A Critical Commentary on the 2017 AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology

Abstract

In 2004, 2011, and 2017, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), a group of German-speaking psychiatric researchers and psychiatrists, published successive versions of therapeutic drug monitoring (TDM) expert group consensus guidelines. The 2017 version has as a major strength its encyclopedic nature, including 1358 references. The guideline has 3 major sections: 1) theoretical aspects of TDM, 2) drug concentration levels in blood to guide neuropsychopharmacotherapy, and 3) practical aspects of TDM in psychiatry and neurology. The writer hopes the time is right for a TDM guideline in psychiatry, which is indicated for: 1) psychiatric researchers ready to value how TDM can contribute to moving psychopharmacology forward, 2) flexible clinicians ready to improve their patient care by personalizing dosing, and 3) today’s psychiatry residents prepared as a new generation ready to be trained in TDM and willing to continue incorporating TDM as new psychiatric drugs are marketed.

Quantitative determination of risperidone, paliperidone and olanzapine in human serum by liquid chromatography–tandem mass spectrometry coupled with on‐line solid‐phase extraction

“…Currently there is renewed interest in TDM for all SGAPs and particularly for these three SGAPs. Two developments may have contributed to this renewed interest in resurrecting the use of TDM in psychiatry (de Leon, 2018): first, technological advances; and second, the maturation of the science of TDM. Technological advances have made TDM of multiple drugs at the same time cheaper and easier to the point that commercial companies are becoming interested in SGAP TDM (Horvitz-Lennon, Mattke, Predmore, & Howes, 2017;de Leon, 2018).…”

“…Two developments may have contributed to this renewed interest in resurrecting the use of TDM in psychiatry (de Leon, 2018): first, technological advances; and second, the maturation of the science of TDM. Technological advances have made TDM of multiple drugs at the same time cheaper and easier to the point that commercial companies are becoming interested in SGAP TDM (Horvitz-Lennon, Mattke, Predmore, & Howes, 2017;de Leon, 2018). A group of experts from German-speaking countries, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), developed a guideline for TDM with a first version in 2004 (Baumann et al, 2004) and a second version in 2011 (Hiemke et al, 2011).…”

“…A group of experts from German-speaking countries, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), developed a guideline for TDM with a first version in 2004 (Baumann et al, 2004) and a second version in 2011 (Hiemke et al, 2011). The third version developed in 2017 and published in 2018 (Hiemke et al, 2018) probably signals the maturation of the science of TDM in psychiatry (de Leon, 2018).…”

“…In the 1980s, therapeutic drug monitoring (TDM) was standard in the clinical practice of psychiatry since some of the older psychiatric drugs, such as lithium and tricyclic antidepressants (TCAs), had narrow therapeutic windows (de Leon, ). With the introduction of the second generation of psychiatric drugs and the decreasing use of lithium and TCAs, TDM lost favor in psychiatry.…”

Editorial to Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology

“…This issue of Pharmacopsychiatry contains only one major paper, the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017 by Hiemke et al [1] and an accompanying invited commentary by de Leon [2]. The consensus guidelines are published by the task force "Therapeutic Drug Monitoring" (TDM) of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie" (AGNP), of which Pharmacopsychiatry is the official organ.…”