Sandra UnholzerOptimierung der Psychopharmakotherapie bipolarer Patienten durch Therapeutisches Drug Monitoring (TDM)

Rezension

[...] Zusammenfassend ist zu sagen, dass allen, die sich mit dem Thema TDM von Psychopharmaka beschäftigen oder sogar selbst im Labor damit arbeiten, die Lektüre dieses Büchleins zu empfehlen ist. Wer über den kleinen Makel hinwegsieht, dass Lithium und Valproinsäure offensichtlich nicht "optimiert" werden, der findet praktisch alles, was er zum Aufbau eines TDM-Programms in seiner Klinik oder Apotheke an Vorkenntnissen benötigt, vorbildlich aufgearbeitet.

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Therapeutic drug monitoring (TDM) can be used to individualize the psychopharmacotherapy: the patient is optimally adjusted to the medication, under- and overdosing are avoided. In order to provide suitable tools for TDM in bipolar disorders, this work deals with the following aspects:

• Pharmacoepidemiological evaluation for the development of the prescription behavior for bipolar disorders over a period of 10 years (inpatient setting): During the evaluation period, the lithium prescriptions were declining, the frequency of the quetiapine prescriptions increased significantly.
• UHPLC method development including sample preparation (SPE) for the measurement of psychiatric drugs which are often used in bipolar disorders from patients’ serum, with subsequent evaluation of the determined drug concentrations. The method can be used to determine mirtazapine, lamotrigine, venlafaxine, desmethylvenlafaxine, quetiapine, carbamazepine, aripiprazole and dehydroaripiprazole. The serum concentrations determined during the measurement were in each case classified into the dose-related (DRR) and therapeutic reference range (TRR). Deviations from the expected values were analysed for possible reasons, particular attention was paid to the recognition of drug interactions.
• Verifying the validity of the therapeutic reference range of lamotrigine for the treatment of bipolar disorders. → Determination of a new therapeutic reference range for prophylaxis of depressive episodes in bipolar disorders: Retrospective database evaluation (KOBEST®) and measurement of patient samples using the newly developed UHPLC method.

Conclusion: For phase prophylaxis, lower serum concentrations are already effective than those used for epilepsy treatment. Therapeutic drug monitoring in bipolar patients is useful: By monitoring the serum concentration, the patient can be adjusted to the optimal serum concentration. Adverse drug reactions can be avoided. A safe drug therapy with a compliant patient is possible.

Ihr Werk im Verlag Dr. Kovač

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