Relevant Issues in the Monitoring and the Toxicology of Antidepressants

• Published in: Critical reviews in clinical laboratory sciences Vol. 45; no. 1; pp. 25 - 89
• Main Authors: Wille, Sarah M. R., Cooreman, Sarah G., Neels, Hugo M., Lambert, Willy E. E.
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 2008; Taylor & Francis; Taylor & Francis Ltd
• Subjects: analytical methods; Antidepressants; Antidepressive Agents - classification; Antidepressive Agents - toxicity; Biochemistry; Centre of Psychiatric Neurosciences; CHUV; Clinical Trials as Topic; Department of Biochemistry and Clinical Psychopharmacology; Depression; Depression - drug therapy; Depression - etiology; Depression - physiopathology; Drug Interactions; Drug Monitoring; Drug Therapy, Combination; Global Health; Humans; Medical research; monoamine oxidase inhibitors; noradrenergic and specific serotonergic antidepressants; Pharmacology; Pierre Baumann; Prilly-Lausanne; selective noradrenaline reuptake inhibitors; selective serotonin reuptake enhancer; selective serotonin reuptake inhibitors; serotonin and noradrenaline reuptake inhibitors; serotonin-antagonist and reuptake inhibitors; St. John's Wort; Switzerland; therapeutic drug monitoring; Toxicology; tricyclic antidepressants; Italy; United Kingdom > UK; France; United States > US; Japan; Spain
• ISSN: 1040-8363; 1549-781X
• DOI: 10.1080/10408360701713112

This review provides specific information concerning the interpretation and usefulness of antidepressant drug monitoring. Fifteen antidepressants (ADs) were selected based on their importance in the 7 major markets (Japan, USA, France, United Kingdom, Italy, Spain, Germany) according to the Cognos Plus Study #11. Literature data were reviewed concerning monitoring of the tricyclic ADs amitriptyline, clomipramine, imipramine, and new generation antidepressants such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, mianserin, mirtazapine, bupropion, and milnacipran. In addition, St.-John's Wort was added as this natural antidepressant is very popular in Europe. The objectives of therapeutic drug monitoring (TDM) for old and new generation ADs differs, as older ADs have narrow therapeutic windows with higher risks of severe drug interactions, while the new ADs have a wide therapeutic range, but an unclear plasma concentration-effect relationship. Therefore, the purpose of TDM for new-generation ADs leads more to the monitoring of patient compliance and special patient groups such as the elderly, patients with liver and kidney impairment, patients with poor metabolism by CYP 450 and comedication with inhibitors and inducers of those enzymes.