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Moschny N, Hefner G, Grohmann R, et al. Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel). 2021;14(6)doi: 10.3390/ph14060514.
Moschny, N., Hefner, G., Grohmann, R., Eckermann, G., Maier, H. B., Seifert, J., Heck, J., Francis, F., Bleich, S., Toto, S., & Meissner, C. (2021). Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel, Switzerland), 14(6), . https://doi.org/10.3390/ph14060514
Moschny, Nicole, et al. "Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics." Pharmaceuticals (Basel, Switzerland) vol. 14,6 (2021). doi: https://doi.org/10.3390/ph14060514
Moschny N, Hefner G, Grohmann R, Eckermann G, Maier HB, Seifert J, Heck J, Francis F, Bleich S, Toto S, Meissner C. Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel). 2021 May 27;14(6). doi: 10.3390/ph14060514. PMID: 34071813; PMCID: PMC8230242.
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Pharmaceuticals (Basel). 2021 May 27;14(6). doi: 10.3390/ph14060514.

Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics.

Pharmaceuticals (Basel, Switzerland)

Nicole Moschny, Gudrun Hefner, Renate Grohmann, Gabriel Eckermann, Hannah B Maier, Johanna Seifert, Johannes Heck, Flverly Francis, Stefan Bleich, Sermin Toto, Catharina Meissner

Affiliations

  1. Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
  2. Department of Psychiatry and Psychotherapy, Vitos Clinic for Forensic Psychiatry, Kloster-Eberbach-Str. 4, 65346 Eltville, Germany.
  3. Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaum-Str. 7, 80336 Munich, Germany.
  4. Department of Forensic Psychiatry and Psychotherapy, Hospital Kaufbeuren, Kemnater-Str. 16, 87600 Kaufbeuren, Germany.
  5. Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.

PMID: 34071813 PMCID: PMC8230242 DOI: 10.3390/ph14060514

Abstract

Both inflammation and smoking can influence a drug's pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients' drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior-both clinically relevant in psychiatry-that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.

Keywords: AGNP consensus guidelines; CYP enzyme induction/de-induction; clozapine; inflammation; intoxication; pharmacokinetics; reference ranges; second- and third-generation antipsychotic drugs; smoking behavior; therapeutic drug monitoring

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