The Wrong Dose
Harms Patients.
As Doctors, we seek the best care for our patients, but current practice dictates dosing regimens that are either ineffective or toxic to our patients. It’s time to change our approach to treating patients.
Watch our video to learn more.
Treatment Success Is Often Attributed To Medication Adherence, However…
MyCare Oncology addresses these current practices in dosing through a new, efficacious form of delivery that provides physicians and caregivers with a full, accurate measure of the patient’s individual dosage requirements.
Clinical Studies
Imatinib Clinical Study
ABSTRACT
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
Schoretsanitis G, Kane JM, Correll CU, et al. J Clin Psychiatry. 2020;81(3):19cs13169.
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.
ABSTRACT
Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology
Hiemke C, Bergemann N, Clement HW, et al. Pharmacopsychiatry. 2018;51(1-02):9-62.
Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood to optimize pharmacotherapy. It considers the interindividual variability of pharmacokinetics and thus enables personalized pharmacotherapy. In psychiatry and neurology, patient populations that may particularly benefit from TDM are children and adolescents, pregnant women, elderly patients, individuals with intellectual disabilities, patients with substance abuse disorders, forensic psychiatric patients or patients with known or suspected pharmacokinetic abnormalities. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. However, the potential benefits of TDM to optimize pharmacotherapy can only be obtained if the method is adequately integrated in the clinical treatment process. To supply treating physicians and laboratories with valid information on TDM, the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued their first guidelines for TDM in psychiatry in 2004. After an update in 2011, it was time for the next update. Following the new guidelines holds the potential to improve neuropsychopharmacotherapy, accelerate the recovery of many patients, and reduce health care costs.
ABSTRACT
The American Psychiatric Association Practice Guidelines For The Treatment of Patients With Schizophrenia Third Edition; Use of Clozapine Levels During Treatment With Clozapine
While the dose of clozapine is being titrated, it is useful to obtain blood levels of clozapine and its major active metabolite, norclozapine (N-desmethylclozapine) (Couchman et al. 2010). Blood levels can also be helpful if there are questions about medication adherence, less efficacy or more side effects than expected, potential medication interactions, or other factors that may be influencing clozapine levels. Although there is substantial variation between individuals, clozapine levels on a specific dosage will generally be greater in nonsmokers than in smokers, in heavy caffeine users than in nonusers, in women than in men, and in older individuals than in younger individuals (Carrillo et al. 1998; Ismail et al. 2012). In addition, changing between different generic forms of clozapine can lead to a 5%–10% difference in blood levels. Levels of clozapine should be drawn at steady state (3 days or more after a dose change) and at a trough in medication levels (about 12 hours after the last dose). Typically, patients will receive a bedtime dose of clozapine and then have a level drawn the following morning before receiving an additional dose. There is not an absolute level of clozapine that is associated with either efficacy or toxicity (Remington et al. 2013; Spina et al. 2000; Stark and Scott 2012; Suzuki et al. 2011; VanderZwaag et al. 1996). In most patients, efficacy will be highest at levels greater than 350 ng/mL of clozapine, but some patients will show response or prevention of relapse at levels as low as 200 ng/mL. The risk of developing seizures increases with the blood level of clozapine.
5-FLUOROURACIL CLINICAL STUDY
ABSTRACT
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
Schoretsanitis G, Kane JM, Correll CU, et al. J Clin Psychiatry. 2020;81(3):19cs13169.
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.
ABSTRACT
Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology
Hiemke C, Bergemann N, Clement HW, et al. Pharmacopsychiatry. 2018;51(1-02):9-62.
Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood to optimize pharmacotherapy. It considers the interindividual variability of pharmacokinetics and thus enables personalized pharmacotherapy. In psychiatry and neurology, patient populations that may particularly benefit from TDM are children and adolescents, pregnant women, elderly patients, individuals with intellectual disabilities, patients with substance abuse disorders, forensic psychiatric patients or patients with known or suspected pharmacokinetic abnormalities. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. However, the potential benefits of TDM to optimize pharmacotherapy can only be obtained if the method is adequately integrated in the clinical treatment process. To supply treating physicians and laboratories with valid information on TDM, the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued their first guidelines for TDM in psychiatry in 2004. After an update in 2011, it was time for the next update. Following the new guidelines holds the potential to improve neuropsychopharmacotherapy, accelerate the recovery of many patients, and reduce health care costs.
ABSTRACT
The American Psychiatric Association Practice Guidelines For The Treatment of Patients With Schizophrenia Third Edition; Use of Clozapine Levels During Treatment With Clozapine
While the dose of clozapine is being titrated, it is useful to obtain blood levels of clozapine and its major active metabolite, norclozapine (N-desmethylclozapine) (Couchman et al. 2010). Blood levels can also be helpful if there are questions about medication adherence, less efficacy or more side effects than expected, potential medication interactions, or other factors that may be influencing clozapine levels. Although there is substantial variation between individuals, clozapine levels on a specific dosage will generally be greater in nonsmokers than in smokers, in heavy caffeine users than in nonusers, in women than in men, and in older individuals than in younger individuals (Carrillo et al. 1998; Ismail et al. 2012). In addition, changing between different generic forms of clozapine can lead to a 5%–10% difference in blood levels. Levels of clozapine should be drawn at steady state (3 days or more after a dose change) and at a trough in medication levels (about 12 hours after the last dose). Typically, patients will receive a bedtime dose of clozapine and then have a level drawn the following morning before receiving an additional dose. There is not an absolute level of clozapine that is associated with either efficacy or toxicity (Remington et al. 2013; Spina et al. 2000; Stark and Scott 2012; Suzuki et al. 2011; VanderZwaag et al. 1996). In most patients, efficacy will be highest at levels greater than 350 ng/mL of clozapine, but some patients will show response or prevention of relapse at levels as low as 200 ng/mL. The risk of developing seizures increases with the blood level of clozapine.
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If you wish to make an apple pie from scratch, you must first invent the universe.
Even the all-powerful Pointing has no control about the blind texts it is an almost unorthographic life One day however a small line of blind text by the name of Lorem Ipsum decided to leave for the far World of Grammar.
If you wish to make an apple pie from scratch, you must first invent the universe.
Even the all-powerful Pointing has no control about the blind texts it is an almost unorthographic life One day however a small line of blind text by the name of Lorem Ipsum decided to leave for the far World of Grammar.
