Blood Levels to Optimize Antipsychotic Treatment in Clinical Practice; a Joint Consensus Statement of the American Society of Clinical Psychopharmacology (ASCP) and the Therapeutic Drug Monitoring (TDM) Task Force of the Arbeitsgemeinschaft Für Neuropsychopharmakologie Und Pharmakopsychiatrie (AGNP)

Abstract

Objective The quantification of antipsychotic levels in blood, also known as therapeutic drug monitoring (TDM), is a potentially useful tool of modern personalized therapy that can be applied to augment antipsychotic use and dosing decisions. The application of TDM for antipsychotics can be helpful in numerous challenging clinical scenarios, such as lack of therapeutic response, relapse, or adverse drug reactions (ADRs) related to antipsychotic treatment. The benefits of TDM may be particularly evident in the treatment of highly vulnerable patient subgroups, such as children, adolescents, pregnant women and the elderly. The main aim of this article is to aide clinicians who routinely prescribe antipsychotics to successfully apply TDM in routine clinical practice in order to help optimize the efficacy and safety of those antipsychotics.

Participants Clinicians and researchers, members of the American Society of Clinical Psychopharmacology (ASCP) and the Therapeutic Drug Monitoring (TDM) Task Force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP).

Evidence We critically reviewed TDM literature on antipsychotics to provide a condensed clinical decision-making algorithm with therapeutic reference ranges for antipsychotic blood levels, within which patients are most likely to respond and tolerate treatment, although TDM is not equally recommended/supported for all antipsychotics.

Consensus process A preliminary draft was prepared and circulated to the writing group members. Consensus was achieved in all cases and resulting recommendations focused on following areas: steady-state and sampling time, levels of recommendations, indications, therapeutic reference ranges and laboratory alert levels, practical issues and interpretation, as well as limitations

Conclusions The integration of TDM in the antipsychotic treatment as a tool for problem solving presents a unique method to improve safety and efficacy outcomes. This consensus statement summarizes essential information on the routine use of TDM for antipsychotics and encourages clinicians to perform TDM under the appropriate indications as part of the clinical decision-making algorithm.