scholarly journals Plasma levels of long-acting injectable antipsychotics in outpatient care: a retrospective analysis

2020 ◽  
Author(s):  
Martin Hýža ◽  
Šilhán Petr ◽  
Češková Eva ◽  
Skřont Tomáš ◽  
Kacířová Ivana ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Plasma Levels ◽  
Drug Application ◽  
Individual Variability ◽  
Therapeutic Drug ◽  
Fluphenazine Decanoate ◽  
Blood Samples ◽  
Usual Clinical Practice ◽  
Long Acting ◽  
The Individual

Abstract Background The antipsychotic efficacy in schizophrenia depends on its availability in the organism. Although therapeutic outcomes remain still far from satisfactory, therapeutic drug monitoring is not a common part of clinical practice during a treatment with long-acting injectable antipsychotics (LAI AP). The real effectiveness of LAI AP is thus uncertain. Methods We made a retrospective evaluation of plasma levels of LAI AP. Collection of blood samples was performed just before the drug application and one week later. Fourty patients with a stabilized clinical condition and steady-state plasma levels were included. Results In the observed cohort of patients, flupentixol decanoate (n = 23) was the most often used drug, followed by fluphenazine decanoate (n = 7), haloperidol decanoate (n = 5), paliperidon palmitate (n = 3), and risperidone microspheres (n = 2). Just 5 of 40 patients were treated with a monotherapy. At the time before the application, 60% of the patients did not reach the therapeutic reference range (TRR) and 20% of the patients had an undetectable plasma level. At the time of collection of the second blood samples performed after 7 days, 24% of the patients were under the TRR. Conclusion We have found the surprisingly high incidence of plasma levels under the TRR in patients treated with LAI AP. Notwithstanding the individual variability in pharmacokinetics, it seems the LAI AP may be underdosed in the usual clinical practice.

scholarly journals Can We Rely on AGNP Therapeutic Targets Also For LAI Antipsychotics?

2017 ◽  
Vol 51 (06) ◽  
pp. 270-271 ◽  
Author(s):  
Sara Baldelli ◽  
Emilio Clementi ◽  
Dario Cattaneo
Keyword(s):  
Clinical Practice ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Atypical Antipsychotics ◽  
Therapeutic Targets ◽  
Therapeutic Drug ◽  
Consensus Guidelines ◽  
Long Acting

AbstractThe updated AGNP Consensus Guidelines for Therapeutic Drug Monitoring (TDM) in Neuropsychopharmacology recently published in the journal have reinforced the key role of TDM to individualize psychoparmacological therapies in clinical practice. However, we believe, that these guidelines have missed the important opportunity to face with, and to provide useful information on, the emerging issue of long-acting injectable formulations of atypical antipsychotics. Specific therapeutic ranges also for these formulations should be included in the next AGNP guidelines.

Plasma Levels of Fluphenazine Decanoate

1988 ◽  
Vol 153 (3) ◽  
pp. 382-384 ◽  
Author(s):  
Som D. Soni ◽  
David Wiles ◽  
A. A. Schiff ◽  
J. S. Bamrah
Keyword(s):  
Maintenance Therapy ◽  
Injection Site ◽  
Plasma Levels ◽  
Muscular Exercise ◽  
Blood Levels ◽  
Fluphenazine Decanoate ◽  
Physicochemical Composition ◽  
Depot Neuroleptics ◽  
Long Acting

Depot neuroleptics are now commonly used for maintenance therapy of schizophrenia. Their physicochemical composition makes them ideal for such use because they are long-acting and show stable blood levels for prolonged periods. Their absorption from the site of injection may, however, be affected by local muscle factors. This paper describes three such factors in relation to fluphenazine decanoate: varying the site of injection; massage of the injection site; and effects of muscular exercise. Our results suggest that fluphenazine pharmacokinetics are not significantly affected by any of these factors.

scholarly journals Effectiveness of paliperidone long-acting injection in clinical practice

2018 ◽  
Vol 8 (5) ◽  
pp. 139-145 ◽  
Author(s):  
Paul Nicholas Deslandes ◽  
Elan Haf Ward ◽  
Kathryn Norris ◽  
Robert David Sewell
Keyword(s):  
Clinical Practice ◽  
Demographic Factors ◽  
Clinical Effectiveness ◽  
Paliperidone Palmitate ◽  
Health Board ◽  
Inpatient Stay ◽  
Term Outcome ◽  
Number Of Patients ◽  
Usual Clinical Practice ◽  
Long Acting

Background: The efficacy of the long-acting injectable formulation of the antipsychotic paliperidone (paliperidone palmitate) has been investigated in randomized controlled trials. Due to the nature of study designs, these may not be representative of usual clinical practice. The aim of this study was to assess the clinical effectiveness of the long-acting injectable antipsychotic paliperidone palmitate using treatment continuation at 1 year as an outcome. Methods: Patients were initiated on paliperidone palmitate prior to December 2014 in a single health board in Wales (UK). Demographic factors that may have influenced outcome, including diagnosis, age at initiation, sex, inpatient or outpatient status on initiation, were analysed to assess whether they influenced patient outcome. For patients completing 1 year of treatment, inpatient stay in the 12 months prior to and following paliperidone palmitate initiation was compared. Results: Data were available for 64 patients; 41 had a diagnosis of schizophrenia and 7 had previously received clozapine. Continuation rates at 6 and 12 months were 69% and 63% respectively. Treatment continuation was not associated with demographic factors. For continuers, mean inpatient stay pre- and post-initiation was 83.2 ± 105.3 and 73.5 ± 103.3 days respectively ( p = 0.61). The most common reason for discontinuation was lack of effect ( n = 9). Conclusions: The proportion of patients remaining on treatment was comparable to that reported in other naturalistic studies. Prescribing for indications outside the product licence was relatively common, but did not appear to influence outcome, although the number of patients in each group was small. Treatment continuation at 6 months appeared to be a predictor of longer-term outcome.

Therapeutic drug monitoring

1999 ◽  
Vol 11 (1) ◽  
pp. 15-16
Author(s):  
J.B.G.M. Noten ◽  
W.M.A. Verhoeven ◽  
S. Tuinier ◽  
D. Touw
Keyword(s):  
Cytochrome P450 ◽  
Therapeutic Drug Monitoring ◽  
Enzyme System ◽  
Individual Variability ◽  
Therapeutic Drug ◽  
Metabolic Capacity ◽  
Potential Value ◽  
Regular Measurement ◽  
Genetic And Environmental Factors ◽  
The Individual

SUMMARYThe cytochrome P450 iso-enzyme system plays a key role in the biotransformation of many drugs, including psychotropics. Its activity is determined by both genetic and environmental factors. The most important iso-enzymes for psychiatry in general are P450 IID6, 3A4 and 1A2. Knowledge about the involvement of these enzymes and biotransformation processes is mandatory because of the individual variability in their metabolic capacity. Regular measurement of plasmaconcentrations of (psycho)pharmacological compounds is therefore essential. In addition, the potential value of pheno- and/or genotyping has to be investigated.

scholarly journals Response and Toxicity to Cytarabine Therapy in Leukemia and Lymphoma: From Dose Puzzle to Pharmacogenomic Biomarkers

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 966
Author(s):  
Raffaele Di Francia ◽  
Stefania Crisci ◽  
Angela De Monaco ◽  
Concetta Cafiero ◽  
Agnese Re ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Outcome ◽  
Genetic Variants ◽  
Neoplastic Meningitis ◽  
Individual Variability ◽  
Intracellular Accumulation ◽  
Pyrimidine Nucleoside ◽  
Comprehensive Information ◽  
Multiagent Chemotherapy ◽  
The Individual

Cytarabine is a pyrimidine nucleoside analog, commonly used in multiagent chemotherapy regimens for the treatment of leukemia and lymphoma, as well as for neoplastic meningitis. Ara-C-based chemotherapy regimens can induce a suboptimal clinical outcome in a fraction of patients. Several studies suggest that the individual variability in clinical response to Leukemia & Lymphoma treatments among patients, underlying either Ara-C mechanism resistance or toxicity, appears to be associated with the intracellular accumulation and retention of Ara-CTP due to genetic variants related to metabolic enzymes. Herein, we reported (a) the latest Pharmacogenomics biomarkers associated with the response to cytarabine and (b) the new drug formulations with optimized pharmacokinetics. The purpose of this review is to provide readers with detailed and comprehensive information on the effects of Ara-C-based therapies, from biological to clinical practice, maintaining high the interest of both researcher and clinical hematologist. This review could help clinicians in predicting the response to cytarabine-based treatments.

Psychiatrists’ opinions on long-acting anti-psychotics drugs: Perceived differences and identification of the ideal patient for each of these medications

2017 ◽  
Vol 41 (S1) ◽  
pp. S762-S763
Author(s):  
V. Verdino ◽  
A. Fagiolini
Keyword(s):  
Clinical Practice ◽  
Daily Clinical Practice ◽  
Community Mental Health Service ◽  
Good Tolerability ◽  
Actual Use ◽  
Competing Interest ◽  
Long Acting ◽  
The Individual ◽  
Image Position ◽  
The Ideal

IntroductionLong-acting anti-psychotic drugs (LAI) are increasingly used in clinical practice, owing to their ability to improve adherence.Objectives and aimsTo understand the variables that inform treatment choice, within the LAI anti-psychotics, in the daily clinical practice.MethodsFifteen attending psychiatrists from the university clinic of Siena and the community mental health service USL 7 Siena and Val d’Elsa were asked to answer a questionnaire comprising 4 questions, and asking for their clinical experience regarding olanzapine, risperidone, haloperidol, zuchlopentixol, paliperidone and aripiprazole LAISs.In particular, they were asked to indicate:– which LAI has been their mostly used;– what have been the most relevant side effects;– an efficacy score ranging from 0 to 5;– who the ideal patient for each of these medications could be.The answers were statistically assessed and the final results described as a percentage of the total.ResultsThe results are shown by the Tables 1 and 2.ConclusionsLAI are still heterogeneously used in the daily clinical practice: their actual use depends on the individual experience with a specific drug as well as on their costs and the availability of resources within the medical service. The most used LAI resulted to be risperidone, although haloperidol LAI is still considered to be the most effective one. Those psychiatrists interviewed had an overall good opinion about the most recent LAI such as paliperidone and aripiprazole. This is due to their good tolerability, which allows them to be administered more safely to the youngest, in order to preserve their good functioning.Table 1Table 2Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Constitutional markers of urticaria and their prognostic significance (analysis of scientific literature)

2021 ◽  
Vol 25 (4) ◽  
pp. 668-671
Author(s):  
Aladwan Amjed Mashoor Ahmad
Keyword(s):  
Clinical Practice ◽  
Scientific Literature ◽  
Prognostic Significance ◽  
Clinical Manifestations ◽  
Individual Variability ◽  
Adverse Outcomes ◽  
Phenotypic Marker ◽  
Genetic Predictors ◽  
The Individual ◽  
Made In

Annotation. The purpose of the work is to analyze the scientific literature regarding the constitutional markers of urticaria and their prognostic significance. The analysis of modern scientific literature in the scientometric databases PubMed and MEDLINE is carried out. A review of the literature indicates that significant progress has been made in understanding the etiopathogenesis of urticaria in recent decades, with some clinical and anamnestic signs suggestive of adverse outcomes. However, identifying patients with the highest risk of complications remains an unresolved issue. In connection with the development and implementation in clinical practice of methods of genetic typing, much attention is paid to the search for genetic predictors of adverse course of this dermatosis. To date, phenotypic marker profiles that have been little modified over a lifetime and available for visualization in everyday clinical practice have not been properly considered in assessing the risk of urticaria. Modern anthropocentric approach to solving the problem of risk prediction in urticaria opens up the prospect of taking into account constitutional (personality-typological, somato-typological) and genetic factors that are the basis of psychobiological reactivity of the individual, determining individual variability of pathogenesis and clinical manifestations, patterns severity and frequency of complications.

Influence of Certain Drugs on the Adhesiveness of Human, Rat, and Rabbit Blood Platelets in Vitro

1965 ◽  
Vol 13 (02) ◽  
pp. 428-438 ◽  
Author(s):  
K Reber ◽  
A Studer
Keyword(s):  
Sodium Citrate ◽  
Blood Platelets ◽  
Drug Application ◽  
Normal Range ◽  
Blood Samples ◽  
Serotonin Antagonist ◽  
Thrombocyte Count ◽  
Particle Count ◽  
Rabbit Blood

SummaryThis is a comparative study of the methods described by H. P. Wright and O’Brien for determining the adhesiveness of thrombocytes. An attempt is made to characterize and statistically correlate both techniques. With the aid of a Coulter Counter for thrombocyte counts, a normal range is presented for human, rat, and rabbit blood. Anticoagulants used are sodium citrate and Heparin.The influence of Cocaine and the Serotonin antagonist Ro 3-0837 was studied on these same substrates, to determine a pharmacological interference with results of either Wright’s test or O’Brien’s. Both drugs are found to induce a statistically significant increase in the “thrombocyte count” as compared to the corresponding controls. These effects are not real but to be attributed to an increase in particle count due to thrombocyte fragmentation as a consequence of drug application. There is no evidence for the claim that these drugs decrease the adhesiveness of thrombocytes.Numerical results of both tests often show a high and statistically significant correlation, especially following the addition of Ro 3-0837. Such is not true of individual blood samples to which no drug has been added. Evidentally, both tests are not specific for the same characteristic of normal blood platelets. But, when Ro 3-0837 is added, the breakdown of unstable platelets is induced; and the corresponding increase in count of thrombocyte fragments is expressed by both tests in the same fashion.

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