Therapeutic Drug Plasma Level Monitoring

AimsTo re audit the monitoring of Plasma Clozapine levels in Rehabilitation setting in CNTW Trust as per Trust Guidelines PGN on “Safe prescribing of Clozapine”.Objectives:To determine if1. The reason for a clozapine plasma level request is recorded.2. Results are recorded correctly.3. Appropriate action is taken and recorded when results are significant.BackgroundClozapine plasma level monitoring is useful when assessing adherence, adjusting the dose, monitoring the effects of changes in smoking habit, investigating clozapine side effects and when toxicity is suspected.An initial audit was carried out within the Trust in 2015 and the following recommendations were made:Check and record clozapine plasma levelAt baseline (a level should be taken once the patient has been on the target dose for at least a week)Annually.When clinically relevant to optimise therapy.An entry must be made in the patient's progress notes recording the reason of requesting the test.On receipt of results, the paper copy must be scanned & an entry made in progress notes.The clinician should comment on the significance of the results and propose an action plan.We re-audited compliance with the guidance in Rehabilitation (inpatients and community) by reviewing patient notes for a 2 year period of 2017–2018.MethodThe audit work involved a review of 31 case records of patients prescribed Clozapine whose last plasma level was taken between 2017–2018. Patient's details were identified from a randomly generated list by the Trust pharmacy.Result<50% compliance was seen with baseline, annual monitoring, reason for recording and proposed action plan by clinician.>50% compliance was seen with scanned results and levels checked when clinically relevant.No significant improvement from the previous audit except improvement in compliance with documentation of levels.ConclusionDissemination of Clozapine Key cards within teams.

Download Full-text

Paliperidone LAI and Aripiprazole LAI Plasma Level Monitoring in the Prophylaxis of Bipolar Disorder Type I with Manic Predominance

Pharmacopsychiatry ◽

10.1055/a-1113-7862 ◽

2020 ◽

Vol 53 (05) ◽

pp. 209-219

Author(s):

Massimo Carlo Mauri ◽

Alessandra Reggiori ◽

Alessandro Minutillo ◽

Gemma Franco ◽

Chiara Di Pace ◽

...

Keyword(s):

Bipolar Disorder ◽

Plasma Level ◽

Rating Scales ◽

Depressive Symptomatology ◽

Type I ◽

Plasma Level Monitoring ◽

Drug Plasma ◽

Long Acting ◽

Drug Plasma Levels ◽

Level Monitoring

Abstract Introduction The objective of this study was the evaluation of utility of plasma level monitoring in the clinical stabilizing efficacy and tolerability of paliperidone palmitate (PP) vs. aripiprazole monohydrate (AM) in bipolar disorder I (BD I) with manic predominance. Methods Fifty-six outpatients of both sexes, age ranging from 18 to 65 years, affected by BD I with manic predominance, orally treated and stabilized after acute episode for at least 2 weeks with paliperidone or aripiprazole (n=31, paliperidone; n=25, aripiprazole) underwent a prospective observational study of switching to the corresponding long-acting injection (LAI) on the basis of clinical evaluation. The efficacy and tolerability of the 2 treatments were assessed by BPRS, PANSS, HAMD21, and MRS rating scales and a check list every month for 12 months. Drug plasma levels determinations (PLs) were performed at the same times. Results A good clinical stability and tolerability of both drugs were reported. Lower mean PLs of PP showed a positive effect on depressive symptoms. AM PLs variability was associated with greater instability of manic symptoms whereas intermediate PLs seem to have more influence on depressive symptomatology. Discussion PLs drug monitoring has been proven to be useful, and further investigations to identify optimal therapeutic ranges for LAI formulations are needed.

Download Full-text