Therapeutic Drug Monitoring of Antidepressants

TCAs, including amitriptyline, doxepin, nortriptyline, imipramine, desipramine, protriptyline, trimipramine, and clomipramine were introduced in the 1950s and the 1960s. These drugs have a narrow therapeutic window, and therapeutic drug monitoring is essential for efficacy of these drugs as well as to avoid drug toxicity. Issues in therapeutic drug monitoring of these drugs are discussed in Chapter 8. The efficacy of lithium in acute mania and for prophylaxis against recurrent episode of mania has been well established. Blood concentrations of lithium have been shown to parallel with total body water and brain concentration of lithium. Therapeutic drug monitoring of lithium is essential for efficacy as well as to avoid lithium toxicity. A guiding principle in the use of lithium salts in the treatment of mental illness is to maintain a serum

Table 7

Therapeutic Drug Monitoring of Antiasthmatic Drugs

Table 7

Therapeutic Drug Monitoring of Antiasthmatic Drugs

Drug

Specimen Requirement

Therapeutic

Costa

Rangeb Trough(^g/mL)

Theophylline

Serum or plasma

10-20

$

Caffeine

Serum or plasma

5-15

$$

$, < $75; $$, < $100; $$$, > $100; $$$$; > $150. a The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges based on ranges used in our hospital laboratory as well as published ranges in textbooks and test catalogues of reference laboratories. Reference ranges may vary significantly depending on patient population, disease states, and others.

$, < $75; $$, < $100; $$$, > $100; $$$$; > $150. a The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges based on ranges used in our hospital laboratory as well as published ranges in textbooks and test catalogues of reference laboratories. Reference ranges may vary significantly depending on patient population, disease states, and others.

Table 8

Therapeutic Drug Monitoring of Antidepressants

Table 8

Therapeutic Drug Monitoring of Antidepressants

Drug

Specimen Requirement

Therapeutic Rangeb Trough

Costa

Amitriptyline and

Serum or plasma

120-250ng/mL

$$$

nortriptyline

(amitriptyline +

nortriptyline)

50-150 ng/mL (nortriptyline

alone)

Clomipramine

Serum

150-450 ng/mL

$$$

Doxepin and

Serum or plasma

150-250 ng/mL (doxepin

$$$

nordoxepin

and nordoxepin)

Imipramine and

Serum or plasma

150-250 ng/mL (imipramine

$$$

desipramine

and desipramine)

Fluoxetine and

Serum

300-1000 ng/mL (fluoxetine

$$$

norfluoxetine

and norfluoxetine)

Paroxetine

Serum

20-200 ng/mL

$$$$

Sertraline

Serum or plasma

30-200 ng/mL

$$$

Lithium

Serum

0.8-1.2 mEq/L

$

Haloperidol

Serum

2-15 ng/mL

$$$$

$, < $75; $$, < $100; $$$, > $100; $$$$, > $150.

a The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges based on ranges used in our hospital laboratory as well as published ranges in textbooks and test catalogues of reference laboratories. Reference ranges may vary significantly depending on patient population, disease states, and others.

$, < $75; $$, < $100; $$$, > $100; $$$$, > $150.

a The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges based on ranges used in our hospital laboratory as well as published ranges in textbooks and test catalogues of reference laboratories. Reference ranges may vary significantly depending on patient population, disease states, and others.

lithium concentration between 0.8 and 1.2mmol/L (134). Lithium therapy has various neurological, cardiovascular, and renal side effects. Serum lithium concentration of 3.5mmol/L or higher is considered potentially lethal and hemodialysis therapy is recommended (135). More recently introduced antidepressants are selective serotonin reuptake inhibitors (SSRIs), including citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. This class of drugs has a flat dose-response curve, thus a wide therapeutic index. Currently, most investigators agree that therapeutic drug monitoring of these drugs in the majority of patients is not essential (136). The reference ranges and costs of monitoring antidepressants are listed in table 8.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

Get My Free Ebook


Post a comment