Therapeutic Drug Monitoring of Lithium in Patients With Bipolar Affective Disorder: Experiences From a Tertiary Care Hospital in India

Background: Lithium continues to be considered first-line therapy for treatment of acute mania, acute mixed bipolar disease and long-term prophylaxis of bipolar disorder. Present study was done to study the pattern of drug therapy in bipolar affective disorder patients with special reference to lithium in the routine psychiatric outpatients care setting of a tertiary care teaching hospital as well as to understand the prospect of therapeutic drug monitoring in optimization of lithium therapy based on outcome.Methods: It was a prospective, non-randomized, observational study of a cohort of subjects who are suffering from bipolar affective disorders and on lithium therapy. Patients were prospectively followed up three monthly for three visits with therapeutic drug monitoring of their plasma lithium level, as and when advised by the treating physician, and pre-formed questionnaires.Results: Results revealed there was significant improvement in symptoms of patients who were monitored with therapeutic drug monitoring and prescribed lithium therapy in accordance with clinical pharmacological consultation for optimal dosing resulting in optimal benefit to patients.Conclusions: With regular therapeutic monitoring, optimal target serum lithium levels can be achieved with dosage modifications thereby reducing the risk of toxicity with improved drug compliance. Thus, individualization of dosing and optimization of treatment can be achieved by dependable analytical laboratory services, better psycho-education, family support and overall a disease-based management team approach with the involvement of clinical Pharmacologist to meet the complexities of lithium therapy.

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Efficacy of Sodium Valproate and Olanzapine in treating bipolar affective disorder 'mania' at a tertiary care hospital in Nepal: A comparative study

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v4i1.16382 ◽

2017 ◽

Vol 4 (1) ◽

pp. 27-35

Author(s):

Lokeshwar Chaurasia ◽

Sunil Kumar Shah ◽

Sudarshana Magham Chetty

Keyword(s):

Affective Disorder ◽

Sodium Valproate ◽

Rating Scale ◽

Tertiary Care Hospital ◽

Bipolar Affective Disorder ◽

Tertiary Care ◽

Care Hospital ◽

Medical Sciences ◽

Significant Difference ◽

The Mean

Background and Objectives: Bipolar affective disorder, mania is the mood of an abnormally elevated arousal energy level or a state of heightened overall activation with enhanced affective expression together with lability of affect. The objective of the study was to compare the efficacy of sodium valproate and olanzapine in bipolar affective disorder, mania patients at a tertiary care hospital in NepalMaterial and Methods: A randomized observational prospective open label study was conducted for one and half year at College of Medical Sciences-Teaching Hospital (CMS-TH), Bharatpur, Nepal in the Psychiatry Department. Sixty patients diagnosed with bipolar affective disorder, mania were enrolled. 30 patients received sodium valproate and 30 patients received olanzapine. Patients were monitored and evaluated on baseline (day 0), day 7 and day 30 and compared to the baseline for the severity of illness using the 11-item Young Mania Rating Scale (YMRS).Results: The mean baseline YMRS score for all cases on sodium valproate (n=30) on day 0 was 38.87 ± 3.73, while it was reduced to 13.90 ± 1.95 (p < 0.001) on day 30. Similarly, the mean baseline YMRS score for all cases on olanzapine (n=30) on day 0was 40.83 ± 6.50, while it was reduced to 14.47 ± 2.83 (p < 0.001) on day 30.The mean decrease in YMRS score by sodium valproate was 64.24% and by olanzapine was 64.56%.Conclusion: Treatment with sodium valproate and olanzapine significantly improves the mean mania ratings score and there is no statistically significant difference in efficacy of both the drugs in patients diagnosed with bipolar affective disorder, mania.Janaki Medical College Journal of Medical Sciences (2016) Vol. 4(1): 27-35

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Therapeutic drug monitoring of phenytoin using high performance liquid chromatography in a tertiary care hospital of Kashmir, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191590 ◽

2019 ◽

Vol 8 (5) ◽

pp. 995

Author(s):

Mohd Adil ◽

Sameena Farhat ◽

Mohd Younis Rather

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

High Performance ◽

Tertiary Care ◽

Therapeutic Drug ◽

Care Hospital ◽

Chi Square ◽

Active Involvement ◽

Chi Square Test ◽

Set Up

Background: Phenytoin is the most commonly used anti-epileptic drug (AED) in this set up due to cost effectiveness and easy availability. Significant fluctuations in serum phenytoin levels leading to toxicities or treatment failures make it an ideal candidate for therapeutic drug monitoring (TDM).Methods: Patients of age ≥18 years who were put on phenytoin were enrolled in this study. Estimation of serum phenytoin levels was done using HPLC. Data was analysed using SPSS version 20.0. Chi square test, Kruskal Wallis test were used to analyse the data.Results: A total of 105 patients enrolled in the study, twenty patients (19%) had normal or therapeutic serum phenytoin levels. Thirty-nine patients (37.2%) had sub therapeutic serum phenytoin levels, while forty-six patients (43.8%) had toxic serum phenytoin levels.Conclusions: The TDM of phenytoin should adopt a multi-disciplinary approach with active involvement of neuro-physicians, pharmacologists, pharmacists and other technical staff for improving the overall management of epilepsy. TDM data will provide the clinicians with greater insight into the factors determining the patient’s response to drug therapy.

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