A Critical Commentary on the 2017 AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology

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15 Scopus citations

Abstract

In 2004, 2011, and 2017, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), a group of German-speaking psychiatric researchers and psychiatrists, published successive versions of therapeutic drug monitoring (TDM) expert group consensus guidelines. The 2017 version has as a major strength its encyclopedic nature, including 1358 references. The guideline has 3 major sections: 1) theoretical aspects of TDM, 2) drug concentration levels in blood to guide neuropsychopharmacotherapy, and 3) practical aspects of TDM in psychiatry and neurology. The writer hopes the time is right for a TDM guideline in psychiatry, which is indicated for: 1) psychiatric researchers ready to value how TDM can contribute to moving psychopharmacology forward, 2) flexible clinicians ready to improve their patient care by personalizing dosing, and 3) today's psychiatry residents prepared as a new generation ready to be trained in TDM and willing to continue incorporating TDM as new psychiatric drugs are marketed.

Original languageEnglish
Pages (from-to)63-68
Number of pages6
JournalPharmacopsychiatry
Volume51
Issue number1-2
DOIs
StatePublished - Jan 1 2018

Bibliographical note

Funding Information:
No commercial organizations had any role in the writing of this paper for publication. Dr. de Leon personally develops his presentations for lecturing, has never lectured using any pharmaceutical or pharmacogenetic company presentation, and has never been a consultant for pharmacogenetic or pharmaceutical companies. In the past, Dr. de Leon has received researcher-initiated grants from Eli Lilly (one ended in 2003 and the other, as co-investigator, ended in 2007); from Roche Molecular Systems, Inc. (ended in 2007); and, in collaboration with Genomas, Inc., from the NIH Small Business Innovation Research program (ended in 2010). He has been on the advisory boards of Bristol-Myers Squibb (2003/04) and AstraZeneca (2003). Roche Molecular Systems supported one of his educational presentations, which was published in a peer-reviewed journal (2005). His lectures have been supported once by Sandoz (1997, at that time the marketer of clozapine), twice by Lund-beck (both in 1999), twice by Pfizer (both in 2001), three times by Eli Lilly (once in 2003 and twice in 2006), twice by Janssen (2000 and 2006), once by Bristol-Myers Squibb (2006), and seven times by Roche Molecular Systems, Inc. (once in 2005 and six times in 2006). Dr. de Leon may have some conflict of interest due to personal relationships with some of the authors of the AGNP guidelines. After the publication of the first version of the AGNP consensus guideline, Dr. de Leon contacted Dr. Hiemke by e-mail. Since 2004, Dr. de Leon has continued, through e-mail and phone, a friendly relationship with Dr. Hiemke although they have never met in person. As they have collaborated in three published articles and share interest in therapeutic drug monitoring, it would be naïve for Dr. de Leon to state that his judgment on any of Dr. Hiemke’s articles can be completely free of bias. Dr. de Leon has also developed a friendly relationship by e-mail and/or other personal contacts with Drs. Stingl and Baumann and has collaborated with Dr. Schoretsanitis in one article. Dr. de Leon is not aware of any other possible conflict of interest with the rest of the authors of the AGNP consensus guideline.

Keywords

  • cytochrome P-450 enzyme system/metabolism
  • drug interactions
  • drug monitoring
  • enzyme induction
  • enzyme inhibitors
  • pharmacokinetics
  • practice guideline
  • psychopharmacology
  • psychotropic drugs.

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

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