1
|
Kuzin M, Haen E, Kuzo N, Endres K, Hiemke C, Paulzen M, Schoretsanitis G. Assessing Pharmacokinetic Correlates of Escitalopram-Related Adverse Drug Reactions. Ther Drug Monit 2024; 46:246-251. [PMID: 38377253 PMCID: PMC10930353 DOI: 10.1097/ftd.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/08/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND To assess the pharmacokinetic correlates of reported adverse drug reactions (ADRs) under antidepressant treatment with escitalopram (ESC) using a large therapeutic drug monitoring database. METHODS A large naturalistic sample of inpatients and outpatients prescribed ESC was analyzed. ADRs were classified using the Udvalg for Kliniske Undersogelser side effect rating scale. We compared ESC-treated patients with (n = 35) and without ADRs (n = 273) using ESC plasma concentrations as the primary outcome. We also compared ADR rates in the 2 groups based on 2 cut-off ESC levels reflecting the recommended upper thresholds of the therapeutic reference range of 80 ng/mL, suggested by the consensus therapeutic drug monitoring guidelines, and 40 ng/mL, based on recent meta-analysis data. The effects of age, sex, smoking, daily ESC dose, plasma concentrations, and concentrations corrected for daily dose were included in a binary logistic regression model to predict ADRs. RESULTS No differences in clinical, demographic, or pharmacokinetic parameters were observed between patients with and without ADRs ( P > 0.05). Patients with ESC-related ADRs were more frequently diagnosed with psychotic disorders than those without (25% vs. 7.1%, P = 0.004). None of the variables was associated with ADR risk. Overall, ADR rates were not significantly different in patients above versus below thresholds of ESC concentrations (ESC concentrations >40 [n = 59] vs. ≤40 ng/mL [n = 249] and >80 [n = 8] vs. ≤80 ng/mL [n = 300]; P = 0.56 and P = 1.0, respectively). CONCLUSIONS No distinct pharmacokinetic patterns underlying ESC-associated ADRs were observed. Further studies with more specific assessments of ADRs in larger cohorts are required to better identify potential underlying patterns.
Collapse
Affiliation(s)
- Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See/Zurich, Switzerland;
- Department of Basic and Clinical Sciences at the Medical School, University of Nicosia, Nicosia, Cyprus
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany;
- Clinical Pharmacology, Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany;
- Clinical Pharmacology, Institute AGATE gGmbH, Pentling, Germany;
| | - Nazar Kuzo
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland;
| | - Katharina Endres
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany;
- Clinical Pharmacology, Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany;
- Clinical Pharmacology, Institute AGATE gGmbH, Pentling, Germany;
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany;
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany;
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany;
- JARA—Translational Brain Medicine, Jülich, Germany;
- Alexianer Hospital Aachen, Aachen, Germany;
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland;
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; and
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
| |
Collapse
|
2
|
Kasperk N, Haen E, Hiemke C, Frodl T, Schoretsanitis G, Paulzen M, Kuzo N. Pharmacokinetic correlates of clinical response in a naturalistic sample of escitalopram-treated patients. Expert Rev Clin Pharmacol 2024; 17:247-253. [PMID: 38299560 DOI: 10.1080/17512433.2024.2314211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/31/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE We assessed pharmacokinetic correlates of treatment response to escitalopram using a large therapeutic drug monitoring database. METHODS A large naturalistic sample of patients receiving escitalopram was analyzed. Responders were defined as 'very much improved' or 'much improved' based on the Clinical Global Impression - Improvement score, CGI-I. We compared responders (n = 83) vs. non-responders (n = 388) with the primary outcome being the escitalopram plasma concentration and concentration corrected by the daily dose (C/D ratio). Effects of age, sex, body-mass-index (BMI), and C/D ratio were assessed in a multivariate logistic regression model predicting response. RESULTS There were no statistically significant differences in clinical and demographic characteristics between responders vs. non-responders. There were also no differences between escitalopram daily doses or plasma concentrations, while C/D ratios were significantly higher in non-responders than in responders (1.6 ± 1.7 vs. 1.2 ± 0.9 (ng/mL)/(mg/day), p = 0.007); C/D ratios (odds ratio 0.52, 95% confidence interval 0.34-0.80, p < 0.003) were associated with response to escitalopram, after controlling for age, sex, and BMI. CONCLUSIONS Patients with low clearance of escitalopram as reflected upon high C/D ratios may be less likely respond to escitalopram. Identifying these patients during dose titration may support clinical decision-making, including switching to a different antidepressant instead of increasing daily dose.
Collapse
Affiliation(s)
- Nicholas Kasperk
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA - Translational Brain Medicine, Aachen, Germany
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany
- Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
- Clinical Pharmacology, Institute AGATE gGmbH, Pentling, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Thomas Frodl
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA - Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA - Translational Brain Medicine, Aachen, Germany
- Alexianer Hospital Aachen, Aachen, Germany
| | - Nazar Kuzo
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Kuzin M, Gardin F, Götschi M, Xepapadakos F, Kawohl W, Seifritz E, Trauzeddel A, Paulzen M, Schoretsanitis G. Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study. Ther Drug Monit 2023; 45:792-796. [PMID: 37296505 DOI: 10.1097/ftd.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limited evidence from case reports suggests that coronavirus disease 2019 (COVID-19) vaccination may interact with the treatment outcomes of psychiatric medications. Apart from clozapine, reports on the effect of COVID-19 vaccination on other psychotropic agents are scarce. This study aimed to investigate the impact of COVID-19 vaccination on the plasma levels of different psychotropic drugs using therapeutic drug monitoring. METHODS Plasma levels of psychotropic agents, including agomelatine, amisulpride, amitriptyline, escitalopram, fluoxetine, lamotrigine, mirtazapine, olanzapine, quetiapine, sertraline, trazodone, and venlafaxine, from inpatients with a broad spectrum of psychiatric diseases receiving COVID-19 vaccinations were collected at 2 medical centers between 08/2021 and 02/2022 under steady-state conditions before and after vaccination. Postvaccination changes were estimated as a percentage of baseline. RESULTS Data from 16 patients who received COVID-19 vaccination were included. The largest changes in plasma levels were reported for quetiapine (+101.2%) and trazodone (-38.5%) in 1 and 3 patients, respectively, 1 day postvaccination compared with baseline levels. One week postvaccination, the plasma levels of fluoxetine (active moiety) and escitalopram increased by 31% and 24.9%, respectively. CONCLUSIONS This study provides the first evidence of major changes in the plasma levels of escitalopram, fluoxetine, trazodone, and quetiapine after COVID-19 vaccination. When planning COVID-19 vaccination for patients treated with these medications, clinicians should monitor rapid changes in bioavailability and consider short-term dose adjustments to ensure safety.
Collapse
Affiliation(s)
- Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Fabian Gardin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - Markus Götschi
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - Franziskos Xepapadakos
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Wolfram Kawohl
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | | | - Michael Paulzen
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA-Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, New York, New York; and
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
| |
Collapse
|
4
|
Kuzo N, Haen E, Ho DM, Takeuchi H, Piras M, Eap CB, de Filippis R, Homan P, Kane JM, Roy MA, Paulzen M, Schoretsanitis G. Clozapine once- versus multiple-daily dosing: a two-center cross-sectional study, systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2023; 273:1567-1578. [PMID: 36580106 PMCID: PMC10465369 DOI: 10.1007/s00406-022-01542-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
Evidence regarding effectiveness and safety of clozapine once- vs. multiple-daily dosing is limited. We compared demographic and clinical parameters between patients with once- vs. multiple-daily dosing in the Department of Psychiatry and Psychotherapy, University of Regensburg, Germany (AGATE dataset), and the Department of Psychiatry, Lausanne University Hospital, Switzerland, using non-parametric tests. Effectiveness and safety outcomes were available in the AGATE dataset. We performed a systematic review in PubMed/Embase until February 2022, meta-analyzing studies comparing clozapine once- vs. multiple-daily-dosing. We estimated a pooled odds ratio for adverse drug-induced reactions (ADRs) and meta-analyzed differences regarding clinical symptom severity, age, percentage males, smokers, clozapine dose, and co-medications between patients receiving once- vs. multiple-daily dosing. Study quality was assessed using the Newcastle-Ottawa-Scale. Of 1494 and 174 patients included in AGATE and Lausanne datasets, clozapine was prescribed multiple-daily in 74.8% and 67.8%, respectively. In the AGATE cohort, no differences were reported for the clinical symptoms severity or ADR rate (p > 0.05). Meta-analyzing eight cohorts with a total of 2810 clozapine-treated individuals, we found more severe clinical symptoms (p = 0.036), increased ADR risk (p = 0.01), higher clozapine doses (p < 0.001), more frequent co-medication with other antipsychotics (p < 0.001), benzodiazepines (p < 0.001), anticholinergics (p = 0.039), and laxatives (p < 0.001) in patients on multiple- vs. once-daily dosing. Of six studies, five were rated as good, and one as poor quality. Patients responding less well to clozapine may be prescribed higher doses multiple-daily, also treated with polypharmacy, potentially underlying worse safety outcomes. Patient preferences and adherence should be considered during regimen selection.
Collapse
Affiliation(s)
- Nazar Kuzo
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Dominic M Ho
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Marianna Piras
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Chin-Bin Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, QC, Canada
- Centre de Recherche CERVO, Quebec City, QC, Canada
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA Translational Brain Medicine, RWTH Aachen University, Aachen, Germany
- Alexianer Hospital Aachen, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| |
Collapse
|
5
|
Paulzen M, Schoretsanitis G. [Psychopharmacotherapy during pregnancy and breastfeeding-Part II: focus on breastfeeding : Support options by using therapeutic drug monitoring]. Nervenarzt 2023; 94:801-810. [PMID: 37449995 DOI: 10.1007/s00115-023-01526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
The drug treatment of mental disorders during lactation requires special knowledge about the possible effects on the breastfed infant. The first part of this 2‑part article is devoted to the use of psychotropic drugs during pregnancy. This second part addresses the use of psychotropic drugs during breastfeeding.The uncertainty about whether maternal breastfeeding can be recommended during drug treatment is high and the clinical management of psychopharmacotherapy during breastfeeding is a major challenge. Due to sparse scientific evidence, the administration of psychotropic drugs must be evaluated individually; however, the risk of mental decompensation of the mother is a weighty factor that can have a very negative impact on the mother-child pair, in the worst case up to suicide or infanticide. Drug treatment during breastfeeding is always off-label and should therefore only be given after a careful risk assessment and comprehensive clarification. Every treatment decision is a case by case decision based on an assessment of the overall constellation. This includes the psychiatric history, the current complaints and a risk assessment for the infant, ideally with the involvement of a social support network in the environment. A multiprofessional support by psychiatrists, pediatricians, gynecologists and midwives should accompany drug treatment during breastfeeding under close monitoring.This second part of the 2‑part article provides an overview of the most frequently used drug classes during the breastfeeding period. Therapeutic drug monitoring (TDM) is a valuable tool for risk and exposure assessment during the breastfeeding period.
Collapse
Affiliation(s)
- Michael Paulzen
- Alexianer Krankenhaus Aachen, Alexianer Aachen GmbH, Alexianergraben 33, 52062, Aachen, Deutschland.
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland.
| | - Georgios Schoretsanitis
- Psychiatrische Universitätsklinik Zürich (PUK), Zürich, Schweiz
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| |
Collapse
|
6
|
Paulzen M, Schoretsanitis G. [Psychopharmacotherapy during pregnancy and breastfeeding-Part I: focus on pregnancy : Support options by using therapeutic drug monitoring]. Nervenarzt 2023; 94:786-798. [PMID: 37460797 DOI: 10.1007/s00115-023-01528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 09/14/2023]
Abstract
The medicinal treatment of mental disorders during pregnancy and lactation requires special knowledge about possible effects of the psychopharmacotherapy on the intrauterine exposure of the embryo/fetus. Therefore, the first part of this 2‑part article focuses on the use of psychotropic drugs during pregnancy. In the second part, the use of psychotropic drugs during breastfeeding is addressed. Possible substance-specific risks as a consequence of the administration have to be assessed compared to the natural risk of pregnancy complications, birth complications and neonatal complications associated with the appropriate (untreated) mental disease. Pharmacokinetic changes during pregnancy require a special focus on the safety of drug treatment and treatment efficacy. Currently, neither the European Medicines Agency (EMA) nor the U. S. Food and Drug Administration (FDA) has approved any psychotropic drug for use during pregnancy or breastfeeding. A more detailed consideration of the risk profiles of all psychotropic drugs, prescribed off-label during this time, is important. Antidepressants, antipsychotics, and mood stabilizers are the main drugs used, despite their lack of approval. This first part of our 2‑part article provides an overview of the most frequently used substance groups during pregnancy and their special characteristics. Therapeutic drug monitoring (TDM) is presented as a clinical tool that can provide a supportive contribution to treatment safety and effectiveness during pregnancy and later also during breastfeeding, not only because of the changing pharmacokinetics. In this context, the measurement of concentrations of the active substance allows a better quantification of the intrauterine and postpartum exposure risk. Despite all clinical support possibilities, each therapeutic decision for the administration of a psychotropic drug remains an individual case decision. For those involved in the treatment, this means a careful balancing of the possible consequences of non-treatment and the possible sequelae of the use of psychopharmacotherapy.
Collapse
Affiliation(s)
- Michael Paulzen
- Alexianer Krankenhaus Aachen, Alexianer Aachen GmbH, Aachen, Deutschland, Alexianergraben 33, 52062.
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland.
| | - Georgios Schoretsanitis
- Psychiatrische Universitätsklinik Zürich (PUK), Zürich, Schweiz
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
| |
Collapse
|
7
|
Schmidt CT, Deligiannidis KM, Kittel-Schneider S, Frodl T, Spigset O, Paulzen M, Schoretsanitis G. Transfer of anticonvulsants and lithium into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 124:110733. [PMID: 36805301 DOI: 10.1016/j.pnpbp.2023.110733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/21/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Data on the ability of anticonvulsants and lithium to enter fetal and newborn circulation has become increasingly available; here we estimated penetration ratios in a series of matrices from combined samples of pregnant/breastfeeding women treated with anticonvulsants or lithium. METHODS We conducted a systematic literature search in PubMed/EMBASE for studies with concentrations of anticonvulsants/lithium from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal concentrations. When data from multiple studies were available, we calculated combined penetration ratios, weighting studies' mean by study size. RESULTS Ninety-one eligible studies for brivaracetam, carbamazepine, clonazepam, ethosuximide, gabapentin, lacosamide, lamotrigine, levetiracetam, lithium, oxcarbazepine, perampanel, phenobarbital, phenytoin, pregabalin, primidone, topiramate, valproate, vigabatrin and zonisamide were identified. For amniotic fluid, the highest penetration ratios were estimated for levetiracetam (mean 3.56, range 1.27-5.85, n = 2) and lowest for valproate (mean 0.11, range 0.02-1.02, n = 57). For umbilical cord plasma, oxcarbazepine had the highest ratio (mean 1.59, range 0.11-4.33, n = 12) with clonazepam having the lowest (mean 0.55, range 0.52-0.59, n = 2). For breast milk, the highest ratios were observed for oxcarbazepine (mean 3.75, range 0.5-7.0, n = 2), whereas the lowest were observed for valproate (mean 0.04, range 0.01-0.22, n = 121). DISCUSSION We observed substantial variability between anticonvulsants and lithium regarding their ability to enter fetal/newborn circulation. Assessing concentrations of anticonvulsants and lithium in maternal samples can provide a surrogate of fetal/infant exposure, although patterns of concentration-dependent effects for maternal/neonatal safety are lacking.
Collapse
Affiliation(s)
- Chiara Theresa Schmidt
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA - Translational Brain Medicine, Aachen, Germany
| | - Kristina M Deligiannidis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry at the Donald and Barbara Zucker, School of Medicine at Northwell/Hofstra, Hempstead, NY, USA; The Departments of Obstetrics & Gynecology and Molecular Medicine at the Zucker, School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Thomas Frodl
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA - Translational Brain Medicine, Aachen, Germany
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA - Translational Brain Medicine, Aachen, Germany; Alexianer Hospital Aachen, Aachen, Germany
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry at the Donald and Barbara Zucker, School of Medicine at Northwell/Hofstra, Hempstead, NY, USA; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
8
|
Weber S, Paulzen M, Elsner F, Weeger-Elsner S, Groß D, Trachsel M, Rolke R, Westermair AL. [Does anorexia nervosa qualify for specialized palliative care?]. Nervenarzt 2023:10.1007/s00115-023-01498-0. [PMID: 37249598 DOI: 10.1007/s00115-023-01498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Sascha Weber
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Michael Paulzen
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
- Alexianer Krankenhaus, Aachen, Deutschland
| | - Frank Elsner
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | | | - Dominik Groß
- Institut für Geschichte, Theorie und Ethik der Medizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Manuel Trachsel
- Abteilung Klinische Ethik, Universitätsspital Basel (USB), Universitäre Psychiatrische Kliniken (UPK), Universitäre Altersmedizin Felix-Platter (UAFP), Universitäres Kinderspital beider Basel (UKBB), Spitalstrasse 21, 4031, Basel, Schweiz
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Anna L Westermair
- Abteilung Klinische Ethik, Universitätsspital Basel (USB), Universitäre Psychiatrische Kliniken (UPK), Universitäre Altersmedizin Felix-Platter (UAFP), Universitäres Kinderspital beider Basel (UKBB), Spitalstrasse 21, 4031, Basel, Schweiz.
- Institut für Biomedizinische Ethik und Geschichte der Medizin, Universität Zürich, Zürich, Schweiz.
| |
Collapse
|
9
|
Margraff T, Schoretsanitis G, Neuner I, Haen E, Gaebler AJ, Paulzen M. Discovering Interactions in Augmentation Strategies: Impact of Duloxetine on the Metabolism of Aripiprazole. Basic Clin Pharmacol Toxicol 2023. [PMID: 37069136 DOI: 10.1111/bcpt.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/01/2023] [Accepted: 04/13/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE We aimed to unravel potential pharmacokinetic interactions between aripiprazole and duloxetine. METHODS Plasma concentrations of aripiprazole in two groups of 78 patients each, receiving aripiprazole as a monotherapy, or combined with duloxetine, were compared. A potential impact of duloxetine on the metabolism of aripiprazole was expected in higher plasma concentrations of aripiprazole and higher dose-adjusted plasma concentrations. RESULTS Patients co-medicated with duloxetine showed significantly higher plasma concentrations of aripiprazole by 54.2% (p=0.019). Dose-adjusted plasma concentrations were 45.6% higher (p=0.001). 12.8% of these patients exhibited aripiprazole plasma concentrations above the upper limit of the therapeutic reference range, in the control group this was only the case for 10.3% of the patients. A positive relationship was found between the daily dose of duloxetine and dose-adjusted plasma concentrations of aripiprazole (p=0.034). As dehydroaripiprazole concentrations were not available, conclusions for the active moiety (aripiprazole plus dehydroaripiprazole) could not be drawn. CONCLUSIONS Combining duloxetine and aripiprazole leads to significantly higher drug concentrations of aripiprazole, most likely via an inhibition of cytochrome P450 CYP2D6 and to a lesser extent of CYP3A4 by duloxetine. Clinicians have to consider increasing aripiprazole concentrations when adding duloxetine to a treatment regimen with aripiprazole.
Collapse
Affiliation(s)
- Teresa Margraff
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany; and JARA-Translational Brain Medicine, RWTH Aachen University, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA and Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany; and JARA-Translational Brain Medicine, RWTH Aachen University, Aachen, Germany
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany
- Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
- Clinical Pharmacology Institute AGATE gGmbH, Pentling, Germany
| | - Arnim Johannes Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany; and JARA-Translational Brain Medicine, RWTH Aachen University, Aachen, Germany
- Institute of Physiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany; and JARA-Translational Brain Medicine, RWTH Aachen University, Aachen, Germany
- Alexianer Hospital Aachen, Aachen, Germany
| |
Collapse
|
10
|
Gaebler AJ, Haen E, Omar NB, Endres K, Hiemke C, Schoretsanitis G, Paulzen M. Lower sertraline plasma concentration in patients co-medicated with clozapine-Implications for pharmacological augmentation strategies in schizophrenia. Pharmacol Res Perspect 2023; 11:e01065. [PMID: 36825450 PMCID: PMC9950877 DOI: 10.1002/prp2.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Augmentation of antipsychotic treatment with antidepressants represents a common and beneficial treatment strategy in patients suffering from schizophrenia. Combining clozapine and the selective serotonin reuptake inhibitor (SSRI) sertraline represents a clinically important strategy in patients with therapy-resistant schizophrenia, but there is limited knowledge about mutual pharmacokinetic interactions. In the present study, we assessed the impact of clozapine on sertraline plasma concentrations. Based on a therapeutic drug monitoring (TDM) database, sertraline plasma concentrations were compared between two groups: patients receiving a combined treatment with sertraline and clozapine (N = 15) and a matched control group receiving sertraline but no clozapine (N = 17). Group differences with respect to raw and dose-adjusted concentrations were assessed using nonparametric tests. Comedication with clozapine was associated with 67% lower median sertraline plasma concentrations (16 vs. 48 ng/mL; p = .022) and 28% lower median dose-adjusted plasma concentrations (C/D; 0.21 vs. 0.29 (ng/mL)/(mg/day); p = .049) as compared to the control group. Scatter plots revealed a complex relationship between the dosage of clozapine and dose-adjusted sertraline concentrations composed of an initial decrease at clozapine doses below 300 mg, an increase between 300 and 600 mg and a final decrease at 800 mg which was best modeled by a third order polynomial term. Cotreatment with clozapine may lead to reduced sertraline plasma concentrations which may be explained by clozapine-induced gastrointestinal hypo-mobility already present at low doses and cytochrome P450 3A4 inducing properties at high clozapine doses. For this drug combination, clinicians should consider TDM to confirm therapeutically effective plasma concentrations of sertraline.
Collapse
Affiliation(s)
- Arnim Johannes Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Aachen, Germany.,JARA - Translational Brain Medicine, Aachen, Germany.,Institute of Physiology, Medical Faculty, Aachen, Germany
| | - Ekkehard Haen
- Clinical Pharmacology Institute AGATE gGmbH, Pentling, Germany.,Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Nagia Ben Omar
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | | | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, New York, New York, USA.,University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Aachen, Germany.,JARA - Translational Brain Medicine, Aachen, Germany.,Alexianer Hospital Aachen, Aachen, Germany
| |
Collapse
|
11
|
Hart X, Hiemke C, Clement HW, Conca A, Eichentopf L, Faltraco F, Florio V, Grüner J, Havemann-Reinecke U, Lense X, Paulzen M, Riemer T, Schoretsanitis G, Gründer G. Therapeutic reference range for aripiprazole revised: A systematic
review and combined analysis. Pharmacopsychiatry 2022. [DOI: 10.1055/s-0042-1757670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Xenia Hart
- Department of Molecular Imaging, Central Institute of Mental Health,
Mannheim, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Centre
Mainz, Mainz, Germany
| | - Hans-Willi Clement
- Department of Child and Adolescent Psychiatry, Psychotherapy and
Psychosomatics, University Clinic Freiburg, Freiburg, Germany
| | - Andreas Conca
- Sanitario di Bolzano, Servizio Psychiatrico del Comprensorio, Bolzano,
Italy
| | - Luzie Eichentopf
- Department of Molecular Imaging, Central Institute of Mental Health,
Mannheim, Germany
| | - Frank Faltraco
- Department of Psychiatry and Psychotherapy, University Medicine
Rostock, Germany
| | - Vincenco Florio
- Sanitario di Bolzano, Servizio Psychiatrico del Comprensorio, Bolzano,
Italy
| | - Jessica Grüner
- Department of Child and Adolescent Psychiatry, Psychotherapy and
Psychosomatics, University Clinic Freiburg, Freiburg, Germany
| | | | - Xenija Lense
- Department of Molecular Imaging, Central Institute of Mental Health,
Mannheim, Germany
| | - Michael Paulzen
- Department of Psychiatry and Psychotherapy, University Medical Centre
Goettingen, Göttingen, Germany
| | - Thomas Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer
Hospital, Aachen, Germany
| | - Georgios Schoretsanitis
- Institute of Clinical Pharmacology and Toxicology, Charité
University Medicine, Berlin, Germany
| | - Gerhard Gründer
- Department of Molecular Imaging, Central Institute of Mental Health,
Mannheim, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, University
Clinic Zurich, Switzerland
| |
Collapse
|
12
|
Schoretsanitis G, Deligiannidis KM, Paulzen M, Spina E, de Leon J. Drug-drug interactions between psychotropic medications and oral contraceptives. Expert Opin Drug Metab Toxicol 2022; 18:395-411. [DOI: 10.1080/17425255.2022.2106214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York. USA
- Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Kristina M. Deligiannidis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York. USA
- Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
- The Departments of Obstetrics & Gynecology and Molecular Medicine at the Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA– Translational Brain Medicine, Aachen, Germany
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| |
Collapse
|
13
|
Hart X, Hiemke C, Clement H, Conca A, Eichentopf L, Faltraco F, Florio V, Grüner J, Havemann-Reinecke U, Lense X, Molden E, Paulzen M, Riemer T, Schoretsanitis G, Gründer G. Therapeutic reference range for aripiprazole revised: A systematic
review and combined analysis. PHARMACOPSYCHIATRY 2022. [DOI: 10.1055/s-0042-1747652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- X.M. Hart
- Central Institute of Mental Health, Department of Molecular
Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - C. Hiemke
- University Medical Center of Mainz, Department of Psychiatry and
Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine,
Mainz, Germany
| | - H.W. Clement
- University of Freiburg, Department of Child and Adolescent Psychiatry,
Freiburg, Germany
| | - A. Conca
- Sanitario di Bolzano, Servizio Psichiatrico del Comprensorio, Bolzano,
Italy
| | - L. Eichentopf
- Central Institute of Mental Health, Department of Molecular
Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - F. Faltraco
- University of Rostock, Department of Psychiatry and Psychotherapy,
Rostock, Germany
| | - V. Florio
- Sanitario di Bolzano, Servizio Psichiatrico del Comprensorio, Bolzano,
Italy
| | - J. Grüner
- University of Freiburg, Department of Child and Adolescent Psychiatry,
Freiburg, Germany
| | - U. Havemann-Reinecke
- Department of Psychiatry and Psychosomatics, University of
Göttingen, Göttingen, Germany
| | - X. Lense
- Central Institute of Mental Health, Department of Molecular
Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | | | - M. Paulzen
- Alexianer Hospital Aachen, Department of Psychiatry, Psychotherapy and
Psychosomatics, Aachen, Germany
| | - T.G. Riemer
- Berlin Institute of Health, Institute of Clinical Pharmacology and
Toxicology, Charité - Universitätsmedizin Berlin, Freie
Universität Berlin, Humboldt-Universität zu Berlin, Berlin,
Germany
| | - G. Schoretsanitis
- University of Zurich, Department of Psychiatry, Psychotherapy and
Psychosomatics, Zurich, Switzerland
| | - G. Gründer
- Central Institute of Mental Health, Department of Molecular
Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| |
Collapse
|
14
|
Gaebler AJ, Finner‐Prével M, Lammertz S, Schaffrath S, Eisner P, Stöhr F, Röcher E, Winkler L, Kaleta P, Lenzen L, Augustin M, Hovancakova J, Schwemmer L, Stormanns E, Keskin F, Hendricks F, Paulzen M, Gründer G, Schneider F, Mathiak K, Augustin M, Cordes J, Demirel E, Dielentheis T, Dreher J, Eisner P, Finner‐Prével M, Gaebler AJ, Gründer G, Hendricks F, Hovancakova J, Kaleta P, Keskin F, Kirchner M, Kirner‐Veselinovic A, Lammertz S, Lange C, Larcher F, Lenzen LM, Mathiak K, Meisenzahl‐Lechner E, Muysers J, Neff A, Paulzen M, Plum M, Röcher E, Ruttmann A, Schaffrath S, Schneider F, Schwemmer L, Stöhr F, Stormanns E, Trauzeddel A, Winkler L. Vitamin D’s negative impact on antipsychotic drug exposure may counteract its potential benefits in schizophrenia. Br J Clin Pharmacol 2022; 88:3193-3200. [DOI: 10.1111/bcp.15223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 10/19/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Arnim Johannes Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Michelle Finner‐Prével
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Sarah Lammertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Sabrina Schaffrath
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Patrick Eisner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Felix Stöhr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Erik Röcher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Lina Winkler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Peter Kaleta
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Laura Lenzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
- Protestant University of Applied Sciences Bochum Germany
| | - Jana Hovancakova
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Lara Schwemmer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Eva Stormanns
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | | | | | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
- Alexianer Hospital Aachen Germany
| | - Gerhard Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim University of Heidelberg Mannheim Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
- University Hospital Düsseldorf Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
- Protestant University of Applied Sciences Bochum Germany
| | - Joachim Cordes
- LVR Klinikum Düsseldorf University Hospital Düsseldorf Germany
| | - Emir Demirel
- LVR Klinikum Düsseldorf University Hospital Düsseldorf Germany
| | | | | | - Patrick Eisner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Michelle Finner‐Prével
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Arnim Johannes Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Gerhard Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim University of Heidelberg Mannheim Germany
| | | | - Jana Hovancakova
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Peter Kaleta
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | | | | | - André Kirner‐Veselinovic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Sarah Lammertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | | | - Federico Larcher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Laura Marianne Lenzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | | | | | | | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
- Alexianer Hospital Aachen Germany
| | | | - Erik Röcher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Axel Ruttmann
- LVR Klinikum Düsseldorf University Hospital Düsseldorf Germany
| | - Sabrina Schaffrath
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
- University Hospital Düsseldorf Germany
| | - Lara Schwemmer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Felix Stöhr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | - Eva Stormanns
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | | | - Lina Winkler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine RWTH Aachen Germany
- JARA ‐ Translational Brain Medicine Aachen Germany
| | | |
Collapse
|
15
|
Schoretsanitis G, Haen E, Piacentino D, Conca A, Endres K, Hiemke C, Gründer G, Paulzen M. Effects of body weight, smoking status, and sex on plasma concentrations of once-monthly paliperidone palmitate. Expert Rev Clin Pharmacol 2021; 15:243-249. [PMID: 34918984 DOI: 10.1080/17512433.2022.2020641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Knowledge about the impact of body composition features on pharmacokinetics of newer long-acting injectable antipsychotics is limited. METHODS We analyzed steady-state plasma concentrations of paliperidone in different body mass index (BMI), age, sex, and smoking status patient subgroups treated with once-monthly paliperidone palmitate (PP1M). Paliperidone plasma concentrations and dose-adjusted-plasma concentrations (C/D) from a therapeutic drug monitoring (TDM) database of PP1M-treated patients were compared among normal BMI, overweight, and obese patients as well as between females vs. males, elderly vs. non-elderly, and smokers vs. non-smokers using non-parametric tests. RESULTS In a total of 183 PP1M-treated patients, we found highly variable paliperidone plasma concentrations between individuals but no significant effect of PP1M dose or dosing intervals (p> 0.05). C/D ratios were similar in 54 obese, 82 overweight, and 47 normal BMI patients (p> 0.05). Females had 13.7% higher C/D ratios compared to males, yet this difference was not significant (p> 0.05). No differences were found between elderly vs. non-elderly patients or for smokers vs. non-smokers (p> 0.05). CONCLUSION Our findings suggest that age, sex, smoking, or body weight may not substantially affect pharmacokinetic indices of PP1M. The high interindividual variation of plasma concentrations implies that TDM may be helpful to enhance PP1M efficacy and tolerability.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, NY, USA and Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Daria Piacentino
- Psychiatric Service of the Health District of Bolzano, Bolzano, Italy.,Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, The National Institutes of Health, Bethesda, MD, USA
| | - Andreas Conca
- Psychiatric Service of the Health District of Bolzano, Bolzano, Italy
| | - Katharina Endres
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and Jara - Translational Brain Medicine, Aachen, Germany
| |
Collapse
|
16
|
Schoretsanitis G, Haen E, Piacentino D, Conca A, Endres K, Hiemke C, Gründer G, Paulzen M. Clinical response in patients treated with once-monthly paliperidone palmitate: analysis of a therapeutic drug monitoring (TDM) database. Eur Arch Psychiatry Clin Neurosci 2021; 271:1437-1443. [PMID: 33821323 DOI: 10.1007/s00406-021-01257-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/30/2021] [Indexed: 12/01/2022]
Abstract
To investigate pharmacokinetic correlates of clinical response in patients treated with once-monthly paliperidone palmitate (PP1M) injections at steady state. Plasma concentrations and dose-adjusted-plasma concentrations (C/D) of paliperidone from a naturalistic therapeutic drug monitoring (TDM) database were compared between responders and non-responders using the Clinical Global Impressions-Improvement scale (CGI-I) ratings. Analyses were based on the non-parametric Mann-Whitney U test and the Pearson Chi-squared test (χ2) with a significance level of 0.05. Subgroup analyses were performed separately in patients with schizophrenia spectrum, schizoaffective disorders and bipolar disorders. Comparing 93 responders with 80 non-responders, we detected no significant differences in the proportion of females, age, and body mass index (p's ranging 0.18-0.83); there were more smokers in the group of non-responders (p = 0.04), which also included more patients with bipolar disorders (p = 0.014). Despite the lack of differences for prescribed PP1M doses and dose intervals (p = 0.42 and p = 0.11, respectively), non-responders had higher paliperidone plasma concentrations and C/D levels (p = 0.033 and p = 0.021, respectively). Subgroup analyses did not yield differences for paliperidone plasma and C/D levels between non-responders and responders with schizophrenia spectrum (p = 0.099 and p = 0.14, respectively) and bipolar disorders (p = 0.95 and p = 0.75, respectively); dose-adjusted plasma concentrations were higher in non-responders compared to responders with schizoaffective disorders (p = 0.039), while no differences were reported for plasma levels (p = 0. 15). Our results show that paliperidone plasma concentrations over injection doses may be associated with patterns of clinical response suggesting potential utility of TDM as part of PP1M-based maintenance treatment.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA.
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Daria Piacentino
- Psychiatric Service of the Health District of Bozen, Bozen, Italy.,Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute On Drug Abuse Intramural Research Program and National Institute On Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, The National Institutes of Health, Bethesda, MD, USA
| | - Andreas Conca
- Psychiatric Service of the Health District of Bozen, Bozen, Italy
| | - Katharina Endres
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA-Translational Brain Medicine, Aachen, Germany
| |
Collapse
|
17
|
Gundlach M, Augustin M, Smith KEC, Kämpfer D, Paulzen M, Hollert H. Effects of the antidepressant mirtazapine on the swimming behaviour and gene expression rate of Danio rerio embryos - Is the sedating effect seen in humans also evident for fish? Sci Total Environ 2021; 792:148368. [PMID: 34147801 DOI: 10.1016/j.scitotenv.2021.148368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 06/12/2023]
Abstract
In the last decade, mirtazapine has become an important antidepressant in clinical use and has also been found at many different environmental sampling sites. Several homologies between the zebrafish Danio rerio and humans, combined with a number of advantages for behavioural and gene expression research using zebrafish embryos, make their use for the analysis of mirtazapine appropriate. The sedative effect of mirtazapine in humans was also found for a specific concentration range in zebrafish embryos (1333.4 μg/L - 2666.9 μg/L). Specifically, 116 hpf old zebrafish embryos showed a reduced swimming distance when exposed to 1334.4 μg/L mirtazapine. Furthermore, changes at the gene regulatory level could be measured (1333.4 μg/L), in particular in the superordinate regulatory systems. For selected transporters of all regulatory systems, an up regulation of the genes by a factor of more than five times could be measured at the highest mirtazapine exposure concentration that was tested. Finally, studies on the protein levels demonstrated an increase in acetylcholinesterase activity for several exposure concentrations (83.3 μg/L and 666.7 μg/L). The physiological changes in zebrafish embryos caused by mirtazapine demonstrate the relevance of these types of studies in aquatic non-target organisms. Such neuroactive substances could pose a potential risk for aquatic organisms below the previously considered concentration threshold for morphological effects.
Collapse
Affiliation(s)
- Michael Gundlach
- Department of Ecosystem Analysis, Institute for Environmental Research, ABBt-Aachen Biology and Biotechnology, RWTH Aachen University, 52074 Aachen, Germany
| | - Marc Augustin
- Protestant University of Applied Sciences, Bochum, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany
| | - Kilian E C Smith
- Department of Ecosystem Analysis, Institute for Environmental Research, ABBt-Aachen Biology and Biotechnology, RWTH Aachen University, 52074 Aachen, Germany; Department of Water, Environment, Construction and Safety, University of Applied Sciences Magdeburg-Stendal, Breitscheidstr. 2, 39114 Magdeburg, Germany
| | - David Kämpfer
- Department of Ecosystem Analysis, Institute for Environmental Research, ABBt-Aachen Biology and Biotechnology, RWTH Aachen University, 52074 Aachen, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany; Alexianer Hospital Aachen, Alexianergraben 33, 52062 Aachen, Germany
| | - Henner Hollert
- Department of Ecosystem Analysis, Institute for Environmental Research, ABBt-Aachen Biology and Biotechnology, RWTH Aachen University, 52074 Aachen, Germany; Department Evolutionary Ecology and Environmental Toxicology, Faculty Biological Sciences, Goethe University Frankfurt, 60438 Frankfurt am Main, Germany.
| |
Collapse
|
18
|
Schoretsanitis G, Kuzin M, Kane JM, Hiemke C, Paulzen M, Haen E. Authors' Reply to Suhas et al.: Comment on: "Elevated Clozapine Concentrations in Clozapine-Treated Patients with Hypersalivation". Clin Pharmacokinet 2021; 60:1077-1079. [PMID: 33899165 DOI: 10.1007/s40262-021-01022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA.
- University Hospital of Psychiatry Zurich, Zurich, Switzerland.
| | - Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- JARA-Translational Brain Medicine, Jülich, Germany
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany
- Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| |
Collapse
|
19
|
Kuzin M, Haen E, Hiemke C, Bochon B, Bochon K, Gründer G, Paulzen M, Schoretsanitis G. Body mass index as a determinant of clozapine plasma concentrations: A pharmacokinetic-based hypothesis. J Psychopharmacol 2021; 35:273-278. [PMID: 33546578 DOI: 10.1177/0269881120985166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knowledge regarding the impact of body composition measures on pharmacokinetics of antipsychotics is limited. AIMS Our aim was to investigate the impact of body weight and body mass index on clozapine pharmacokinetics using a therapeutic drug monitoring database. METHODS A large therapeutic drug monitoring dataset of clozapine plasma concentrations considering three patient subgroups was analysed: a control group (CLZ0, 20-30 kg/m2, n=266), a group with high body mass index (CLZhigh, body mass index ⩾30 kg/m2, n=162) and with low body mass index values (CLZlow, body mass index <20 kg/m2, n=27). Comparisons of plasma and dose-adjusted plasma concentrations (C/D) of clozapine were based on the Spearman's correlation (rs), Kruskal Wallis and Mann-Whitney-U tests. For percentages we used the Pearson chi-square test (χ2). To assess effects of confounders we used bootstrapping analysis of covariates. RESULTS/OUTCOMES Regarding demographic characteristics, groups differed only for sex percentage with more females than males in CLZlow and CLZhigh compared to CLZ0 (p=0.001 for χ2 test). Plasma and C/D values were positively associated with body mass index (rs=0.108, p=0.022 and rs=0.156, p=0.001 respectively). Intergroup differences were observed for plasma and dose-adjusted concentrations of clozapine (p=0.031 and p=0.029 for Kruskal Wallis respectively): post-hoc pairwise comparisons showed higher plasma concentrations and C/D of clozapine in CLZhigh compared to CLZ0 (p=0.014 and p=0.007 respectively for Mann-Whitney U-test), by mean 21 and 18%, respectively. Differences for C/D values remained after accounting for sex (p=0.02). CONCLUSIONS/INTERPRETATION In obese patients, bioavailability, distribution or elimination of clozapine may be altered due to increased clozapine deposits in fat tissue and hepatic enzyme activity changes.
Collapse
Affiliation(s)
- Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Zurich, Switzerland
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Benjamin Bochon
- Psychiatric Services of Thurgovia, Academic Teaching Hospital of the Medical University of Salzburg, Münsterlingen, Switzerland
| | | | - Gerhard Gründer
- Department of Molecular Neuroimaging, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich, Germany
| | | |
Collapse
|
20
|
Schoretsanitis G, Westin AA, Stingl JC, Deligiannidis KM, Paulzen M, Spigset O. Antidepressant transfer into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110228. [PMID: 33358964 PMCID: PMC7882033 DOI: 10.1016/j.pnpbp.2020.110228] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/22/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Data regarding the ability of antidepressants to enter fetal, newborn and infant fluids have become gradually available, but mechanisms of antidepressant transfer remain poorly understood. Here we calculated penetration ratios in an array of matrices from combined samples of pregnant/breastfeeding women taking antidepressants. METHOD We performed a systematic literature search of PubMed and EMBASE to identify studies with concentrations of antidepressants from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal plasma concentration. When data from multiple studies were available, we calculated combined penetration ratios, weighting the study mean by study size. RESULTS Eighty-five eligible studies were identified. For amniotic fluid, the highest penetration ratios were estimated for venlafaxine (mean 2.77, range 0.43-4.70 for the active moiety) and citalopram (mean 2.03, range 0.35-6.97), while the lowest ratios were for fluvoxamine (mean 0.10) and fluoxetine (mean 0.11, range 0.02-0.20 for the active moiety). For umbilical cord plasma, nortriptyline had the highest ratio (mean 2.97, range 0.25-26.43) followed by bupropion (mean 1.14, range 0.3-5.08). For breast milk, the highest ratios were observed for venlafaxine (mean 2.59, range 0.85-4.85), mianserin (mean 2.22, range 0.80-3.64) and escitalopram (mean 2.19, range 1.68-3.00). CONCLUSION We observed considerable variability across antidepressants regarding their ability to enter fetal, newborn and infant fluids. Measuring antidepressant concentrations in a maternal blood sample can provide a reliable estimate of fetal/infant exposure, although further evidence for concentration-dependent effects is required.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.
| | - Andreas A. Westin
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Kristina M. Deligiannidis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA,Zucker School of Medicine, Hempstead, New York and The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany,JARA - Translational Brain Medicine, Aachen, Germany
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
21
|
Gründer G, Bauknecht P, Klingberg S, Leopold K, Paulzen M, Schell S, Stengler K, Leucht S. Treatment Goals for Patients with Schizophrenia - A Narrative Review of Physician and Patient Perspectives. Pharmacopsychiatry 2020; 54:53-59. [PMID: 33291156 DOI: 10.1055/a-1298-4546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION There are many possible treatment goals for patients with schizophrenia. Two major perspectives on treatment goals are the patient's and the physician's perspective. Patient-centered treatment mandates that an individual patient's treatment goals are taken into account when treatment is planned. In this narrative review, we address the commonalities and differences of the patient's and physician's perspectives. METHODS We searched for literature on treatment goals for patients with schizophrenia from the last 10 years. RESULTS Fifty-two relevant records were identified, 4 of which directly compare patient's and physician's perspectives. Two further articles used the same set of goals to ask patients or physicians for their assessment. DISCUSSION Agreement between patients and physicians regarding valuation of treatment goals was high. However, physicians tended to put more emphasis on the classical "textbook" goals of symptom resolution and functioning, while patients stressed well-being and quality of life more. Results on treatment goals from patients are difficult to generalize, since recruiting representative patient samples is challenging and patient subgroups may have differing priorities.
Collapse
Affiliation(s)
- Gerhard Gründer
- Department of Molecular Neuroimaging,Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
| | - Karolina Leopold
- Vivantes Klinikum Am Urban, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Carl Gustav Carus University Hospital, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany
| | - Michael Paulzen
- Alexianer Hospital, Aachen, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich, Germany
| | - Stefanie Schell
- Harzklinikum Dorothea Christiane Erxleben, Klinikum Blankenburg, Akademisches Lehrkrankenhaus der Otto-von-Guericke-Universität Magdeburg, Germany
| | - Katarina Stengler
- Helios Parkklinikum Leipzig, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Universität Leipzig, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, Germany
| |
Collapse
|
22
|
Schoretsanitis G, Kuzin M, Kane JM, Hiemke C, Paulzen M, Haen E. Elevated Clozapine Concentrations in Clozapine-Treated Patients with Hypersalivation. Clin Pharmacokinet 2020; 60:329-335. [PMID: 33000411 DOI: 10.1007/s40262-020-00944-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypersalivation is a common, clozapine-related adverse drug reaction with a serious impact on quality of life. Pharmacokinetic correlates of clozapine-related hypersalivation have evaded attention. The purpose of this study was to compare pharmacokinetic parameters between clozapine-treated patients with vs. without hypersalivation from a large therapeutic drug monitoring database. METHODS Out of a large therapeutic drug monitoring dataset of clozapine-treated patients, we compared a group of patients with hypersalivation (n = 72) and a control group of patients without any adverse reactions in this regard (n = 323). Comparisons included plasma concentrations and concentrations-by-dose as well as demographic characteristics between groups. Post-hoc analyses were performed separately in smokers and non-smokers. We used the non-parametric Mann-Whitney U test and the chi-square test, while effects of confounders were assessed using a bootstrapping analysis of covariance. RESULTS Patients with hypersalivation had higher clozapine plasma concentrations and concentrations-by-dose (p < 0.001 for the Mann-Whitney U test in both cases). Groups did not differ regarding demographic characteristics except for clozapine daily dose and percentage of smokers (p = 0.005 for the Mann-Whitney U test and p = 0.028 for the chi-square test, respectively). There were fewer smokers across patients with hypersalivation compared with patients without and daily doses were higher in patients with hypersalivation. After analysis of covariance, differences remained for both plasma concentrations and concentrations-by-dose (p < 0.001 for both). Post hoc analyses in smokers and non-smokers separately reported similar findings. CONCLUSIONS Elevated clozapine plasma concentrations and higher concentrations-by-dose were observed in patients with hypersalivation. A potential role for therapeutic drug monitoring in the prevention or management of clozapine-related hypersalivation is suggested.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA.
| | - Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil Am See, Zurich, Switzerland
| | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Alexianergraben 33, 52062, Aachen, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.,JARA, Translational Brain Medicine, Jülich, Germany
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| |
Collapse
|
23
|
Gaebler AJ, Schoretsanitis G, Ben Omar N, Haen E, Endres K, Hiemke C, Paulzen M. Metamizole but not ibuprofen reduces the plasma concentration of sertraline: Implications for the concurrent treatment of pain and depression/anxiety disorders. Br J Clin Pharmacol 2020; 87:1111-1119. [PMID: 32652557 DOI: 10.1111/bcp.14471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
AIM Comorbidity of pain and depression or anxiety is a challenging clinical phenomenon, often requiring the concurrent application of antidepressant and analgesic drugs. Growing evidence suggests that the analgesic metamizole exhibits cytochrome P450 inducing properties. In the present study, we assessed the impact of metamizole and ibuprofen on plasma concentrations of the selective serotonin reuptake inhibitor sertraline. METHODS Out of a therapeutic drug monitoring (TDM) database, three groups of patients were compared: patients receiving sertraline and metamizole (n = 15), patients receiving sertraline and ibuprofen (n = 19), and a matched control group without one of the analgesics (n = 19). RESULTS Metamizole was associated with 67% lower median sertraline plasma concentrations compared to the control group (14 vs 42 ng/mL, P < 0.001). In contrast, differences between the ibuprofen group and the control group did not reach statistical significance (31 vs 42 ng/mL, P = 0.128). Moreover, the metamizole group demonstrated lower dose-adjusted drug concentrations than the ibuprofen group (0.10 vs 0.26 (ng/mL)/(mg/day), P = 0.008). Finally, the metamizole group exhibited a higher proportion of patients whose sertraline concentrations were below the therapeutic reference range (40% in the metamizole group, 5% in the ibuprofen group, 0% in the control group, P = 0.005) indicating therapeutically insufficient drug concentrations. CONCLUSION Our findings support preliminary evidence that metamizole acts as a potent inductor of cytochrome P450 isoenzymes CYP2B6 and CYP3A4. We observed a clinically meaningful pharmacokinetic interaction between metamizole and sertraline, leading to insufficiently low sertraline drug concentrations. Clinicians should therefore consider alternative drug combinations or apply TDM-guided dose adjustment of sertraline.
Collapse
Affiliation(s)
- Arnim Johannes Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany.,JARA-Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- Psychiatry Research, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Hofstra Northwell School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Nagia Ben Omar
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Katharina Endres
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany.,JARA-Translational Brain Medicine, Aachen, Germany.,Alexianer Hospital Aachen, Aachen, Germany
| |
Collapse
|
24
|
Schoretsanitis G, Haen E, Conca A, Piacentino D, Ridders F, Hiemke C, Gründer G, Paulzen M. Lack of Smoking Effects on Pharmacokinetics of Oral Paliperidone-analysis of a Naturalistic Therapeutic Drug Monitoring Sample. Pharmacopsychiatry 2020; 54:31-35. [PMID: 32767297 DOI: 10.1055/a-1221-5293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Major smoking effects have been reported for a series of psychotropic agents, mainly including substrates of CYP450 1A2, although smoking may also affect alternative metabolic pathways. To our knowledge, smoking effects on paliperidone pharmacokinetics have not been assessed yet. METHODS We compared plasma concentrations of paliperidone as well as dose-corrected-plasma concentrations (C/D) from a naturalistic database between smokers and nonsmokers using nonparametrical tests, such as the Mann-Whitney U-test (MWU). Additionally, we compared light and heavy smokers with nonsmokers separately. RESULTS Comparing 55 smokers with 37 nonsmokers treated with oral paliperidone, no differences in the percentage of females, age, body weight, body mass index, and daily paliperidone dose were reported (p=0.709 for χ2, p=0.26, p=0.38, p=0.67, and p=0.8 for MWU). No differences were detected in plasma concentrations or C/D values (p=0.50 and p=0.96 for MWU). Likewise, differences in daily dose, plasma concentrations, or C/D values were not significant between light smokers (n=17) and nonsmokers (p=0.61, p=0.81, and p=0.33 for MWU) or heavy smokers (n=22) and nonsmokers (p=0.874, p=0.38, and p=0.59; MWU in all cases). DISCUSSION Paliperidone is not affected by smoking, and paliperidone dose-adjustments in smokers may not be necessary. This may be seen as an essential difference to risperidone, whose cytochrome-mediated metabolism might be affected by smoking.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Andreas Conca
- Servizio Psichiatrico del Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Daria Piacentino
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, The National Institutes of Health, Bethesda, USA
| | - Florian Ridders
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany, and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA - Translational Brain Medicine, Aachen, Germany
| |
Collapse
|
25
|
Gaebler AJ, Schneider KL, Stingl JC, Paulzen M. Subtherapeutic bupropion and hydroxybupropion serum concentrations in a patient with CYP2C19*1/*17 genotype suggesting a rapid metabolizer status. Pharmacogenomics J 2020; 20:840-844. [PMID: 32475982 DOI: 10.1038/s41397-020-0169-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/09/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022]
Abstract
Bupropion is hydroxylated to its primary active metabolite hydroxybupropion by cytochrome P450 enzyme CYP2B6. In vitro data suggest the existence of alternative hydroxylation pathways mediated by the highly polymorphic enzyme CYP2C19. However, the impact of its genetic variants on bupropion metabolism in vivo is still under investigation. We report the case of a 28-year-old male Caucasian outpatient suffering from major depressive disorder who did not respond to a treatment with bupropion. Therapeutic drug monitoring revealed very low serum concentrations of both bupropion and hydroxybupropion. Genotyping identified a heterozygous status for the gain-of-function allele with the genotype CYP2C19*1/*17 predicting enhanced enzymatic activity. The present case shows a reduced bupropion efficacy, which may be explained by a reduced active moiety of bupropion and its active metabolite hydroxybupropion, due to alternative hydroxylation pathways mediated by CYP2C19 in an individual with CYP2C19 rapid metabolizer status. The case report thus illustrates the clinical relevance of therapeutic drug monitoring in combination with pharmacogenetics diagnostics for a personalized treatment approach.
Collapse
Affiliation(s)
- Arnim Johannes Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. .,JARA-Translational Brain Medicine, Aachen, Germany.
| | - Katharina Luise Schneider
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.,Centre for Translational Medicine, Medical Faculty of the University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Julia Carolin Stingl
- Institute of Clinical Pharmacology, Medical Faculty, RWTH Aachen, Wendlingweg 2, 52074, Aachen, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,JARA-Translational Brain Medicine, Aachen, Germany.,Alexianer Hospital Aachen, Alexianergraben 33, 52062, Aachen, Germany
| |
Collapse
|
26
|
Schoretsanitis G, Kane JM, Correll CU, Marder SR, Citrome L, Newcomer JW, Robinson DG, Goff DC, Kelly DL, Freudenreich O, Piacentino D, Paulzen M, Conca A, Zernig G, Haen E, Baumann P, Hiemke C, Gründer G, Pharmakopsychiatrie TTDMTFOTAFNU. Blood Levels to Optimize Antipsychotic Treatment in Clinical Practice: A Joint Consensus Statement of the American Society of Clinical Psychopharmacology and the Therapeutic Drug Monitoring Task Force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie. J Clin Psychiatry 2020; 81. [PMID: 32433836 DOI: 10.4088/jcp.19cs13169] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
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 aid 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 Participants were clinicians and researchers, members of the American Society of Clinical Psychopharmacology, and the Therapeutic Drug Monitoring Task Force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (Association of Neuropsychopharmacology and Pharmacopsychiatry). EVIDENCE TDM literature on antipsychotics was critically reviewed to provide a condensed clinical decision-making algorithm with therapeutic reference ranges for blood antipsychotic 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 utilization of TDM as a tool for problem solving in antipsychotic treatment offers a unique method to improve safety and efficacy. This consensus statement summarizes essential information on the routine use of TDM for antipsychotics and encourages clinicians to perform TDM with the appropriate indications as part of the clinical decision-making process.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004. .,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, and Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, and Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, and Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Stephen R Marder
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - John W Newcomer
- Thriving Mind South Florida Behavioral Health Network, Miami, Florida; and Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA
| | - Delbert G Robinson
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, and Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Donald C Goff
- Department of Psychiatry, NYU Langone Medical Center, New York, and Nathan Kline Institute, Orangeburg, New York, USA
| | - Deanna L Kelly
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daria Piacentino
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, and Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen; and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University; and JARA-Translational Brain Medicine, Aachen, Germany
| | - Andreas Conca
- Servizio Psichiatrico del Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Gerald Zernig
- Experimental Psychiatry Unit, Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, and Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Pierre Baumann
- Department of Psychiatry, University of Lausanne, Prilly-Lausanne, Switzerland
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | -
- Members of the Therapeutic Drug Monitoring Task Force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie are listed at the end of the article
| | | |
Collapse
|
27
|
Kuzin M, Scharrer I, Nolan D, Baumgartner M, Paulzen M, Schoretsanitis G, Xepapadakos F. The role of the poor metabolizer genotype CYP2D6 and CYP1A2 phenotype in the pharmacokinetics of duloxetine and venlafaxine—A case report. Basic Clin Pharmacol Toxicol 2020; 127:354-357. [DOI: 10.1111/bcpt.13428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Maxim Kuzin
- Clienia SchloessliPrivate Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich Oetwil am See, Zurich Switzerland
| | - Isabel Scharrer
- Clienia SchloessliPrivate Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich Oetwil am See, Zurich Switzerland
| | - Daniele Nolan
- Clienia SchloessliPrivate Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich Oetwil am See, Zurich Switzerland
| | - Markus Baumgartner
- Clienia SchloessliPrivate Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich Oetwil am See, Zurich Switzerland
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen University Aachen Germany
- JARA – Translational Brain Medicine Jülich Germany
- Alexianer Hospital Aachen Aachen Germany
| | | | - Franziskos Xepapadakos
- Clienia SchloessliPrivate Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich Oetwil am See, Zurich Switzerland
| |
Collapse
|
28
|
Kuzin M, Schoretsanitis G, Haen E, Ridders F, Hiemke C, Gründer G, Paulzen M. Pharmacokinetic interactions between clozapine and sertraline in smokers and non-smokers. Basic Clin Pharmacol Toxicol 2020; 127:303-308. [PMID: 32307853 DOI: 10.1111/bcpt.13421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
Clozapine is an effective antipsychotic drug for treatment-resistant schizophrenia. Sertraline is a widely prescribed antidepressant and often concomitantly applied to address negative symptoms or depression. However, data on interactions between clozapine and sertraline are inconsistent. The aim of our study was to evaluate pharmacokinetic interactions between clozapine and sertraline analysing a therapeutic drug monitoring database of 1644 clozapine-medicated patients. We compared four groups: non-smokers (n = 250) and smokers (n = 326) with co-medication without known effects on cytochrome P450 and without sertraline, and non-smokers (n = 18) and smokers (n = 17) with sertraline co-medication. Measured and dose-corrected concentrations (C/D) of clozapine were compared between the groups using non-parametrical tests with a significance level of 0.05. Post hoc analyses included pairwise comparisons to account for smoking status. Although we detected significant differences for clozapine levels and C/D values between study groups (P < .001 for Kruskal-Wallis test in both cases), post hoc analyses revealed no differences for concentrations and C/D values of clozapine (P > .05 for Mann-Whitney U test in both cases). A negative correlation between the sertraline dose and the clozapine concentration was found in non-smokers (Spearman's rank correlation, rs = -0.535, P = .048). A potential pharmacokinetic interaction between clozapine and a standard therapeutic sertraline dose seems to be of minor clinical importance.
Collapse
Affiliation(s)
- Maxim Kuzin
- Psychiatric and Psychotherapeutic Private Clinic Clienia Schlössli, Academic Teaching Hospital of the University of Zurich, Oetwil am See, Switzerland
| | | | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Florian Ridders
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich, Germany.,Alexianer Hospital Aachen, Aachen, Germany
| |
Collapse
|
29
|
Schoretsanitis G, Spigset O, Stingl JC, Deligiannidis KM, Paulzen M, Westin AA. The impact of pregnancy on the pharmacokinetics of antidepressants: a systematic critical review and meta-analysis. Expert Opin Drug Metab Toxicol 2020; 16:431-440. [PMID: 32238008 DOI: 10.1080/17425255.2020.1750598] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Pregnancy-related physiological changes exert a crucial impact on the pharmacokinetics of antidepressants; however, the current evidence presents inconsistencies. A clearer understanding of pregnancy-related effects on antidepressant disposition may facilitate the development of guidelines for appropriate dose adjustments during the course of pregnancy based on therapeutic drug monitoring.Areas covered: We systematically reviewed studies comparing antidepressant levels in the same individuals during pregnant and non-pregnant states. Using dose-adjusted plasma concentration measurements, we estimated alteration ratios between the 3rd trimester and baseline (before or after pregnancy). Additionally, we performed a meta-analysis for changes in dose-adjusted concentrations to estimate mean differences.Expert opinion: Data for several antidepressants display clear alteration patterns during pregnancy. On the basis of the alteration ratios trimipramine, fluvoxamine, and nortriptyline show a prominent decrease in dose-adjusted levels, especially in the 3rd trimester. Clomipramine, imipramine, citalopram, and paroxetine show smaller decreases in dose-adjusted concentrations in the third trimester. For escitalopram, venlafaxine and fluoxetine, changes are considered negligible. For sertraline, there was a tendency toward increased dose-adjusted concentrations in pregnancy. Available evidence suffers from major limitations and factors affecting pharmacokinetics have been insufficiently addressed. Further research is required to promote knowledge on pregnancy effects on antidepressant pharmacokinetics.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Kristina M Deligiannidis
- The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Zucker School of Medicine, Hempstead, New York, Manhasset, New York, USA.,The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA - Translational Brain Medicine, Aachen, Germany
| | - Andreas A Westin
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| |
Collapse
|
30
|
Paulzen M, Schoretsanitis G, Gründer G, Franz C, Stingl JC, Augustin M. Pregnancy exposure to venlafaxine-Therapeutic drug monitoring in maternal blood, amniotic fluid and umbilical cord blood and obstetrical outcomes. J Affect Disord 2020; 266:578-584. [PMID: 32056930 DOI: 10.1016/j.jad.2020.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/19/2020] [Accepted: 02/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND For treatment with psychotropic drugs during pregnancy, extended therapeutic drug monitoring is recommended for individual therapy adjustment. We measured venlafaxine (VEN), O-desmethylvenlafaxine (ODV) and active moiety, AM (sum of VEN+ODV) concentrations in maternal serum, amniotic fluid and umbilical cord blood. METHODS Concentrations of VEN, ODVEN and AM were measured in nine mother-infant pairs at time of delivery; in five cases, amniotic fluid samples were available. Concentrations are reported as median values, first (Q1) and third (Q3) quartiles and ranges. Penetration ratio was calculated by dividing concentrations of VEN, ODVEN and AM in amniotic fluid and umbilical cord blood by maternal serum concentrations. RESULTS Median daily dosage of venlafaxine was 75 mg (range 37.5-225 mg). There were no significant correlations between daily dose, maternal serum, umbilical cord blood and amniotic fluid concentrations. Median penetration ratio into amniotic fluid was 2.5 (range 0.56-4.48). Median penetration ratio into fetal circulation was 1.05 (range 0.62-2.08). Median concentration of AM was 223.8 ng/mL, range 33.9-338.0 ng/mL (maternal serum), 789.0 ng/mL, range 309-1052.5 ng/mL (amniotic fluid) and 291.0 ng/mL, range 21.1-448.4 ng/mL (cord blood). DISCUSSION VEN, ODVEN and AM concentrations in maternal serum, amniotic fluid and umbilical cord blood indicate that the fetus might have been exposed to relatively high concentrations throughout pregnancy. High concentrations in amniotic fluid indicate an increased penetration into and/or accumulation within amniotic fluid and a decreased elimination out of amniotic fluid. Findings indicate that fetal in-utero exposition to venlafaxine is higher compared to other antidepressants.
Collapse
Affiliation(s)
- Michael Paulzen
- Alexianer Hospital Aachen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA-Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA; Hofstra Northwell School of Medicine, Hempstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Cordula Franz
- Department of Gynecology and Obstetrics, RWTH Aachen University, Aachen, Germany
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA-Translational Brain Medicine, Aachen, Germany; Protestant University of Applied Sciences Bochum, Immanuel-Kant-Str. 18-20, 44803 Bochum, Germany.
| |
Collapse
|
31
|
Schoretsanitis G, Haen E, Hiemke C, Gründer G, Paulzen M. 22 Using TDM to improve efficacy and safety outcomes of antipsychotic treatment. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0040-1710130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G Schoretsanitis
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health
| | - E Haen
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health
| | - C Hiemke
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health
| | - G Gründer
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health
| | - M Paulzen
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health
| |
Collapse
|
32
|
Kuzin M, Haen E, Bochon B, Endres K, Ridders F, Hiemke C, Gründer G, Paulzen M, Schoretsanitis G. Patterns of clozapine pharmacokinetics in patient subgroups with different body mass index. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0039-3403047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Kuzin
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - E Haen
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - B Bochon
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - K Endres
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - F Ridders
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - C Hiemke
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - G Gründer
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - M Paulzen
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| | - G Schoretsanitis
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern, Switzerland
| |
Collapse
|
33
|
Piacentino D, Kotzalidis GD, Schoretsanitis G, Paulzen M, Haen E, Cappelletti S, Giupponi G, Grözinger M, Conca A. Plasma Risperidone-related Measures in Children and Adolescents with Oppositional Defiant/Conduct Disorders. Clin Psychopharmacol Neurosci 2020; 18:41-48. [PMID: 31958904 PMCID: PMC7006987 DOI: 10.9758/cpn.2020.18.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022]
Abstract
Objective Therapeutic drug monitoring helps clinicians in choosing the right drug and adjust its dose in specific patients. To this end, we aimed to assess time patterns of risperidone and its metabolite, 9-hydroxyrisperidone, in children and adolescents with oppositional defiant and/or conduct disorder. Methods We measured plasma concentrations of risperidone and 9-hydroxyrisperidone, their sum (active moiety, AM) and ratio, as well as plasma concentrations corrected for daily dose (C/D), from 140 children/adolescents with the above-mentioned disorders. We used Student’s t test to compare females versus males, patients under versus over 16-year-old, patients with lower versus higher than the median body weight, and patients with lower versus higher than the median body mass index (BMI). Two mixed-effects logistic regression models were fitted for risperidone/9-hydroxyrisperidone ratio and AM, respectively, by considering risperidone daily dose and patients’ demographic characteristics. Results Females had higher 9-hydroxyrisperidone and AM plasma concentrations than males (p = 0.004 and p = 0.034). Younger patients had lower risperidone plasma concentration and risperidone/9-hydroxyrisperidone ratio (p = 0.02 and p = 0.021), but higher C/D 9-hydroxyrisperidone and AM than older patients (p = 0.013 and p = 0.043). Lower-weight patients had lower plasma risperidone and risperidone/9-hydroxyrisperidone ratio (p = 0.014 and p = 0.019), but higher C/D 9-hydroxyrisperidone concentration than heavier patients (p = 0.03). All these results could be accounted for by daily dose. Patients with lower and higher BMI did not differ significantly. Regression analyses showed that only risperidone daily dose predicted risperidone/9-hydroxyrisperidone ratio, whereas risperidone daily dose, sex, and age predicted AM. Conclusion Clinicians prescribing risperidone need to consider sex, age, and weight, but not BMI when adjusting daily doses.
Collapse
Affiliation(s)
- Daria Piacentino
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse, Intramural Research Program, Nation.,Department of Psychiatry, Central Hospital, Health Agency of South Tyrol, Bozen, Italy
| | - Georgios D Kotzalidis
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Georgios Schoretsanitis
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Simone Cappelletti
- Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences (SAIMLAL) Department, Sapienza University, Rome, Italy
| | - Giancarlo Giupponi
- Department of Psychiatry, Central Hospital, Health Agency of South Tyrol, Bozen, Italy
| | - Michael Grözinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Andreas Conca
- Department of Psychiatry, Central Hospital, Health Agency of South Tyrol, Bozen, Italy
| |
Collapse
|
34
|
Abstract
This article provides an overview of the pharmacokinetic drug-drug interactions (DDIs) for agents prescribed for attention-deficit/hyperactivity disorder (ADHD). Polypharmacy in the treatment of patients with ADHD leads to high exposures to DDIs and possibly adverse safety outcomes. We performed a systematic search of DDI reports for ADHD agents in Embase and Medline. We also searched for agents in the pharmacological pipeline, which include (1) mazindol, molindone and viloxazine, which were previously prescribed for other indications; (2) centanafadine and AR-08, never before approved; and (3) two extracts (Polygala tenuifolia extract and the French maritime pine bark extracts). The identified literature included case reports, cross-sectional, cross-over and placebo-controlled studies of patient cohorts and healthy volunteers. The DDIs were classified as follows: ADHD agents acting as perpetrators, i.e., affecting the clearance of co-prescribed agents (victim drugs), or ADHD agents being the victim drugs, being affected by other agents. Ratios for changes in pharmacokinetic parameters before and after the DDI were used as a rough estimate of the extent of the DDI. Alcohol may increase plasma dextroamphetamine concentrations by presystemic effects. Until studies are done to orient clinicians regarding dosing changes, clinicians need to be aware of the potential for cytochrome P450 (CYP) 2D6 inhibitors to increase amphetamine levels, which is equivalent to increasing dosages. Atomoxetine is a wide therapeutic window drug. The CYP2D6 poor metabolizers who do not have CYP2D6 activity had better atomoxetine response, but also an increased risk of adverse effects. CYP2D6 inhibitors have been used to increase atomoxetine response in CYP2D6 extensive metabolizers. Guanfacine is mainly metabolized by CYP3A4, which can be induced and inhibited. The package insert recommends that in guanfacine-treated patients, after adding potent CYP3A4 inducers, the guanfacine dose should be doubled; after adding potent CYP3A4 inhibitors the guanfacine dose should be halved. Based on a phenobarbital case report and our experience with CYP3A4-metabolized antipsychotics, these correction factors may be too low. According to two case reports, carbamazepine is a clinically relevant inducer of methylphenidate (MPH). A case series study suggested that MPH may be associated with important elevations in imipramine concentrations. Due to the absence of or limitations in the data, no comments for clinicians can be provided on the pharmacokinetic DDIs for clonidine, centanafadine, mazindol, molindone, AR-08, P. tenuifolia extract and the French maritime pine bark extracts. According to currently available data, clinicians should not expect that ADHD drugs modify each other's serum concentrations. A summary table for clinicians provides our current recommendations on pharmacokinetic DDIs of ADHD agents based on our literature review and the package inserts; whenever it was possible, we provide information on serum concentrations and dose correction factors. There will be a need to periodically update these recommendations and these correction factors as new knowledge becomes available.
Collapse
Affiliation(s)
| | - Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, Centre for Psychiatric Neuroscience, Lausanne University Hospital, Hospital of Cery, University of Lausanne, Prilly, Switzerland
- Institute of Pharmaceutical Sciences of Western, Switzerland University of Geneva, Geneva, Switzerland
| | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- The Hofstra Northwell School of Medicine, Hempstead, NY, USA
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen, Alexianergraben 33, 52062, Aachen, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.
- JARA-Translational Brain Medicine, Aachen, Germany.
| |
Collapse
|
35
|
Gründer P, Augustin M, Paulzen M, Gründer G. Influence of Kidney Function on Serum Risperidone Concentrations in Patients Treated With Risperidone. J Clin Psychiatry 2019; 80. [PMID: 31774943 DOI: 10.4088/jcp.19m12890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Risperidone is one of the most commonly prescribed antipsychotics worldwide. Its main metabolite, 9-hydroxyrisperidone (9-OH-RIS), is excreted renally. The present study examined the relationship of kidney function and serum risperidone concentrations in a large sample of risperidone-treated patients. METHODS Serum concentrations of risperidone and its active metabolite 9-OH-RIS, as well as creatinine concentrations, from which glomerular filtration rates (GFRs) were estimated, were determined in 175 risperidone-medicated patients (75 female, 100 male). Data were collected between July 2013 and December 2016. Patients were clustered in 4 groups according to their estimated GFR (eGFR) (30-60; > 60-90; > 90-120; and > 120 mL/min/1.73 m²), and serum concentrations of risperidone and 9-OH-RIS and their sum (active moiety [AM]) were compared groupwise. Additionally, serum concentrations were correlated with kidney function. RESULTS Dose-corrected AM and dose-corrected 9-OH-RIS concentrations were significantly higher in patients with an eGFR of 30-60 mL/min/1.73 m² than in patients with an eGFR > 90-120 mL/min/1.73 m² (P < .001 for dose-corrected AM and P = .001 for dose-corrected 9-OH-RIS) or > 120 mL/min/1.73 m² (P = .036 and .021, respectively). Dose-corrected AM levels were more than doubled in the 30-60 mL/min/1.73 m² group compared to the > 90-120 mL/min/1.73 m² group (mean ± SD = 22.2 ± 14.0 [ng/mL]/[mg/d] vs 10.1 ± 7.7 [ng/mL]/[mg/d]). In the total group, eGFR and dose-corrected 9-OH-RIS and dose-corrected AM were weakly but statistically significantly correlated (Spearman rank correlation coefficient [Rs] = -0.2, P = .004, and Rs = -0.17, P = .01, respectively). CONCLUSIONS Kidney function is an important determinant of risperidone clearance. These data suggest reducing the risperidone dose by 50% in patients with a GFR below 60 mL/min.
Collapse
Affiliation(s)
- Philipp Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, Aachen, Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, Aachen, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, Aachen, Germany.,Alexianer Hospital Aachen, Aachen, Germany.,JARA-Translational Brain Medicine, RWTH Aachen University, Aachen, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, J5, 68159 Mannheim, Germany. .,Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
36
|
Kuzin M, Schoretsanitis G, Haen E, Dammann G, Hiemke C, Gründer G, Paulzen M. The Effects of Co-prescription of Pantoprazole on the Clozapine Metabolism. Pharmacopsychiatry 2019; 53:65-70. [DOI: 10.1055/a-1021-8827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background Polypharmacy including somatic medications such as proton pump inhibitors is a common phenomenon in psychiatric care. The aim of this study was to evaluate the pantoprazole effects on clozapine metabolism.
Methods A large therapeutic drug-monitoring database containing plasma concentrations of CLZ was analyzed. The results were stratified into four groups: a non-smoking (n=250) and a smoking group (n=326), and two groups co-medicated with pantoprazole: non-smokers (n=26) and smokers (n=29). The analysis was based on the non-parametrical Mann-Whitney U test (M-W-U) with a significance level of 0.05.
Results Differences reached statistical significance for pharmacokinetic parameters between CLZ monotherapy and co-medication with pantoprazole neither in smokers nor in non-smokers (p>0.05 for M-W-U in pairwise comparisons). In patients with clozapine monotherapy, smokers had a higher daily dosage of CLZ compared to non-smokers (mean dosage 363±181 vs. 291±145 mg/day, p<0.001 for M-W-U).
Conclusions Adding pantoprazole to an ongoing treatment with clozapine does not alter the metabolism of clozapine to a significant extent.
Collapse
Affiliation(s)
- Maxim Kuzin
- Psychiatric and Psychotherapeutic Private Clinic Clienia Schlössli, Academic Teaching Hospital of the University of Zurich, Oetwil am See, Switzerland
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany
- Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Gerhard Dammann
- Psychiatric Services of Thurgovia, Academic Teaching Hospital of the Medical University of Salzburg, Münsterlingen, Switzerland
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany, and JARA – Translational Brain Medicine, Jülich, Germany
| |
Collapse
|
37
|
Schoretsanitis G, Haen E, Hiemke C, Endres K, Ridders F, Veselinovic T, Gründer G, Paulzen M. Pharmacokinetic correlates of venlafaxine: associated adverse reactions. Eur Arch Psychiatry Clin Neurosci 2019; 269:851-857. [PMID: 30923938 DOI: 10.1007/s00406-019-01005-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/21/2019] [Indexed: 01/03/2023]
Abstract
To address the potential correlation between plasma concentrations of venlafaxine (VEN), its active metabolite O-desmethylvenlafaxine (ODVEN) and the active moiety, AM, (ODVEN + VEN) and adverse drug reactions (ADR) in a large naturalistic sample of in- and outpatients. We compared plasma concentrations of VEN, ODVEN and AM and dose-adjusted (C/D) levels as well the ODVEN/VEN ratios between patients complaining ADRs, following the Udvalg for Kliniske Undersogelser side effect rating scales (UKU) (n = 114) and patients without ADRs (control group, n = 688) out of a naturalistic database. We also investigated potential pharmacokinetic correlates of the four UKU categories by comparing patients complaining ADRs with those who did not. Based on previous literature we applied different ODVEN/VEN ratio values as cut-offs to split our sample into two groups at a time and compare frequencies of ADRs between the groups. No differences for demographic and pharmacokinetic variables including plasma and C/D concentrations as well as ODVEN/VEN ratios were observed between study groups. Neither the comparisons between females and males nor between elderly and non-elderly patients revealed significant differences (p > 0.05 in all cases). No differences were also reported exploring the patients complaining ADRs from the 4 UKU categories separately. After applying various ODVEN/VEN cut-offs, groups did not display differences in frequencies of ADRs (p > 0.05 in all cases). Our findings do not demonstrate a direct link between venlafaxine metabolism measures and ADRs. Therefore, additional dimensions are needed to be considered in future trials aiming to disentangle the involved aspects of ADRs in patients receiving venlafaxine.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Katharina Endres
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Florian Ridders
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Tanja Veselinovic
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.,JARA: Translational Brain Medicine, Aachen, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.,JARA: Translational Brain Medicine, Aachen, Germany.,Alexianer Hospital Aachen, Aachen, Germany
| |
Collapse
|
38
|
Unterecker S, Hefner G, Baumann P, Gründer G, Bergemann N, Clement HW, Conca A, Deckert J, Domschke K, Eckermann G, Egberts K, Gerlach M, Greiner C, Haen E, Havemann-Reinecke U, Helmer R, Janssen G, Jaquenoud E, Laux G, Messer T, Mössner R, Müller MJ, Paulzen M, Pfuhlmann B, Riederer P, Saria A, Schoppek B, Schoretsanitis G, Schwarz M, Gracia MS, Stegmann B, Steimer W, Stingl JC, Uhr M, Ulrich S, Waschgler R, Zernig G, Zurek G, Hiemke C. [Erratum to: Therapeutic drug monitoring in neuropsychopharmacology : Summary of the consensus guidelines 2017 of the TDM task force of the AGNP]. Nervenarzt 2019; 90:958-960. [PMID: 31309271 DOI: 10.1007/s00115-019-0766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Stefan Unterecker
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Deutschland.
| | - Gudrun Hefner
- Waldkrankenhaus Köppern, Vitos Klinik Hochtaunus, Friedrichsdorf, Deutschland
| | - Pierre Baumann
- Klinik für Psychiatrie, Universität Lausanne, Prilly-Lausanne, Schweiz
| | - Gerd Gründer
- Abteilung Molekulares Neuroimaging, Medizinische Fakultät Mannheim, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - Niels Bergemann
- Klinik für Psychosomatik und Psychotherapie, Kitzberg-Kliniken, Bad Mergentheim, Deutschland
| | - Hans-Willi Clement
- Klinik für Kinder- und Jugendpsychiatrie, Universität Freiburg, Freiburg, Deutschland
| | - Andreas Conca
- Servizio Psichiatrico del Comprensorio Sanitario di Bolzano, Bolzano, Italien
| | - Jürgen Deckert
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Deutschland
| | - Katharina Domschke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | | | - Karin Egberts
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Manfred Gerlach
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Christine Greiner
- Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Deutschland
| | - Ekkehard Haen
- Klinische Pharmakologie, Institut AGATE, Pentling, und Klinische Pharmakologie am Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland
| | | | | | - Ger Janssen
- Medizinisches Labor Stein, Limbach Group, Mönchengladbach, Deutschland
| | | | - Gerd Laux
- Institut für Psychologische Medizin und Zentrum für Neuropsychiatrie, Soyen und Waldkraiburg, Deutschland
| | - Thomas Messer
- Psychiatrische Klinik, Danuviuskliniken, Pfaffenhofen, Deutschland
| | - Rainald Mössner
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - Matthias J Müller
- Psychiatrische Klinik Oberberggruppe und Justus-Liebig-Universität Gießen, Berlin und Gießen, Deutschland
| | - Michael Paulzen
- Alexianer Krankenhaus, Aachen, Deutschland
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | | | - Peter Riederer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Deutschland
| | - Alois Saria
- Department für Psychiatrie, Psychotherapie und Psychosomatik, 1, Abteilung für Experimentelle Psychiatrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Bernd Schoppek
- Psychiatrische Klinik, kbo-Isar-Amper Klinikum München-Ost, München-Haar, Deutschland
| | | | - Markus Schwarz
- Institut für Laboratoriumsmedizin, Klinikum der Universität München, Ludwig Maximilian Universität, München, Deutschland
| | - Margarethe Silva Gracia
- Klinische Pharmakologie, Institut AGATE, Pentling, und Klinische Pharmakologie am Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland
| | - Benedikt Stegmann
- Klinische Pharmakologie, Institut AGATE, Pentling, und Klinische Pharmakologie am Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland
| | - Werner Steimer
- Institut für klinische Chemie und Pathobiochemie, Technische Universität München, München, Deutschland
| | - Julia C Stingl
- Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Deutschland
| | - Manfred Uhr
- Max Planck Institut für Psychiatrie, München, Deutschland
| | | | | | - Gerald Zernig
- Department für Psychiatrie, Psychotherapie und Psychosomatik, 1, Abteilung für Experimentelle Psychiatrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
- Gerichtssachverständiger und Psychotherapeut, Hall in Tirol, Österreich
| | | | - Christoph Hiemke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Mainz, Mainz, Deutschland
- Institut für klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Mainz, Mainz, Deutschland
| |
Collapse
|
39
|
Augustin M, Schoretsanitis G, Pfeifer P, Gründer G, Liebe C, Paulzen M. Effect of fluvoxamine augmentation and smoking on clozapine serum concentrations. Schizophr Res 2019; 210:143-148. [PMID: 31182321 DOI: 10.1016/j.schres.2019.05.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/18/2019] [Accepted: 05/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clozapine (CLZ) is metabolized via cytochrome P450 CYP1A2 to N-desmethylclozapine (NCLZ). Smoking induces CYP1A2 thereby increasing clozapine metabolism whereas fluvoxamine inhibits CYP1A2. Studies suggest that the beneficial effect of fluvoxamine augmentation in raising serum clozapine concentrations also occurs when serum concentrations are low due to smoking. Yet, little is known about the influence of fluvoxamine augmentation on clozapine serum concentrations in smoking versus non-smoking patients. METHODS A TDM database was analyzed. Serum concentrations of CLZ, NCLZ, dose-adjusted serum concentrations (C/D) and metabolite-to-parent ratios (MPR) were compared using non-parametrical tests in four groups: clozapine-monotherapy in non-smokers (VNS, n = 28) and smokers (VS, n = 43); combined treatment with clozapine and fluvoxamine in non-smokers (VNS+F, n = 11) and smokers (VS+F, n = 43). RESULTS The CLZ monotherapy smoking group showed lower values of C/D CLZ of -38.6% (p < 0.001), C/D NCLZ -35.6% (p < 0.001) and a higher MPR (p = 0.021) than in the non-smoking group. The combination of CLZ and fluvoxamine in non-smoking patients led to higher C/D values: C/D CLZ +117.9% (p < 0.001), C/D NCLZ +60.8% (p = 0.029) while the MPR did not differ between groups (p = 0.089). Changes were comparable to fluvoxamine augmentation in the smoking group with increased C/D CLZ of +120.1% (p < 0.001), C/D NCLZ of +85.8% (p < 0.001) and lower MPR (p = 0.006). CONCLUSIONS Smoking in clozapine monotherapy reduced median dose-adjusted serum concentrations more than a third. Combined treatment with fluvoxamine and clozapine led to higher median C/D values in both, smokers and non-smokers. The opposing effects of CYP1A2 induction by smoking and inhibition by fluvoxamine on clozapine serum concentrations balanced out.
Collapse
Affiliation(s)
- Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany.
| | - Georgios Schoretsanitis
- University Hospital of Psychiatry, Bern, Switzerland; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Hempstead, New York and The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Philippe Pfeifer
- University Hospital of Psychiatry Bern, University of Bern, Bern, Switzerland
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany; Alexianer Hospital Aachen, Aachen, Germany
| |
Collapse
|
40
|
Augustin M, Schoretsanitis G, Hiemke C, Gründer G, Haen E, Paulzen M. Differences in Duloxetine Dosing Strategies in Smoking and Nonsmoking Patients: Therapeutic Drug Monitoring Uncovers the Impact on Drug Metabolism. J Clin Psychiatry 2018; 79. [PMID: 30192450 DOI: 10.4088/jcp.17m12086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND For certain psychotropic drugs, such as clozapine or olanzapine, the influence of smoking on drug metabolism is well studied. Tobacco smoke increases the metabolism of drugs that are substrates for cytochrome P450 (CYP) 1A2 due to CYP induction. The antidepressant duloxetine, acting as a serotonin-norepinephrine reuptake inhibitor, is mainly metabolized via CYP1A2. To date, little is known about the influence of smoking on serum duloxetine concentrations. METHODS A therapeutic drug monitoring database consisting of plasma concentrations of duloxetine collected from January 2013 to June 2017 was analyzed. A group of nonsmoking patients undergoing treatment with duloxetine (n = 89) was compared to a group of active smokers also receiving duloxetine (n = 36). Serum concentrations of duloxetine and dose-adjusted serum concentrations were compared using non-parametric tests. RESULTS Groups did not differ concerning sex (P = .063), but the group of active smokers was younger (P < .001) and received higher daily doses of duloxetine (P = .001). Smokers showed significantly lower median serum duloxetine concentrations (38.4% lower, P = .002) and 53.6% lower dose-adjusted serum concentrations (0.325 [ng/mL]/[mg/d] in smokers vs 0.7 [ng/mL]/[mg/d] in nonsmokers, P < .001). CONCLUSIONS Despite higher daily doses, smokers had considerably lower serum duloxetine concentrations. The induction of CYP1A2 by tobacco smoke is a clinically relevant factor for drugs that are substrates for CYP1A2. Clinicians should actively assess smoking status, inform patients about the effect of smoking on duloxetine metabolism, and anticipate higher serum concentrations in the case of smoking cessation. Therapeutic drug monitoring ensures treatment efficacy by enabling the personalizing of treatment, as smokers need higher duloxetine doses to target serum concentrations within the therapeutic reference range.
Collapse
Affiliation(s)
- Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics and JARA-Translational Brain Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany. .,Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen and JARA-Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen and JARA-Translational Brain Medicine, Aachen, Germany.,University Hospital of Psychiatry, Bern, Switzerland
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen and JARA-Translational Brain Medicine, Aachen, Germany.,Alexianer Hospital, Aachen, Germany
| |
Collapse
|
41
|
Veselinović T, Vernaleken I, Janouschek H, Cumming P, Paulzen M, Mottaghy FM, Gründer G. The role of striatal dopamine D 2/3 receptors in cognitive performance in drug-free patients with schizophrenia. Psychopharmacology (Berl) 2018; 235:2221-2232. [PMID: 29717334 DOI: 10.1007/s00213-018-4916-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE A considerable body of research links cognitive function to dopaminergic transmission in the prefrontal cortex, but less is known about cognition in relation to striatal dopamine D2/3 receptors in unmedicated patients with psychosis. METHODS We investigated this association by obtaining PET recordings with the high-affinity D2/3 antagonist ligand [18F] fallypride in 15 medication-free patients with schizophrenia and 11 healthy controls. On the day of PET scanning, we undertook comprehensive neuropsychological testing and assessment of psychopathology using the Positive and Negative Syndrome Scale (PANSS). RESULTS The patients' performance in cognitive tests was significantly impaired in almost all domains. Irrespective of medication history, the mean [18F] fallypride binding potential (BPND) in the patient group tended to be globally 5-10% higher than that of the control group, but without reaching significance in any brain region. There were significant positive correlations between individual patient performance in the Trail Making Test (TMT(A) and TMT(B)) and Digit-Symbol-Substitution-Test with regional [18F] fallypride BPND, which remained significant after Bonferroni correction for the TMT(A) in caudate nucleus (CN) and for the TMT(B) in CN and putamen. No such correlations were evident in the control group. DISCUSSION The association between better cognitive performance and greater BPND in schizophrenia patients may imply that relatively lower receptor occupancy by endogenous dopamine favors better sparing of cognitive function. Absence of comparable correlations in healthy controls could indicate a greater involvement of signaling at dopamine D2/3 receptors in certain cognitive functions in schizophrenia patients than in healthy controls.
Collapse
Affiliation(s)
- Tanja Veselinović
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany. .,Jülich Aachen Research Alliance JARA, Translational Brain Medicine, Jülich, Germany.
| | - Ingo Vernaleken
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.,Jülich Aachen Research Alliance JARA, Translational Brain Medicine, Jülich, Germany
| | - Hildegard Janouschek
- Department of Psychiatry and Iowa Neuroscience Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Paul Cumming
- School of Psychology and Counselling and IHBI, Queensland University of Technology, and QIMR-Berghofer Institute, Brisbane, Australia
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.,Jülich Aachen Research Alliance JARA, Translational Brain Medicine, Jülich, Germany.,Alexianer Hospital Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
42
|
Kuzin M, Schoretsanitis G, Haen E, Dammann G, Hiemke C, Gründer G, Paulzen M. The effect of pharmacological interaction between a proton pump inhibitor pantoprazole and clozapine. PHARMACOPSYCHIATRY 2018. [DOI: 10.1055/s-0038-1649536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Kuzin
- Psychiatric Services of Thurgovia, Academic Teaching Hospital of the Medical University of Salzburg, Münsterlingen, Switzerland
| | - G Schoretsanitis
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany, and JARA – Translational Brain Medicine, Jülich, Germany
| | - E Haen
- Clinical Pharmacology at the Department of Psychiatry and Psychotherapy and at the Department of Pharmacology and Toxicology, University of Regensburg, Germany
| | - G Dammann
- Psychiatric Services of Thurgovia, Academic Teaching Hospital of the Medical University of Salzburg, Münsterlingen, Switzerland
| | - C Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - G Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany, and JARA – Translational Brain Medicine, Jülich, Germany
- Alexianer Hospital Aachen, Alexianergraben 33, 52062, Aachen, Germany
| |
Collapse
|
43
|
Paulzen M, Goecke TW, Kuzin M, Augustin M, Gründer G, Schoretsanitis G. Pregnancy exposure to quetiapine - Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood and obstetrical outcomes. Schizophr Res 2018; 195:252-257. [PMID: 28965779 DOI: 10.1016/j.schres.2017.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE This prospective study is the first to measure and correlate quetiapine concentrations in maternal blood, amniotic fluid and umbilical cord blood to account for the distribution of quetiapine. METHODS Concentrations of quetiapine are quantified in seven mother infant pairs at the time of delivery. Data are provided as median values, first (Q1) and third (Q3) quartiles and ranges. To account for the penetration ratio, the concentration of quetiapine in amniotic fluid and cord blood was divided by maternal concentrations. Correlations between daily dosage, maternal serum and umbilical cord blood concentrations were computed for seven patients while calculations for amniotic fluid were only available for six mother-infant pairs. RESULTS The median daily dosage of quetiapine was 300mg (Q1: 300mg, Q3: 600mg, range 200-800mg). There was a strong and significant correlation between maternal serum and cord blood concentrations (r=0.893, p=0.007). The median penetration ratio into fetal circulation was 0.18 (Q1: 0.16, Q3: 0.32; range 0.13-0.42), suggesting a low penetration. The median penetration ratio into amniotic fluid was 0.44 (Q1: 0.15, Q3: 0.96; range 0.09-1.70). CONCLUSIONS Quetiapine concentrations in amniotic fluid and cord blood give evidence that quetiapine is constantly accessible to the fetus with a relatively low penetration ratio. A high correlation between maternal serum and umbilical cord blood concentrations highlights a predictive role of quantifying drug concentrations in maternal serum for assessing drug concentrations in fetal circulation. Findings support the important role of therapeutic drug monitoring in supporting the efficacy and safety of psychopharmacological treatment strategies in highly vulnerable populations.
Collapse
Affiliation(s)
- Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Alexianer Hospital Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany.
| | - Tamme W Goecke
- Department of Gynecology and Obstetrics, RWTH Aachen University, Germany
| | - Maxim Kuzin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; University Hospital of Psychiatry, Bern, Switzerland
| |
Collapse
|
44
|
Paulzen M, Stingl JC, Augustin M, Saßmannshausen H, Franz C, Gründer G, Schoretsanitis G. Comprehensive measurements of intrauterine and postnatal exposure to lamotrigine. PHARMACOPSYCHIATRY 2018. [DOI: 10.1055/s-0038-1649539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Paulzen
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany, and JARA – Translational Brain Medicine
| | - JC Stingl
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany
- Centre for Translational Medicine, University Bonn Medical Faculty, Bonn, Germany
| | - M Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany, and JARA – Translational Brain Medicine
| | - H Saßmannshausen
- Department of Gynecology and Obstetrics, RWTH Aachen University, Germany
| | - C Franz
- Department of Gynecology and Obstetrics, RWTH Aachen University, Germany
| | - G Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - G Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany, and JARA – Translational Brain Medicine
- University Hospital of Psychiatry, Bern, Switzerland
| |
Collapse
|
45
|
Schoretsanitis G, Paulzen M, Unterecker S, Schwarz M, Conca A, Zernig G, Gründer G, Haen E, Baumann P, Bergemann N, Clement HW, Domschke K, Eckermann G, Egberts K, Gerlach M, Greiner C, Havemann-Reinecke U, Hefner G, Helmer R, Janssen G, Jaquenoud-Sirot E, Laux G, Messer T, Mössner R, Müller MJ, Pfuhlmann B, Riederer P, Saria A, Schoppek B, Silva Gracia M, Stegmann B, Steimer W, Stingl JC, Uhr M, Ulrich S, Waschgler R, Zurek G, Hiemke C. TDM in psychiatry and neurology: A comprehensive summary of the consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology, update 2017; a tool for clinicians<sup/>. World J Biol Psychiatry 2018; 19:162-174. [PMID: 29493375 DOI: 10.1080/15622975.2018.1439595] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Therapeutic drug monitoring (TDM) combines the quantification of drug concentrations in blood, pharmacological interpretation and treatment guidance. TDM introduces a precision medicine tool in times of increasing awareness of the need for personalized treatment. In neurology and psychiatry, TDM can guide pharmacotherapy for patient subgroups such as children, adolescents, pregnant women, elderly patients, patients with intellectual disabilities, patients with substance use disorders, individuals with pharmacokinetic peculiarities and forensic patients. Clear indications for TDM include lack of clinical response in the therapeutic dose range, assessment of drug adherence, tolerability issues and drug-drug interactions. METHODS Based upon existing literature, recommended therapeutic reference ranges, laboratory alert levels, and levels of recommendation to use TDM for dosage optimization without specific indications, conversion factors, factors for calculation of dose-related drug concentrations and metabolite-to-parent ratios were calculated. RESULTS This summary of the updated consensus guidelines by the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie offers the practical and theoretical knowledge for the integration of TDM as part of pharmacotherapy with neuropsychiatric agents into clinical routine. CONCLUSIONS The present guidelines for TDM application for neuropsychiatric agents aim to assist clinicians in enhancing safety and efficacy of treatment.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- a Department of Psychiatry , University of Bern , Bern , Switzerland.,b Department of Psychiatry, Psychotherapy and Psychosomatics , RWTH Aachen University, JARA - Translational Brain Medicine , Aachen , Germany
| | - Michael Paulzen
- b Department of Psychiatry, Psychotherapy and Psychosomatics , RWTH Aachen University, JARA - Translational Brain Medicine , Aachen , Germany.,c Alexianer Hospital Aachen , Aachen , Germany
| | - Stefan Unterecker
- d Department of Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Germany
| | - Markus Schwarz
- e Department of Laboratory Medicine , Ludwig Maximilian University , Munich , Germany
| | - Andreas Conca
- f Servizio Psichiatrico del Comprensorio Sanitario di Bolzano , Bolzano , Italy
| | - Gerald Zernig
- g Experimental Psychiatry Unit, Department of Psychiatry and Psychotherapy , Medical University of Innsbruck , Innsbruck , Austria.,h Private Practice for Psychotherapy and Court-Certified Witness , Hall in Tirol , Austria
| | - Gerhard Gründer
- i Department of Molecular Neuroimaging , Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg , Mannheim , Germany
| | - Ekkerhard Haen
- j Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology , University of Regensburg , Regensburg , Germany
| | - Pierre Baumann
- k Department of Psychiatry , University of Lausanne , Lausanne , Switzerland
| | - Niels Bergemann
- l Kitzberg Hospitals, Center for Psychosomatic Medicine and Psychotherapy , Bad Mergentheim , Germany
| | - Hans Willi Clement
- m Department of Child and Adolescent Psychiatry , University of Freiburg , Freiburg , Germany
| | - Katharina Domschke
- n Department of Psychiatry and Psychotherapy , Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg , Freiburg , Germany
| | | | - Karin Egberts
- p Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , Center of Mental Health, University Hospital of Würzburg , Germany
| | - Manfred Gerlach
- p Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , Center of Mental Health, University Hospital of Würzburg , Germany
| | - Christine Greiner
- q Federal Institute for Drugs and Medical Devices (BfArM) , Bonn , Germany
| | | | - Gudrun Hefner
- s Psychiatric Hospital, Vitos Klinik Hochtaunus , Friedrichsdorf , Germany
| | | | - Ger Janssen
- u Medical Laboratory Stein , Limbach Group , Mönchengladbach , Germany
| | | | - Gerd Laux
- w Institute of Psychological Medicine , Haag in Oberbayern , Germany
| | - Thomas Messer
- x Danuviuskliniken, Psychiatric Hospital , Pfaffenhofen , Germany
| | - Rainald Mössner
- y Department of Psychiatry and Psychotherapy , University of Tübingen , Tübingen , Germany
| | | | | | - Peter Riederer
- d Department of Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Germany
| | - Alois Saria
- g Experimental Psychiatry Unit, Department of Psychiatry and Psychotherapy , Medical University of Innsbruck , Innsbruck , Austria
| | - Bernd Schoppek
- ab kbo-Isar-Amper Klinikum München-Ost, Psychiatric Hospital , Munich , Germany
| | - Margarete Silva Gracia
- j Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology , University of Regensburg , Regensburg , Germany
| | - Benedikt Stegmann
- j Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology , University of Regensburg , Regensburg , Germany
| | - Werner Steimer
- ac Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich , Munich , Germany
| | - Julia C Stingl
- q Federal Institute for Drugs and Medical Devices (BfArM) , Bonn , Germany
| | - Manfred Uhr
- ad Max Planck Institute of Psychiatry , Munich , Germany
| | | | | | | | - Christoph Hiemke
- ah Department of Psychiatry and Psychotherapy , University Medical Center of Mainz , Mainz , Germany.,ai Institute of Clinical Chemistry and Laboratory Medicine , University Medical Center of Mainz , Mainz , Germany
| |
Collapse
|
46
|
Paulzen M, Haen E, Hiemke C, Fay B, Unholzer S, Gründer G, Schoretsanitis G. Antidepressant polypharmacy and the potential of pharmacokinetic interactions: Doxepin but not mirtazapine causes clinically relevant changes in venlafaxine metabolism. J Affect Disord 2018; 227:506-511. [PMID: 29156365 DOI: 10.1016/j.jad.2017.11.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/07/2017] [Accepted: 11/11/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND To uncover pharmacokinetic interactions between venlafaxine and doxepin or mirtazapine in a naturalistic sample. METHODS A therapeutic drug monitoring database containing plasma concentrations of venlafaxine (VEN) and its active metabolite O-desmethylvenlafaxine (ODVEN) was analyzed. We included 1067 of 1594 patients in the analysis. Three study groups were considered; a group of patients under venlafaxine without confounding medications, V0 (n = 905), a group of patients co-medicated with doxepin, VDOX (n = 25) and a second group, co-medicated with mirtazapine, VMIR, n = 137. Plasma concentrations of VEN, ODVEN and the clinically relevant active moiety, sum of venlafaxine and O-desmethylvenlafaxine (ODVEN) (AM), as well as dose-adjusted plasma concentrations (C/D) were compared. RESULTS Median concentrations in the doxepin group showed 57.7% and 194.4% higher values for AM and VEN respectively; these differences were statistically significant (p < 0.001 for AM and p = 0.002 for VEN). Similar differences were detected for C/D concentrations of active moiety and VEN (p < 0.001 and p = 0.001) with higher values also in the doxepin group. The ratios ODVEN/VEN were lower in the doxepin group (p < 0.001). A co-medication with mirtazapine did not cause any changes in venlafaxine metabolism. CONCLUSIONS Higher concentrations for VEN and AM imply an inhibiting effect of doxepin on the metabolism of venlafaxine, although the huge variability of concentrations has to be taken into account. It is recommended to monitor plasma concentrations in combination treatment to avoid problems in safety and efficacy. LIMITATIONS Despite the large size of our study sample, the naturalistic nature of this data may arise some concerns of information bias potentially resulting from non-standardized data recording.
Collapse
Affiliation(s)
- Michael Paulzen
- Alexianer Hospital Aachen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - Bianca Fay
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Sandra Unholzer
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany; University Hospital of Psychiatry, Bern, Switzerland.
| |
Collapse
|
47
|
Hiemke C, Bergemann N, Clement HW, Conca A, Deckert J, Domschke K, Eckermann G, Egberts K, Gerlach M, Greiner C, Gründer G, Haen E, Havemann-Reinecke U, Hefner G, Helmer R, Janssen G, Jaquenoud E, Laux G, Messer T, Mössner R, Müller MJ, Paulzen M, Pfuhlmann B, Riederer P, Saria A, Schoppek B, Schoretsanitis G, Schwarz M, Gracia MS, Stegmann B, Steimer W, Stingl JC, Uhr M, Ulrich S, Unterecker S, Waschgler R, Zernig G, Zurek G, Baumann P. Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017. Pharmacopsychiatry 2018; 51:e1. [PMID: 29390205 DOI: 10.1055/s-0037-1600991] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - N Bergemann
- Kitzberg Hospitals, Center for Psychosomatic Medicine and Psychotherapy, Bad Mergentheim, Germany
| | - H W Clement
- Department of Child and Adolescent Psychiatry, University of Freiburg, Freiburg, Germany
| | - A Conca
- Servizio Psichiatrico del Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - J Deckert
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Würzburg, Germany
| | - K Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - K Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
| | - M Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Germany
| | - C Greiner
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - G Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, and JARA - Translational Brain Medicine, Aachen, Germany
| | - E Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - U Havemann-Reinecke
- Department of Psychiatry and Psychosomatics, University of Göttingen, Göttingen, Germany
| | - G Hefner
- Psychiatric Hospital, Vitos Klinik, Eichberg, Eltville, Germany
| | - R Helmer
- Center of Epilepsy, Bielefeld, Germany
| | - G Janssen
- Medical Laboratory Stein, Limbach Group, Mönchengladbach, Germany
| | - E Jaquenoud
- Psychiatric Hospital, Königsfelden, Brugg, Aargau, Switzerland
| | - G Laux
- Institute of Psychological Medicine, Haag in Oberbayern, Germany
| | - T Messer
- Danuviuskliniken, Psychiatric Hospital, Pfaffenhofen, Germany
| | - R Mössner
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - M J Müller
- Psychiatric Hospitals Oberberggruppe, Berlin, Germany
| | - M Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, and JARA - Translational Brain Medicine, Aachen, Germany
| | - B Pfuhlmann
- Psychiatric Hospital Weisser Hirsch, Dresden, Germany
| | - P Riederer
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Würzburg, Germany
| | - A Saria
- Experimental Psychiatry Unit, Department of Psychiatry 1, Medical University of Innsbruck, Innsbruck, Austria
| | - B Schoppek
- kbo-Isar-Amper Klinikum München-Ost, Psychiatric Hospital, Munich-Haar, Germany
| | | | - M Schwarz
- Department of Laboratory Medicine, Ludwig Maximilian University, Munich, Germany
| | - M Silva Gracia
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - B Stegmann
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - W Steimer
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
| | - J C Stingl
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - M Uhr
- Max Planck Institute of Psychiatry, Munich, Germany
| | - S Ulrich
- Aristo Pharma GmbH, Berlin, Germany
| | - S Unterecker
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Würzburg, Germany
| | | | - G Zernig
- Experimental Psychiatry Unit, Department of Psychiatry 1, Medical University of Innsbruck, Innsbruck, Austria.,Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria
| | - G Zurek
- Medical Laboratory Bremen, Bremen, Germany
| | - P Baumann
- Department of Psychiatry, University of Lausanne, Prilly-Lausanne, Switzerland
| |
Collapse
|
48
|
Veselinović T, Vernaleken I, Cumming P, Henning U, Winkler L, Kaleta P, Paulzen M, Luckhaus C, Gründer G. Antidopaminergic medication in healthy subjects provokes subjective and objective mental impairments tightly correlated with perturbation of biogenic monoamine metabolism and prolactin secretion. Neuropsychiatr Dis Treat 2018; 14:1125-1138. [PMID: 29731635 PMCID: PMC5927059 DOI: 10.2147/ndt.s148557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Off-label prescription of antipsychotics to patients without psychotic symptoms has become a routine matter for many psychiatrists and also some general practitioners. Nonetheless, little is known about the possibly detrimental effects of antidopaminergic medications on general psychopathology, subjective mental state, or a possible association with physiological parameters in nonpsychotic individuals. METHODS In this randomized, single-blinded study, groups of healthy volunteers (n=18) received low doses of reserpine, aripiprazole, haloperidol, or placebo on 7 successive days. Relevant physiological parameters (plasma prolactin, concentrations of catecholamine metabolites in plasma, and 24-hour urine) and each subject's mental state (Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression, visual analogue scale, Beck Depression Inventory II) were assessed at the start and end of the trial. RESULTS Of the three active treatments, only reserpine caused a significant increase in some plasma- and urine-catecholamine metabolites, but all three medications evoked objective and subjective changes in general psychopathology scores, which correlated with individual increases in plasma homovanillic acid concentrations. Both objective and subjective impairments were significantly more pronounced in the subgroup with greatest increase of plasma prolactin. Subjects experiencing the most pronounced side effects under haloperidol, which compelled them to drop out, showed significantly higher prolactin concentration increases than those who tolerated haloperidol well. CONCLUSION We found consistent associations between altered markers of dopamine transmission and several objective and subjective mental impairments in healthy volunteers after 1 week's treatment with antidopaminergic medications. These findings should draw attention to a more intensive risk-benefit evaluation in cases of off-label prescription of antipsychotic medications.
Collapse
Affiliation(s)
- Tanja Veselinović
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Ingo Vernaleken
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Paul Cumming
- IHBI, School of Psychology and Counselling, Queensland University of Technology.,QIMR Berghofer Institute, Brisbane, Australia
| | - Uwe Henning
- Neurobiochemical Research Unit, Department of Psychiatry, Heinrich Heine University, Düsseldorf
| | - Lina Winkler
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Peter Kaleta
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Christian Luckhaus
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr University Bochum, Bochum
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany.,Department of Molecular Neuroimaging, Central Institute of Mental Health, Mannheim, Germany
| |
Collapse
|
49
|
Schoretsanitis G, de Leon J, Haen E, Stegmann B, Hiemke C, Gründer G, Paulzen M. Pharmacokinetics of risperidone in different application forms - Comparing long-acting injectable and oral formulations. Eur Neuropsychopharmacol 2018; 28:130-137. [PMID: 29153926 DOI: 10.1016/j.euroneuro.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/06/2017] [Accepted: 11/03/2017] [Indexed: 12/20/2022]
Abstract
We aimed to explore the differences in the pharmacokinetics of risperidone between oral and long-acting injectable (LAI) formulations using a large database of therapeutic drug monitoring (TDM). Plasma concentrations of risperidone (RIS), its active metabolite (9-OH-RIS) and the active moiety (AM) (RIS+9-OH-RIS), their concentration-to-dose (C/D) ratios and ratio of RIS/9-OH-RIS (an index of CYP2D6 metabolic activity) were used to compare patients receiving risperidone orally (n = 851) and those treated with LAI RIS (n = 63). Patients taking CYP inducers or inhibitors or with liver/renal impairment were eliminated. Our study demonstrated that patients on LAI RIS, despite slightly higher RIS doses in the oral group, showed no significant differences in total AM or 9-OH-RIS. Conversely, RIS concentration, RIS C/D ratio and total C/D ratio were slightly higher in the LAI RIS group, reaching significance due to the large sample size. More importantly, the median ratio of RIS/9-OH-RIS was 0.52 in LAI RIS vs. 0.25 in the oral group, providing a significant difference (p < 0.001). After controlling for confounding factors, we replicated the RIS/9-OH-RIS ratio increases in patients with LAI RIS, probably reflecting a decrease in first-pass metabolism. More studies are required to establish the clinical use of TDM for patients on LAI RIS.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- University Hospital of Psychiatry, Bern, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Germany.
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, 18971 Granada, Spain; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, 01004 Vitoria, Spain
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Benedikt Stegmann
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Germany
| |
Collapse
|
50
|
Schoretsanitis G, Kirner-Veselinovic A, Gründer G, Paulzen M. Clinically relevant changes in clozapine serum concentrations after breast reduction surgery. Aust N Z J Psychiatry 2017; 51:1059-1060. [PMID: 28810804 DOI: 10.1177/0004867417726584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Georgios Schoretsanitis
- 1 JARA-Translational Brain Medicine and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.,2 Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - André Kirner-Veselinovic
- 1 JARA-Translational Brain Medicine and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Gerhard Gründer
- 1 JARA-Translational Brain Medicine and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Michael Paulzen
- 1 JARA-Translational Brain Medicine and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| |
Collapse
|