What Does Antidepressant Drug level Monitoring Reveal About Outpatient Treatment and Patient Adherence?

2018 ◽  
Vol 52 (02) ◽  
pp. 78-83 ◽  
Author(s):  
Petr Silhan ◽  
Romana Urinovska ◽  
Ivana Kacirova ◽  
Martin Hyza ◽  
Milan Grundmann ◽  
...  
Keyword(s):  
Plasma Level ◽  
Outpatient Treatment ◽  
Plasma Levels ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Reference Range ◽  
Patient Adherence ◽  
Antidepressant Drug ◽  
Drug Level ◽  
Maximum Plasma ◽  
Significant Difference

Abstract Introduction The evaluation of plasma levels of antidepressants may improve the treatment outcome. The aim was to verify adherence and adequacy of administered doses of antidepressants among patients hospitalized for inadequate outpatient therapeutic response. Methods Selective serotonin reuptake inhibitors or venlafaxine plasma levels were assessed on the first day of hospitalization and after 3 days of controlled administration. The patients were considered adherent if the plasma level on admission was within the interval of the minimum and maximum plasma level on the fourth day, expanded by 30%. The adequacy of antidepressant doses used during the outpatient treatment was assessed by comparing the plasma level on the fourth day with the therapeutic reference range. Results Out of 83 patients, 52 (62.7%) were adherent. The plasma levels of antidepressants on the fourth day were found to be within the therapeutic reference range in 35 (43.2%) patients. The same number manifested levels below the therapeutic reference range. In 11 (13.6%) patients, the levels were higher than recommended. No significant difference in rate of adherence was found among individual antidepressants. Conclusion The results show that antidepressant nonresponders are frequently under-dosed or nonadherent.

scholarly journals PERBEDAAN KADAR PSA DAN TGF-β1 TERHADAP PEMBERIAN KOMBINASI INHIBITOR 5α-REDUKTASE (DUTASTERIDE) DAN ANTI ESTROGEN (TAMOXIFEN) PADA PASIEN BPH LUTS

1970 ◽  
Vol 15 (2) ◽  
Author(s):  
Rachmat Budi Prasetyo ◽  
Soetojo Soetojo ◽  
Doddy M Soebadi
Keyword(s):  
Placebo Group ◽  
Plasma Level ◽  
Urinary Retention ◽  
Plasma Levels ◽  
Reductase Inhibitor ◽  
Combination Group ◽  
Tamoxifen Group ◽  
Significant Difference ◽  
Before And After ◽  
Tgf Β1

Objective: To compare the PSA and TGF-β1 plasma level before and after administration of a 5α-reductase inhibitor (dutasteride) and an anti estrogen (tamoxifen) in nonobstructive patients with BPH. Material and Method: We enrolled 40 patients with a diagnosis of BPH without urinary retention. Patients were allocated into 4 groups of 10 patients and were given tamoxifen, dutasteride, a combination of tamoxifen and dutasteride, or placebo. We measured PSA and TGF-β1 plasma levels at study entry and 3 months after administration. Data were analysed using SPSS 12. Results: Increase of TGF-β1, as high as 54% (2,18 ± 0,88 to 3,36 ± 1,06) in the tamoxifen group, 26% (2,75 ± 0,62 to 3,47 ± 0,82) in the dutasteride group, and 92% (2,37 ± 0,75 to 4,56 ± 1,98) in the combination group, was significant (p < 0,05). PSA was not significantly decreased in all groups (p > 0,05). PSA decreased 28% (4,25 ± 3,28 to 3,06 ± 3,08) in the tamoxifen group, 27% (2,20 ± 2,17 to 1,60 ± 0, 982) in the dutasteride group, and 19% (2,95 ± 1,22 to 2,40 ± 1,78) in the combination group. In the placebo group was no significant difference of both parameters. Conclusion: TGF-β1 was significantly increased in all groups except in placebo. PSA was decreased in all groups but not significant statistically. We concluded that TGF-β1 may better be used as a biomarker in the evaluation and management of BPH than PSA.

scholarly journals The Plasma Levels of Dehydroepiandrosterone Sulfate Are Decreased in Patients with Chronic Heart Failure in Proportion to the Severity*

2000 ◽  
Vol 85 (5) ◽  
pp. 1834-1840 ◽  
Author(s):  
Yasushi Moriyama ◽  
Hirofumi Yasue ◽  
Michihiro Yoshimura ◽  
Yuji Mizuno ◽  
Koichi Nishiyama ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Plasma Level ◽  
Natriuretic Peptide ◽  
Plasma Levels ◽  
Thiobarbituric Acid ◽  
The Elderly ◽  
Dehydroepiandrosterone Sulfate ◽  
Significant Difference

Abstract Dehydroepiandrosterone sulfate (DHEAS) is the major secretory steroid of the human adrenal glands. The secretion of DHEAS decreases with aging. The incidence of heart failure also rises in the elderly population. We measured the plasma levels of DHEAS and cortisol in 49 patients with chronic heart failure (CHF) and 32 age-matched controls and assessed its relation to plasma levels of A-type natriuretic peptide and B-type natriuretic peptide, biochemical markers of heart failure. Plasma levels of DHEAS were significantly lower in patients with CHF than in controls, whereas there was no significant difference in plasma levels of cortisol between the two groups. In stepwise regression analysis, the plasma level of DHEAS was significantly and independently correlated with age (β = −0.451; P &lt; 0.0001) and the plasma level of B-type natriuretic peptide (β = −0.338; P &lt; 0.001), and the plasma cortisol/DHEAS ratio was significantly and independently correlated with the plasma levels of A-type natriuretic peptide (β = 0.598; P &lt; 0.0001) and thiobarbituric acid-reactive substances (a marker of oxidative stress;β = 0.252; P &lt; 0. 01) and age (β = 0.171; P &lt; 0.05). These results indicate that the plasma levels of DHEAS are decreased in patients with CHF in proportion to its severity and that oxidative stress is associated with decreased levels of DHEAS in patients with CHF.

scholarly journals The role of asymmetric dimethylarginine (ADMA) in the follow-up of patients with precapillary pulmonary hypertension (PH)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Shafran ◽  
V Probst ◽  
J Campean ◽  
R Sadushi-Kolici ◽  
C Gerges ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
High Risk ◽  
Plasma Level ◽  
Plasma Levels ◽  
Asymmetric Dimethylarginine ◽  
Low Risk ◽  
Hemodynamic Assessment ◽  
Significant Difference

Abstract Introduction Asymmetric dimethylarginine (ADMA) interferes with L-arginine in the production of nitric oxide, a key mediator of endothelial cell function. ADMA is elevated in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with unfavorable outcomes. Aim To assess the role of ADMA to monitor disease progression of PH patients treated with PAH-specific therapy. Methods ADMA was measured by competitive ELISA at baseline (BL) and follow-up (FU). Risk assessment including a clinical assessment, echocardiography, 6-minute walking test, NT-pro-BNP and hemodynamic assessment by right heart catheterization was performed accordingly. Risk was calculated according to the ESC/ERS 2015 guidelines by the SPHAR method. Results ADMA samples were collected from 113 patients treated at our institution between 2012 and 2019. 89 (79%) patients had PAH, 15 (13%) were diagnosed with CTEPH and 9 (8%) with group 3 – PH associated with lung disease. 69% were females. 15 (13.3%) patients had a low risk at baseline, 96 (85%) intermediate risk and 2 (1.8%) were high risk patients. 75% received oral medications, 31% received subcutaneous treprostinil. Median baseline ADMA was 0.738umol/l. At BL no significant difference of ADMA plasma levels was found among the different PH types (p=0.063), or between different risk categories (p=0.531). Change in ADMA plasma levels correlated with change in risk (p=0.002, rs 0.291) and with change in mixed venous saturation (p=0.034, rs −0.205). Change in ADMA plasma levels also correlated with risk at FU (p=0.011, rs 0.240). Patients categorized as low risk at FU had a median ADMA plasma level decrease of 22%, compared with −3 to 0% ADMA plasma level change in patients with moderate to high risk at FU (p=0.04). Patients who improved their risk category had a median decrease of ADMA plasma level of 23% vs. 2.3% in patients who did not improve (p=0.011). Decrease of ADMA plasma levels was a weak but significant discriminator for improvement of risk in ROC analysis (p=0.032, AUC 0.374). Conclusion ADMA plasma levels paralleled the hemodynamic and clinical benefit of PAH-specific treatments in patients with precapillary PH. ADMA could be used as a biomarker for monitoring treatment effects in precapillary PH. Funding Acknowledgement Type of funding source: None

δ-Aminolaevulinic acid in plasma, cerebrospinal fluid, saliva and erythrocytes: Studies in normal, uraemic and porphyric subjects

1987 ◽  
Vol 72 (1) ◽  
pp. 103-112 ◽  
Author(s):  
A. Gorchein ◽  
R. Webber
Keyword(s):  
Cerebrospinal Fluid ◽  
Plasma Level ◽  
Plasma Levels ◽  
Acute Intermittent Porphyria ◽  
Maternal Plasma ◽  
Electron Capture Detection ◽  
Maximum Plasma ◽  
Aminolaevulinic Acid ◽  
The Mean ◽  
High Level

1. ô-Aminolaevulinic acid (ALA) was determined by g.l.c. with electron-capture detection. Normal plasma level was 92 nmol/l (sd = 39, n = 89, range 24–270 nmol/l). 2. ALA was undetectable in 35 of 53 samples of normal cerebrospinal fluid (limit of assay 2 nmol/l). The mean of the other 18 samples was 19 nmol/l (sd = 10, range 6–36 nmol/l). 3. Salivary ALA was generally only 10–30% of the plasma level in normal and porphyric subjects. 4. Erythrocytes of normal and porphyric subjects contained no detectable ALA and were impermeable to its entry. 5. ALA clearance correlated closely with that of creatinine, consistent with it being excreted by glomerular filtration with limited tubular reabsorption. 6. In chronic renal failure, serum ALA was elevated to a maximum of three to four times the normal, but its urinary excretion was reduced, in keeping with lessened production. 7. In two cases of acute intermittent porphyria with overwhelming neuropathy the maximum plasma levels of ALA were 9 and 12 μmol/l. Haematin infusion decreased the ALA levels but without obvious clinical benefit. Limited neurological recovery occurred without major reduction in plasma levels of ALA. 8. One subject's attack was precipitated by pregnancy. The neonate was apparently normal, despite high levels of ALA in maternal plasma throughout gestation and a high level of ALA in the cord blood. 9. The observations described here do not support the view that ALA may be directly neurotoxic.

scholarly journals Variation in dose and plasma level of lamotrigine in patients discharged from a mental health trust

2016 ◽  
Vol 7 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Petrina Douglas-Hall ◽  
Olubanke Dzahini ◽  
Fiona Gaughran ◽  
Ahmed Bile ◽  
David Taylor
Keyword(s):  
Mental Health ◽  
Plasma Level ◽  
Plasma Levels ◽  
Enzyme Inhibitor ◽  
Smoking Status ◽  
Plasma Concentrations ◽  
Significant Difference ◽  
The Mean ◽  
Health Trust ◽  
Enzyme Inducers

Background: The objectives of this study were to investigate the dose of lamotrigine when prescribed with an enzyme inhibitor or enzyme inducer in patients discharged from a mental health trust and to determine the corresponding lamotrigine plasma concentrations and the factors that may affect these. Methods: All patients discharged on lamotrigine between October 2007 and September 2012 were identified using the pharmacy dispensing database. We recorded demographic details, lamotrigine dose and plasma levels and coprescribed medication. Results: During the designated period, 187 patients were discharged on lamotrigine of whom 117 had their plasma levels recorded. The mean lamotrigine daily dose was 226.1 mg (range 12.5–800 mg) and the mean plasma level 5.9 mg/l (range 0.8–18.1 mg/l). Gender, ethnicity, diagnosis and smoking status had no significant effect on dose or plasma levels. Patients taking an enzyme-inducing drug ( n = 6) had significantly lower plasma levels [mean (SD) 3.40 (1.54) mg/l] than those not taking enzyme inducers [ n = 111; 6.03 (3.13) mg/l; p = 0.043]. Patients taking an enzyme-inhibiting drug ( n = 23) had significantly higher levels [7.47 (3.99) mg/l] than those not taking an inhibitor [ n = 94; 5.52 (2.75) mg/l; p = 0.035]. No significant difference was found between the doses of lamotrigine in patients taking an enzyme inhibitor and those not taking one ( p = 0.376). No significant difference was found between the doses of lamotrigine in patients taking an enzyme-inducing drug and those not taking any ( p = 0.574). Conclusions: Current dosing recommendations indicate that lamotrigine doses should be halved in individuals taking enzyme inhibitors and doubled in those on enzyme inducers. In our survey these recommendations were rarely followed with the consequence that patients received too high or too low a dose of lamotrigine, respectively.

Rapamycin Has Biological Activity in a Subset of Patients with Myelodysplastic Syndrome - Results of a Phase I/II Trial.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1449-1449
Author(s):  
Uwe Platzbecker ◽  
Michael Haase ◽  
Regina Herbst ◽  
Anette Hanel ◽  
Karsten Voigtmann ◽  
...  
Keyword(s):  
Biological Activity ◽  
Side Effects ◽  
Plasma Level ◽  
Myelodysplastic Syndrome ◽  
Phase I ◽  
Plasma Levels ◽  
Immune Surveillance ◽  
Therapeutic Benefit ◽  
Significant Difference ◽  
Median Plasma

Abstract The pathophysiology of myelodysplastic syndrome (MDS) involves disturbed regulation of angiogenesis, apoptosis, proliferation and differentiation as well as immune surveillance. There is increasing evidence that rapamycin (sirolimus) might affect these pathways positively thus possibly being of therapeutic benefit in patients with this disease. These data prompted us to perform a phase I/II study to evaluate the safety and efficacy of rapamycin in the treatment of patients with MDS. Nineteen patients (median age 72 years) diagnosed with MDS according to the WHO classification received rapamycin orally with a target blood concentration of 3–12 ng/ml. Rapamycin was administered for a median of 3.7 months (range 0.3–11). Three patients (1 x RAEB-2, 1 x RAEB-1, 1 x RCMD) showed either a major (1 x platelet, 1 x neutrophil) or a minor (1 x erythroid, 2 x platelet) hematological response according to the IWG criteria. There was no statistically significant difference in the rapamycin plasma levels between the three responders (median plasma level 3.62, range 1.63–4.39) and non-responders (median plasma level 4.22, range 2.81–7.4). Major side effects were hyperlipidemia (n=4), stomatitis (n=3), thrombocytopenia (n=2) and urinary tract infection (n=1). Study medication had to be stopped due to side effects in five patients (26 %), one of them being a responder to rapamycin. Plasma levels of rapamycin were not elevated in patients experiencing toxicity. Taken together these data demonstrate that rapamycin might have biological activity in patients with rather advanced MDS. New and possibly less toxic analogues of rapamycin are currently developed. They could be candidates for future trials in patients with MDS.

scholarly journals EPID-36. ANTIDEPRESSANT DRUG USE IN GLIOBLASTOMA PATIENTS: AN EPIDEMIOLOGICAL VIEW

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii86-ii86
Author(s):  
Dorothee Gramatzki ◽  
James Rogers ◽  
Marian Neidert ◽  
Caroline Hertler ◽  
Emilie Le Rhun ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Drug Use ◽  
Survival Data ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Methylation Status ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Population Level ◽  
Disease Course

Abstract PURPOSE Antidepressant drugs have shown anti-tumor activity in preclinical glioblastoma studies. Antidepressant drug use, as well as its association with survival, in glioblastoma patients has not been well characterized on a population level. METHODS Patient characteristics, including the frequency of antidepressant drug use, were assessed in a glioblastoma cohort diagnosed in a 10-year time-frame between 2005 and 2014 in the Canton of Zurich, Switzerland. Cox proportional hazards regression models were applied for multivariate analysis. Kaplan-Meier survival curves were used to estimate overall survival data and the log-rank test was performed for comparisons. RESULTS Four hundred four patients with isocitrate dehydrogenase (IDH) wildtype glioblastoma were included in this study. Sixty-five patients (16.1%) took antidepressant drugs at some point during the disease course. Patients were most commonly prescribed selective serotonin reuptake inhibitors at any time (N=46, 70.8%). Nineteen patients (29.2%) were on antidepressant drugs at the time of their tumor diagnosis. No differences were observed in overall survival between those patients who had taken antidepressants at some point in their disease course and those who had not (p=0.356). These data were confirmed in a multivariate analysis including age, Karnofsky performance status, gender, extent of resection, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, and first-line treatment as cofounders (p=0.315). Also, there was no association of use of drugs modulating voltage-dependent potassium channels (citalopram; escitalopram) with survival (p=0.639). CONCLUSIONS This signal-seeking study does not support the hypothesis that antidepressants have antitumor efficacy in glioblastoma on a population level.

Debate resolved: there are differential effects of serotonin selective reuptake inhibitors on cytochrome P450 enzymes

1998 ◽  
Vol 12 (4_suppl) ◽  
pp. S89-S97 ◽  
Author(s):  
Sheldon H. Preskorn
Keyword(s):  
Cytochrome P450 ◽  
Plasma Levels ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Original Position ◽  
Selective Serotonin ◽  
Cytochrome P450 Enzymes ◽  
Extensive Body ◽  
Cyp 2D6

In 1993, it was first proposed that an important difference between selective serotonin reuptake inhibitors (SSRIs) was the degree of inhibition of the cytochrome P450 (CYP) enzyme 2D6 that they produced under usually dosing conditions (Preskorn, 1993). Specifically, fluoxetine and paroxetine, in contrast to sertraline, were identified as causing substantial increases in the plasma levels of coadministered drugs, which were principally dependent on CYP 2D6 for their metabolism. Over the next 5 years, this position was hotly contested (Preskorn and Nemeroff, 1997). However, an extensive body of research has now accumulated, which incontrovertibly supports the original position. This paper will reviews this research and extends the discussion to all five SSRIs and four other important CYP enzymes: 1A2, 2C9/10, 2C19, and 3A3/4.

Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis

2021 ◽  
pp. 875647932110210
Author(s):  
Idigo Felicitas Ugochinyere ◽  
Nwankwo Sylvia Chiamaka ◽  
Abonyi Everistus Obinna ◽  
Anakwue Angel-Mary Chukwunyelu ◽  
Agbo Julius Amechi
Keyword(s):  
Reference Range ◽  
Interobserver Variability ◽  
Correct Diagnosis ◽  
Negative Relationship ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Renal Volume ◽  
Cross Sectional ◽  
Significant Difference ◽  
Induced Hypertension

Objective: Renal volume (RV) assessment during obstetric sonography is rarely considered in our locality. Understanding the changes in RV in both normotensive pregnant (NP) and pregnancy-induced hypertensive (PIH) women is important in making correct diagnosis regarding pregnancy outcome. This study is aimed at determining the RV in NP and PIH women and correlating RV with fetal gestational age (FGA), body mass index (BMI), and parity in NP women. Materials and Methods: This cross-sectional study involved 450 patients recruited at a Tertiary Hospital. A pilot study was done to determine the interobserver variability in RV measurement. RV was calculated using the following formula: L × W × AP × 0.523. Parity, BMI, and blood pressure were documented, while FGA was calculated as an average of FGAs obtained from the measurements of fetal biometric parameters. Results: Mean RV of PIH women was significantly higher than that of NP women ( P < .05). RV shows a positive significant relationship with BMI and FGA, while it shows a negative relationship with parity in NP ( P < .05). Conclusion: Reference range values of RV were generated for clinical use in our locality, while there is statistically significant difference between RV in NP and PIH women.

SECRETION OF DIHYDROTESTOSTERONE BY HUMAN PROSTATE IN BENIGN PROSTATIC HYPERTROPHY

1974 ◽  
Vol 77 (2) ◽  
pp. 401-407 ◽  
Author(s):  
J. A. Mahoudeau ◽  
A. Delassalle ◽  
H. Bricaire
Keyword(s):  
Plasma Levels ◽  
Benign Prostatic Hypertrophy ◽  
Prostatic Hypertrophy ◽  
Human Prostate ◽  
Control Subjects ◽  
Peripheral Plasma ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
And Control

ABSTRACT Plasma levels of testosterone (T) and 5α-dihydrotestosterone (DHT) were determined by radioimmunoassay in 29 patients with benign prostatic hypertrophy (BPH) and in 56 control men of various ages. No significant difference was found in T, DHT nor DHT/T ratio between BPH and control subjects of similar age. Plasma DHT was higher in the prostatic than in the peripheral veins in 8/9 patients with BPH during laparotomy, indicating a prostatic secretion of DHT. No difference in the mean T nor the mean DHT was found in peripheral plasma before and after adenomectomy.

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