Format

Send to

Choose Destination
Psychopharmacology (Berl). 2016 May;233(9):1695-705. doi: 10.1007/s00213-015-3976-0. Epub 2015 Jun 3.

Inflammation and psychotropic drugs: the relationship between C-reactive protein and antipsychotic drug levels.

Author information

1
Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany. gudrun.hefner@unimedizin-mainz.de.
2
Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre, Langenbeckstrasse 1, 55131, Mainz, Germany. gudrun.hefner@unimedizin-mainz.de.
3
Department of Pharmaceutics, Faculty of Pharmacy, University of Mansoura, Mansoura, Egypt.
4
Department of Pharmacy Practice, College of Health Sciences, Ministry of Health, Muscat, Oman.
5
Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
6
Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre, Langenbeckstrasse 1, 55131, Mainz, Germany.
7
Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany.

Abstract

RATIONALE:

In psychiatric clinical practice, there is a need to identify psychotropic drugs whose metabolisms are prone to be altered with increased inflammatory activity in an individual patient.

OBJECTIVES:

The aim of this study was to find out whether elevated serum levels (≥5 mg/l) of C-reactive protein (CRP), an established laboratory marker of infection and inflammation, are associated with increased serum concentrations of the atypical antipsychotic drugs clozapine, quetiapine, and risperidone.

METHODS:

Therapeutic drug monitoring request forms of patients whose antipsychotic drug concentrations had been measured under conditions of normal (<5 mg/l) and pathological (>5 mg/l) levels of C-reactive protein were retrospectively screened. The serum concentrations in relation to the daily doses [concentration per dose (C/D) (ng/mL/mg)] and the metabolic ratios [ratio of concentrations (metabolite/drug)] were compared intraindividually by the Wilcoxon signed rank test. To the study effects of the intensity of infections on drug concentrations, C-reactive protein and C/D levels were submitted to Spearman's correlation analysis.

RESULTS:

Elevated levels of C-reactive protein were found in 105 patients. They were significantly associated with elevated values in C/D for clozapine (n = 33, P < 0.01) and risperidone (n = 40, P < 0.01). A trend for an increase was found for quetiapine (n = 32, P = 0.05). Median increases were 48.0 % (clozapine), 11.9 % (quetiapine), and 24.2 % (active moiety of risperidone), respectively.

CONCLUSIONS:

In patients who exhibit signs of inflammation or infection with increased C-reactive protein values during psychopharmacological treatment, especially under clozapine and risperidone, therapeutic drug monitoring is recommendable in order to minimize the risk of intoxications due to elevated drug concentrations.

KEYWORDS:

Antipsychotics; C-reactive protein; Clozapine; Drug metabolism; Inflammation; Pharmacokinetics; Psychiatry; Quetiapine; Risperidone; Therapeutic drug monitoring

PMID:
26032842
DOI:
10.1007/s00213-015-3976-0
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center