The relevance of clinical pharmacokinetics and therapeutic drug monitoring: anticonvulsant mood stabilizers and antipsychotics

J Clin Psychiatry. 1993 Sep:54 Suppl:35-41; discussion 55-6.

Abstract

This review considers the relevance of clinical pharmacokinetics and the role of therapeutic drug monitoring (TDM) for two classes of psychotropics: the anticonvulsant mood stabilizers and the antipsychotics. In the first class, carbamazepine is a potent stimulator of the hepatic microsomal enzyme oxidation system, while valproic acid inhibits these same enzymes. In addition, these agents' highly protein-bound status can alter the availability of the free fraction of other coadministered agents. For both reasons, TDM during their administration may be useful. The antipsychotics demonstrate wide variations in absorption, first-pass effect, and volume of distribution among individuals. Depot antipsychotics have long elimination half-lives, often taking months to achieve steady-state levels or, conversely, to complete their washout. While correlations between antipsychotic plasma concentrations and clinical response are still under study, there are specific instances when TDM can be used to maximize clinical benefit and/or avoid adverse events.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Anticonvulsants / pharmacokinetics*
  • Anticonvulsants / therapeutic use
  • Antipsychotic Agents / pharmacokinetics*
  • Antipsychotic Agents / therapeutic use
  • Carbamazepine / pharmacokinetics
  • Carbamazepine / therapeutic use
  • Delayed-Action Preparations
  • Drug Interactions
  • Drug Monitoring*
  • Humans
  • Mental Disorders / drug therapy
  • Psychiatric Status Rating Scales
  • Valproic Acid / pharmacokinetics
  • Valproic Acid / therapeutic use

Substances

  • Anticonvulsants
  • Antipsychotic Agents
  • Delayed-Action Preparations
  • Carbamazepine
  • Valproic Acid