受性，从而使患者直接受益。 心理药物治疗、药物不良反应、药物警戒、治疗药物监测、质量保证。
