First-generation (typical) antipsychotic
drugs qualify for therapeutic drug monitoring primarily for compliance control and to avoid extrapyramidal reactions by keeping chronic exposure to minimal adequate blood levels. For clozapine, drug safety with regards to agranulocytosis is another reason to use therapeutic drug monitoring. With second-generation antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole), the rationale to monitor drug levels is debatable. Positron emission tomography (PET) enables measurement of the occupancy of
dopamine D2 receptors and reveals receptor occupancy interacts better with plasma concentrations than with doses of the antipsychotics. There is a consistent requirement of 65% D2 receptor occupancy for antipsychotic efficacy in functional imaging studies. Regarding plasma levels related to therapeutic effects, there are established ideal concentrations for clozapine (350 ng/mL to 600 ng/mL), risperidone (20 ng/mL to 60 ng/mL), and olanzapine (20 ng/mL to 80 ng/mL) but not for the other second-generation antipsychotics. In conclusion, the evidence is growing that drug monitoring may improve efficacy and safety in patients treated with the new antipsychotic drugs, especially when patients do not respond or develop side effects under therapeutic doses. Due to the fewer extrapyramidal and anticholinergic effects, second-generation antipsychotics are the first-line treatment for
psychotic disorders (e.g., schizophrenia). Second-generation antipsychotics have correlations with weight gain, type 2
diabetes mellitus, metabolic syndrome, drowsiness, sedation, and QTc prolongation. Among the second-generation antipsychotics, clozapine is most effective in reducing psychotic symptoms and suicidality. The use of clozapine is mostly for treatment-resistant schizophrenia. However, due to the significant adverse side effect of agranulocytosis, clozapine is reserved for severe cases of
psychotic disorders after a patient has had an insufficient response to two adequate trials of other antipsychotic medications. This information can be published in our peer-reviewed journal with impact factors and are calculated using citations not only from research
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Relevant Topics in Neuroscience & Psychology
