An update on therapeutic drug monitoring and pharmacogenetic testing for the optimization of therapy with psychiatric medication

Abstract

Abstract Therapeutic drug monitoring of psychiatric medication as well as pharmacogenetic testing is performed more and more frequently in numerous laboratories. In this review, a summary of the literature in the years 2011 and 2012 has been completed. The guidelines of the German AGNP (Association for Neuropsychopharmacology and Pharmacopsychiatry) contain all the information needed for the interpretation of drug concentrations. The determination of serotonin in urine could be a marker for the assessment of the response of antidepressants, and correlations between the occupancy of the target receptors in the brain and drug concentration have been established using positron emission tomography. The influence of age on drug concentrations has been controversially described, and additionally females have always showed a slower metabolism and higher serum concentrations. Several liquid chromatography-mass spectrometry (LC-MS)/MS multi-analyte procedures for the quantification of psychiatric medication have been described. All methods showed good validation data, but there have always been some compounds with less good validation results due to the fact that not all compounds of a multi-analyte procedure can be analyzed optimally. Pharmacogenetic testing is not routinely performed prior to the prescription of psychiatric medication. This relies, among other things, on missing large randomized trials and the absence of standardized analytical methods, which allow the identification of the whole genetic variability.