Abstract
The primary aims of pharmacovigilance are supervision and prevention of medication-related problems under everyday conditions. Pharmacovigilance is an indication for monitoring plasma concentrations, i.e. conducting therapeutic drug monitoring (TDM). Using TDM, it can be clarified if observed unwanted drug effects may be attributed to abnormally high or low drug concentrations. Utmost benefits from TDM are obtained for pharmacovigilance when the method is adequately integrated into the clinical treatment process. How to do this is described in consensus guidelines for TDM in psychiatry. During the last 20 years, TDM was very successful for detection of multiple pharmacokinetic drug-drug interactions. Many of them were discovered in individual cases. This gave rise to systematic prospective studies to verify or falsify such observations. Confirmatory studies, however, are critical when drug combinations are potentially harmful. Then TDM databases should be used for retrospective analysis. They enable to study retrospectively the safety and tolerability of psychotropic drugs and drug combinations taken in a broad spectrum of patients, including risk patients like children or adolescent patients, old-aged patients or patients with comorbid diseases. For such studies, however, TDM databases must contain not only laboratory but also clinical data. This is actually quite rare. Work in this regard is necessary. When functioning TDM software is available and TDM is widely used in psychiatry, data can be pooled to emerge large databases for data mining. TDM has thus the potential to be and become a valuable part of pharmacovigilance.
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References
Åsberg M, Crönholm B, Sjöqvist F, Tuck D (1971) Relationship between plasma level and therapeutic effect of nortriptyline. Br Med J 3(5770):331–334
Bates DW (1998) Improving the use of therapeutic drug monitoring. Ther Drug Monit 20:550–555
Baumann P, Hiemke C, Ulrich S, Eckermann G, Gaertner I, Gerlach M, Kuss HJ, Laux G, Müller-Oerlinghausen B, Rao ML, Riederer P, Zernig G (2004) Arbeitsge-meinschaft fur neuropsychopharmakologie und pharmakopsychiatrie. The AGNP-TDM expert group consensus guidelines: therapeutic drug monitoring in psychiatry. Pharmacopsychiatry 37(6):243–265
Bertschy G, Baumann P, Eap CB, Baettig D (1994) Probable metabolic interaction between methadone and fluvoxamine in addict patients. Ther Drug Monit 16(1):42–45
Bertschy G, Eap CB, Powell K, Baumann P (1996) Fluoxetine addition to methadone in addicts: pharmacokinetic aspects. Ther Drug Monit 18(5):570–572
Botts S, Diaz FJ, Santoro V, Spina E, Muscatello MR, Cogollo M, Castro FE, de Leon J (2008) Estimating the effects of co-medications on plasma olanzapine concentrations by using a mixed model. Prog Neuropsychopharmacol Biol Psychiatry 32(6):1453–1458
Castberg I, Spigset O (2008) Prescribing patterns and the use of therapeutic drug monitoring of psychotropic medication in a psychiatric high-security unit. Ther Drug Monit 30(5):597–603
Castberg I, Helle J, Aamo TO (2005) Prolonged pharmacokinetic drug interaction between terbinafine and amitriptyline. Ther Drug Monit 27(5):680–682
Chermá MD, Ahlner J, Bengtsson F, Gustafsson PA (2011) Antidepressant drugs in children and adolescents: analytical and demographic data in a naturalistic, clinical study. J Clin Psychopharmacol 31(1):98–102
Conus P, Bondolfi G, Eap CB, Macciardi F, Baumann P (1996) Pharmacokinetic fluvoxamine-clomipramine interaction with favorable therapeutic consequences in therapy-resistant depressive patient. Pharmacopsychiatry 29(3):108–110
Diaz FJ, Eap CB, Ansermot N, Crettol S, Spina E, de Leon J (2014) Can valproic acid be an inducer of clozapine metabolism? Pharmacopsychiatry 47(3):89–96
Eap CB, Bertel-Laubscher R, Zullino D, Amey M, Baumann P (2000) Marked increase of venlafaxine enantiomer concentrations as a consequence of metabolic interactions: a case report. Pharmacopsychiatry 33(3):112–115
Egberts KM, Mehler-Wex C, Gerlach M (2011) Therapeutic drug monitoring in child and adolescent psychiatry. Pharmacopsychiatry 44(6):249–253
Egberts K, Karwautz A, Plener PL, Mehler-Wex C, Kölch M, Dang SY, Taurines R, Romanos M, Gerlach M (2015) Pharmacovigilance in child and adolescent psychiatry. Z Kinder Jugendpsychiatr Psychother 43(1):21–28
EMA (2014) Guideline on good pharmacovigilance practices http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2013/05/WC500143294.pdf
Fry DE, Marks V (1971) Value of plasma-lithium monitoring. Lancet 1(7705):886–888
Geber C, Ostad Haji E, Schlicht K, Hiemke C, Tadić A (2013) Severe tremor after cotrimoxazole-induced elevation of venlafaxine serum concentrations in a patient with major depressive disorder. Ther Drug Monit 35(3):279–282
Gerbaulet M, Engel A, Hiemke C, Dahmen N (2012) High venlafaxine serum levels after prior fluoxetine medication. J Clin Psychopharmacol 32(2):295–297
Gjestad C, Westin AA, Skogvoll E, Spigset O (2015) Effect of proton pump inhibitors on the serum concentrations of the selective serotonin reuptake inhibitorscitalopram, escitalopram, and sertraline. Ther Drug Monit 37(1):90–97
Grözinger M, Härtter S, Hiemke C, Röschke J (1999) Oxybutynin enhances themetabolism of clomipramine and dextrorphan possibly by induction of a cytochrome P450 isoenzyme. J Clin Psychopharmacol 19(3):287–289
Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T (2015) The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010. BMC Med 13(1):74 [Epub ahead of print]
Guy W (1976) Early clinical drug evaluation unit (ECDEU) assessment manual for psychopharmacology. Revised. NIMH publication (DHEW publ No ADM 76-338). National Institute of Mental Health, Bethesda, p 217–222
Haen E (2011) Therapeutic drug monitoring in pharmacovigilance and pharmacotherapy safety. Pharmacopsychiatry 44(6):254–258
Haen E, Greiner C, Bader W, Wittmann M (2008) Expanding therapeutic reference ranges using dose-related reference ranges. Nervenarzt 79(5):558–566
Härtter S, Dingemanse J, Baier D, Ziegler G, Hiemke C (1998) Inhibition of dextromethorphan metabolism by moclobemide. Psychopharmacology (Berl) 135(1):22–26
Hefner G, Laib AK, Sigurdsson H, Hohner M, Hiemke C (2013) The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy. Int Rev Psychiatry 25(5):494–508
Hefner G, Geschke K, Hiemke C (2014) Severe adverse drug events under combination of nortriptyline and melperone due to pharmacokinetic interaction. J Clin Psychopharmacol 34(3):394–396
Hiemke C, Weigmann H, Härtter S, Dahmen N, Wetzel H, Müller H (1994) Elevated levels of clozapine in serum after addition of fluvoxamine. J Clin Psychopharmacol 14(4):279–281
Hiemke C, Peled A, Jabarin M, Hadjez J, Weigmann H, Härtter S, Modai I, Ritsner M, Silver H (2002) Fluvoxamine augmentation of olanzapine in chronic schizophrenia: pharmacokinetic interactions and clinical effects. J Clin Psychopharmacol 22(5):502–506
Hiemke C, Dragicevic A, Gründer G, Hätter S, Sachse J, Vernaleken I, Müller MJ (2004) Therapeutic monitoring of new antipsychotic drugs. Ther Drug Monit 26(2):156–160
Hiemke C, Baumann P, Bergemann N, Conca A, Dietmaier O, Egberts K, Fric M, Gerlach M, Greiner C, Gründer G, Haen E, Havemann-Reinecke U, Jaquenoud Sirot E, Kirchherr H, Laux G, Lutz UC, Messer T, Müller MJ, Pfuhlmann B, Rambeck B, Riederer P, Schoppek B, Stingl J, Uhr M, Ulrich S, Waschgler R, Zernig G (2011) AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: update 2011. Pharmacopsychiatry 44(6):195–235
Jaquenoud Sirot E, van der Velden JW, Rentsch K, Eap CB, Baumann P (2006) Therapeutic drug monitoring and pharmacogenetic tests as tools in pharmacovigilance. Drug Saf 29(9):735–768
Jerling M, Bertilsson L, Sjöqvist F (1994a) The use of therapeutic drug monitoring data to document kinetic drug interactions: an example with amitriptyline and nortriptyline. Ther Drug Monit 16(1):1–12
Jerling M, Lindström L, Bondesson U, Bertilsson L (1994b) Fluvoxamine inhibition and carbamazepine induction of the metabolism of clozapine: evidence from a therapeutic drug monitoring service. Ther Drug Monit 16(4):368–374
Lange-Asschenfeldt C, Weigmann H, Hiemke C, Mann K (2002) Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology. J Clin Psychopharmacol 22(4):440–441
Lingjærde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K (1987) The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 334:1–100
Marzolini C, Troillet N, Telenti A, Baumann P, Decosterd LA, Eap CB (2000) Efavirenz decreases methadone blood concentrations. AIDS 14(9):1291–1292
Ostad Haji E, Hiemke C, Pfuhlmann B (2012) Therapeutic drug monitoring for antidepressant drug treatment. Curr Pharm Des 18(36):5818–5827
Pfuhlmann B, Hiemke C, Unterecker S, Burger R, Schmidtke A, Riederer P, Deckert J, Jabs B (2009) Toxic clozapine serum levels during inflammatory reactions. J Clin Psychopharmacol 29(4):392–394
Preskorn SH, Fast GA (1991) Therapeutic drug monitoring for antidepressants: efficacy, safety, and cost effectiveness. J Clin Psychiatry 52(Suppl):23–33
Preskorn SH, Fast GA (1992) Tricyclic antidepressant-induced seizures and plasma drug concentration. J Clin Psychiatry 53(5):160–162
Seifritz E, Holsboer-Trachsler E, Hemmeter U, Eap CB, Baumann P (1994) Increased trimipramine plasma levels during fluvoxamine comedication. Eur Neuropsychopharmacol 4(1):15–20
Sigurdsson HP, Hefner G, Ben-Omar N, Köstlbacher A, Wenzel-Seifert K, Hiemke C, Haen E (2014) Steady-state serum concentrations of venlafaxine in patients with late-life depression. Impact of age, sex and BMI. J Neural Transm [Epub ahead of print] PubMed
Simpson GM, Cooper TA (1978) Clozapine plasma levels and convulsions. Am J Psychiatry 135(1):99–100
Sjöqvist F, Bertilsson L, Asberg M (1980) Monitoring tricyclic antidepressants. Ther Drug Monit 2(1):85–93
Spina E, de Leon J (2015) Clinical applications of CYP genotyping in psychiatry. J Neural Transm 122(1):5–28
Spina E, Campo GM, Avenoso A, Pollicino MA, Caputi AP (1992) Interaction between fluvoxamine and imipramine/desipramine in four patients. Ther Drug Monit 14(3):194–196
Spina E, Avenoso A, Pollicino AM, Caputi AP, Fazio A, Pisani F (1993a) Carbamazepine coadministration with fluoxetine or fluvoxamine. Ther Drug Monit 15(3):247–250
Spina E, Pollicino AM, Avenoso A, Campo GM, Perucca E, Caputi AP (1993b) Effect of fluvoxamine on the pharmacokinetics of imipramine and desipramine in healthy subjects. Ther Drug Monit 15(3):243–246
Spina E, Avenoso A, Campo GM, Caputi AP, Perucca E (1996) Phenobarbital induces the 2-hydroxylation of desipramine. Ther Drug Monit 18(1):60–64
Spina E, Arena D, Scordo MG, Fazio A, Pisani F, Perucca E (1997) Elevation of plasma carbamazepine concentrations by ketoconazole in patients with epilepsy. Ther Drug Monit 19(5):535–538
Spina E, Avenoso A, Facciolà G, Fabrazzo M, Monteleone P, Maj M, Perucca E, Caputi AP (1998) Effect of fluoxetine on the plasma concentrations of clozapine and its major metabolites in patients with schizophrenia. Int Clin Psychopharmacol 13(3):141–145
Spina E, Avenoso A, Facciolà G, Salemi M, Scordo MG, Giacobello T, Madia AG, Perucca E (2000a) Plasma concentrations of risperidone and 9-hydroxyrisperidone: effect of comedication with carbamazepine or valproate. Ther Drug Monit 22(4):481–485
Spina E, Avenoso A, Salemi M, Facciolá G, Scordo MG, Ancione M, Madia A (2000b) Plasma concentrations of clozapine and its major metabolites during combined treatment with paroxetine or sertraline. Pharmacopsychiatry 33(6):213–217
Spina E, Avenoso A, Facciolà G, Scordo MG, Ancione M, Madia A (2001a) Plasmaconcentrations of risperidone and 9-hydroxyrisperidone during combined treatment with paroxetine. Ther Drug Monit 23(3):223–227
Spina E, Avenoso A, Scordo MG, Ancione M, Madia A, Levita A (2001b) No effect ofreboxetine on plasma concentrations of clozapine, risperidone, and their activemetabolites. Ther Drug Monit 23(6):675–678
Spina E, Avenoso A, Scordo MG, Ancione M, Madia A, Gatti G, Perucca E (2002) Inhibition of risperidone metabolism by fluoxetine in patients with schizophrenia: a clinically relevant pharmacokinetic drug interaction. J Clin Psychopharmacol 22(4):419–423
Spina E, D’Arrigo C, Migliardi G, Morgante L, Zoccali R, Ancione M, Madia A (2004) Plasma risperidone concentrations during combined treatment with sertraline. Ther Drug Monit 26(4):386–390
Spina E, D’Arrigo C, Migliardi G, Santoro V, Muscatello MR, Micò U, D’Amico G, Perucca E (2006) Effect of adjunctive lamotrigine treatment on the plasma concentrations of clozapine, risperidone and olanzapine in patients with schizophrenia or bipolar disorder. Ther Drug Monit 28(5):599–602
Spina E, D’Arrigo C, Santoro V, Muscatello MR, Pandolfo G, Zoccali R, Diaz FJ, de Leon J (2009) Effect of valproate on olanzapine plasma concentrations in patients with bipolar or schizoaffective disorder. Ther Drug Monit 31(6):758–763
Szegedi A, Wiesner J, Hiemke C (1995) Improved efficacy and fewer side effects under clozapine treatment after addition of fluvoxamine. J Clin Psychopharmacol 15(2):141–143
Szegedi A, Wetzel H, Leal M, Härtter S, Hiemke C (1996) Combination treatment with clomipramine and fluvoxamine: drug monitoring, safety, and tolerability data. J Clin Psychiatry 57(6):257–264
Taurines R, Burger R, Wewetzer C, Pfuhlmann B, Mehler-Wex C, Gerlach M, Egberts K (2013) The relation between dosage, serum concentrations, and clinical outcome in children and adolescents treated with sertraline: a naturalistic study. Ther Drug Monit 35(1):84–91
Touw DJ, Neef C, Thomson AH, Vinks AA (2005) Cost-effectiveness of Therapeutic Drug Monitoring Committee of the International Association for Therapeutic Drug Monitoring and Clinical Toxicology. Cost-effectiveness of therapeutic drug monitoring: a systematic review. Ther Drug Monit 27(1):10–17
Unterecker S, Hiemke C, Greiner C, Haen E, Jabs B, Deckert J, Pfuhlmann B (2012) The effect of age, sex, smoking and co-medication on serum levels of venlafaxine and O-desmethylvenlafaxine under naturalistic conditions. Pharmacopsychiatry 45(6):229–235
Vandel S, Bertschy G, Baumann P, Bouquet S, Bonin B, Francois T, Sechter D, Bizouard P (1995) Fluvoxamine and fluoxetine: interaction studies with amitriptyline, clomipramine and neuroleptics in phenotyped patients. Pharmacol Res 31(6):347–353
Vuille F, Amey M, Baumann P (1991) Use of plasma level monitoring in clinical practice. Towards an analysis of clinical utility. Pharmacopsychiatry 24:190–195
Wenzel-Seifert K, Brandl R, Hiemke C, Haen E (2014) Influence of concomitant medications on the total clearance and the risk for supra-therapeutic plasma concentrations of Citalopram. A population-based cohort study. Pharmacopsychiatry 47(7):239–244
Wetzel H, Anghelescu I, Szegedi A, Wiesner J, Weigmann H, Härter S, Hiemke C (1998) Pharmacokinetic interactions of clozapine with selective serotonin reuptake inhibitors: differential effects of fluvoxamine and paroxetine in a prospective study. J Clin Psychopharmacol 18(1):2–9
World Health Organization (WHO) (2002) The importance of pharmacovigilance: safety monitoring of medicinal products. WHO, Genève
Zanger UM, Schwab M (2013) Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation. Pharmacol Ther 138(1):103–141
Zanger UM, Klein K, Thomas M, Rieger JK, Tremmel R, Kandel BA, Klein M, Magdy T (2014) Genetics, epigenetics, and regulation of drug-metabolizing cytochrome p450 enzymes. Clin Pharmacol Ther 95(3):258–261
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Hiemke, C., Haen, E. (2016). Monitoring of Plasma Concentrations of Psychotropic Drugs in Pharmacovigilance. In: Spina, E., Trifirò, G. (eds) Pharmacovigilance in Psychiatry. Adis, Cham. https://doi.org/10.1007/978-3-319-24741-0_6
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