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3 - Level Interpretation Including Laboratory Reporting Issues, Responding to High Plasma Levels, Special Situations (Hepatic Dysfunction, Renal Dysfunction and Hemodialysis, Bariatric Surgery)

Published online by Cambridge University Press:  19 October 2021

Jonathan M. Meyer
Affiliation:
University of California, San Diego
Stephen M. Stahl
Affiliation:
University of California, Riverside and San Diego
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Summary

It is rare that clinicians ordering psychotropic levels must concern themselves with the details of laboratory assay methods, or how the results are reported. For example, knowledge of lithium kinetics has existed for nearly 50 years, and lithium is preferentially administered as a single bedtime dose to minimize the renal dysfunction associated with multiple daily doses, to improve adherence, and to facilitate obtaining levels as 12h troughs in the morning [1–4]. Nearly all commercial laboratories use a standard assay method (ion-selective electrode), and there is limited variation in the laboratory reported therapeutic range: the lower limit is typically 0.5 or 0.6 mEq/l, and the upper limit 1.2 mEq/l, with alerts for levels > 1.2, 1.5 or 1.6 mEq/l [3, 5, 6].

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Publisher: Cambridge University Press
Print publication year: 2021

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References

Amdisen, A. (1977). Serum level monitoring and clinical pharmacokinetics of lithium. Clin Pharmacokinet, 2, 7392.Google Scholar
Swartz, C. M. (1987). Correction of lithium levels for dose and blood sampling times. J Clin Psychiatry, 48, 6064.Google Scholar
Grandjean, E. M. and Aubry, J.-M. (2009). Lithium: Updated human knowledge using an evidence-based approach. Part II: Clinical pharmacology and therapeutic monitoring. CNS Drugs, 23, 331349.Google Scholar
Castro, V. M., Roberson, A. M., McCoy, T. H., et al. (2016). Stratifying risk for renal insufficiency among lithium-treated patients: An electronic health record study. Neuropsychopharmacology, 41, 11381143.Google Scholar
Hiemke, C., Bergemann, N., Clement, H. W., et al. (2018). Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: Update 2017. Pharmacopsychiatry, 51, 962.Google Scholar
Schoot, T. S., Molmans, T. H. J., Grootens, K. P., et al. (2020). Systematic review and practical guideline for the prevention and management of the renal side effects of lithium therapy. Eur Neuropsychopharmacol, 31, 1632.Google Scholar
Malhi, G. S. and Tanious, M. (2011). Optimal frequency of lithium administration in the treatment of bipolar disorder: Clinical and dosing considerations. CNS Drugs, 25, 289298.Google Scholar
Buckley, T., Kitchen, C., Vyas, G., et al. (2020). Comparison of novel immunoassay with liquid chromatography / tandem mass spectrometry (LC–MS/MS) for therapeutic drug monitoring of clozapine. Ther Drug Monit, 42, 771777.Google Scholar
Meyer, J. M. (2020). Monitoring and improving antipsychotic adherence in outpatient forensic diversion programs. CNS Spectr, 25, 136144.Google Scholar
Schoretsanitis, G., Kane, J. M., Correll, C. U., et al. (2020). Blood levels to optimize antipsychotic treatment in clinical practice: A joint consensus statement of the American Society of Clinical Psychopharmacology (ASCP) and the Therapeutic Drug Monitoring (TDM) Task Force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP). J Clin Psychiatry, 81, https://doi.org/10.4088/JCP.4019cs13169.Google Scholar
Meyer, J. M. and Nasrallah, H. A., eds. (2009). Medical Illness and Schizophrenia, 2nd edn. Washington, DC: American Psychiatric Press, Inc.Google Scholar
Meyer, J. M. (2003). Prevalence of hepatitis A, hepatitis B, and HIV among hepatitis C-seropositive state hospital patients: Results from Oregon State Hospital. J Clin Psychiatry, 64, 540545.Google Scholar
Hsu, J. H., Chien, I. C., Lin, C. H., et al. (2014). Increased risk of chronic liver disease in patients with schizophrenia: A population-based cohort study. Psychosomatics, 55, 163171.Google Scholar
Tzeng, N. S., Hsu, Y. H., Ho, S. Y., et al. (2015). Is schizophrenia associated with an increased risk of chronic kidney disease? A nationwide matched-cohort study. BMJ Open, 5, e006777.Google Scholar
Morlán-Coarasa, M. J., Arias-Loste, M. T., Ortiz-García de la Foz, V., et al. (2016). Incidence of non-alcoholic fatty liver disease and metabolic dysfunction in first episode schizophrenia and related psychotic disorders: A 3-year prospective randomized interventional study. Psychopharmacology (Berl), 233, 39473952.Google Scholar
Kouidrat, Y., Amad, A., Stubbs, B., et al. (2017). Surgical management of obesity among people with schizophrenia and bipolar disorder: A systematic review of outcomes and recommendations for future research. Obes Surg, 27, 18891895.Google Scholar
Yan, J., Hou, C., and Liang, Y. (2017). The prevalence and risk factors of young male schizophrenics with non-alcoholic fatty liver disease. Neuropsychiatr Dis Treat, 13, 14931498.Google Scholar
Xu, H. and Zhuang, X. (2019). Atypical antipsychotics-induced metabolic syndrome and nonalcoholic fatty liver disease: A critical review. Neuropsychiatr Dis Treat, 15, 20872099.Google Scholar
Everson, G., Lasseter, K. C., Anderson, K. E., et al. (2000). The pharmacokinetics of ziprasidone in subjects with normal and impaired hepatic function. Br J Clin Pharmacol, 49 Suppl 1, 21s26s.Google Scholar
Roerig Division of Pfizer Inc. (2001). Geodon package insert. New York.Google Scholar
Verbeeck, R. K. (2008). Pharmacokinetics and dosage adjustment in patients with hepatic dysfunction. Eur J Clin Pharmacol, 64, 11471161.Google Scholar
Levy, N. B. (1985). Use of psychotropics in patients with kidney failure. Psychosomatics, 26, 699–701, 705, 709.Google Scholar
Levy, N. B. (1990). Psychopharmacology in patients with renal failure. Int J Psychiatry Med, 20, 325334.Google Scholar
Levy, N. B., Blumenfield, M., Beasley, C. M., Jr., et al. (1996). Fluoxetine in depressed patients with renal failure and in depressed patients with normal kidney function. Gen Hosp Psychiatry, 18, 813.Google Scholar
Cohen, L. M., Tessier, E. G., Germain, M. J., et al. (2004). Update on psychotropic medication use in renal disease. Psychosomatics, 45, 3448.Google Scholar
Mahgoub, Y. and Jacob, T. (2019). Schizoaffective exacerbation in a Roux-en-Y gastric bypass patient maintained on clozapine. Prim Care Companion CNS Disord, 21, 19l02462–19l02463.Google Scholar
McGrane, I. R., Salyers, L. A., Molinaro, J. R., et al. (2020). Roux-en-Y gastric bypass and antipsychotic therapeutic drug monitoring: Two cases. J Pharm Pract, 897190020905467.Google Scholar
Hagi, K., Tadashi, N., and Pikalov, A. (2020). S5. Does the time of drug administration alter the adverse event risk of lurasidone? Schizophr Bull, 46, S3132.Google Scholar
Meyer, J. M. and Stahl, S. M. (2019). The Clozapine Handbook. Cambridge: Cambridge University Press.Google Scholar
Iyo, M., Tadokoro, S., Kanahara, N., et al. (2013). Optimal extent of dopamine D2 receptor occupancy by antipsychotics for treatment of dopamine supersensitivity psychosis and late-onset psychosis. J Clin Psychopharmacol, 33, 398404.Google Scholar
Servonnet, A. and Samaha, A. N. (2020). Antipsychotic-evoked dopamine supersensitivity. Neuropharmacology, 163, 107630.Google Scholar
Horowitz, M. A., Jauhar, S., Natesan, S., et al. (2021). A method for tapering antipsychotic treatment that may minimize the risk of relapse. Schizophr Bull, doi: 10.1093/schbul/sbab017, 114.Google Scholar
Velligan, D. I., Wang, M., Diamond, P., et al. (2007). Relationships among subjective and objective measures of adherence to oral antipsychotic medications. Psychiatr Serv, 58, 11871192.Google Scholar
Pérez-Ruixo, C., Remmerie, B., Peréz-Ruixo, J. J., et al. (2019). A receiver operating characteristic framework for non-adherence detection using drug concentration thresholds – application to simulated risperidone data in schizophrenic patients. AAPS J, 21, 40.Google Scholar
Ruan, C. J., Zang, Y. N., Wang, C. Y., et al. (2019). Clozapine metabolism in East Asians and Caucasians: A pilot exploration of the prevalence of poor metabolizers and a systematic review. J Clin Psychopharmacol, 39, 135144.Google Scholar
Bogers, J. P. A. M., Hambarian, G., Michiels, M., et al. (2020). Risk factors for psychotic relapse after dose reduction or discontinuation of antipsychotics in patients with chronic schizophrenia: A systematic review and meta-analysis. Schizophr Bull Open, 10.1093/schizbullopen/sgaa1002/5771215.Google Scholar
Nakata, Y., Kanahara, N., and Iyo, M. (2017). Dopamine supersensitivity psychosis in schizophrenia: Concepts and implications in clinical practice. J Psychopharmacol, 31, 15111518.Google Scholar
Emsley, R., Nuamah, I., Gopal, S., et al. (2018). Relapse after antipsychotic discontinuation in schizophrenia as a withdrawal phenomenon vs illness recurrence: A post hoc analysis of a randomized placebo-controlled study. J Clin Psychiatry, 79, e1e9.Google Scholar
Meyer, J. M. (2016). Forgotten but not gone: New developments in the understanding and treatment of tardive dyskinesia. CNS Spectr, 21, 1324.Google Scholar
Meyer, J. M. (2018). Future directions in tardive dyskinesia research. J Neurol Sci, 389, 7680.Google Scholar
Robinson, M. J. and Levenson, J. L. (2000). The use of psychotropics in the medically ill. Curr Psychiatry Rep, 2, 247255.Google Scholar
Food and Drug Administration Center for Drug Evaluation and Research (2003). Guidance for industry – pharmacokinetics in patients with impaired hepatic function: Study design, data analysis, and impact on dosing and labeling, www.fda.gov/cder/guidance/index.htm.Google Scholar
Frye, R. F., Zgheib, N. K., Matzke, G. R., et al. (2006). Liver disease selectively modulates cytochrome P450-mediated metabolism. Clin Pharmacol Ther, 80, 235245.Google Scholar
Cholongitas, E., Papatheodoridis, G. V., Vangeli, M., et al. (2005). Systematic review: The model for end-stage liver disease – should it replace Child–Pugh’s classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther, 22, 10791089.Google Scholar
Kamath, P. S. and Kim, W. R. (2007). The model for end-stage liver disease (MELD). Hepatology, 45, 797805.Google Scholar
Preskorn, S. (2019). Three clinically important but underutilized and misunderstood tools: Formulas to estimate creatinine clearance, the package insert, and therapeutic drug monitoring. J Clin Psychiatry, 80, e1e2.Google Scholar
Morgan, D. J. and McLean, A. J. (1995). Clinical pharmacokinetic and pharmacodynamic considerations in patients with liver disease: An update. Clin Pharmacokinet, 29, 370391.Google Scholar
Rule, A. D., Gussak, H. M., Pond, G. R., et al. (2004). Measured and estimated GFR in healthy potential kidney donors. Am J Kidney Dis, 43, 112119.Google Scholar
Chiu, C.-C., Shen, W. W., Chen, K.-P., et al. (2007). Application of the Cockcroft–Gault method to estimate lithium dosage requirement. Psychiatry Clin Neurosci, 61, 269274.Google Scholar
Pottel, H., Hoste, L., Dubourg, L., et al. (2016). An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant, 31, 798806.Google Scholar
Hill, N. R., Fatoba, S. T., Oke, J. L., et al. (2016). Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLoS One, 11, e0158765.Google Scholar
Grunder, P., Augustin, M., Paulzen, M., et al. (2019). Influence of kidney function on serum risperidone concentrations in patients treated with risperidone. J Clin Psychiatry, 80.Google Scholar
Zazgornik, J., Kuska, J., Kokot, F., et al. (1991). Pharmacokinetics of ritanserin in patients undergoing hemodialysis. J Clin Pharmacol, 31, 657661.Google Scholar
Sanga, M. and Shigemura, J. (1998). [Pharmacokinetics of haloperidol in patients on hemodialysis]. Nihon Shinkei Seishin Yakurigaku Zasshi, 18, 4547.Google Scholar
De Donatis, D., Porcelli, S., Serretti, A., et al. (2020). Serum aripiprazole concentrations prehemodialysis and posthemodialysis in a schizophrenic patient with chronic renal failure: A case report. J Clin Psychopharmacol, 40, 200202.Google Scholar
Otsuka America Pharmaceutical Inc. (2020). Rexulti package insert. Rockville, MD.Google Scholar
Roerig Division of Pfizer Inc. (2020). Geodon package insert. New York.Google Scholar
Grant, S. and Fitton, A. (1994). Risperidone: A review of its pharmacology and therapeutic potential in the treatment of schizophrenia. Drugs, 48, 253273.Google Scholar
Fisher, D., Coleman, K. J., Arterburn, D. E., et al. (2017). Mental illness in bariatric surgery: A cohort study from the PORTAL network. Obesity (Silver Spring), 25, 850856.Google Scholar
Fuller, A. K., Tingle, D., DeVane, C. L., et al. (1986). Haloperidol pharmacokinetics following gastric bypass surgery. J Clin Psychopharmacol, 6, 376378.Google Scholar
Ward, H. B., Yudkoff, B. L., and Fromson, J. A. (2019). Lurasidone malabsorption following bariatric surgery: A case report. J Psychiatr Pract, 25, 313317.Google Scholar
Schoretsanitis, G., Kirner-Veselinovic, A., Gründer, G., et al. (2017). Clinically relevant changes in clozapine serum concentrations after breast reduction surgery. Aust N Z J Psychiatry, 51, 10591060.Google Scholar

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