Drug and Clinical
DING Jing, ZHANG Suo, XING Huan, LI Luyao, GONG Yangze, TIAN Mi, CHEN Yanming, YANG Liu
OBJECTIVE To analyze the therapeutic drug monitoring (TDM) results of six second-generation antipsychotics, and to provide reference for individualized and rationalized schizophrenia treatment. METHODS Retrospective analyses of the TDM results of six second-generation antipsychotics were obtained from the outpatient and inpatient cases in Xi’an Mental Health Center from January 2020 to December 2020. A Med Calc 5.2 statistical software was used to analyze the subsequent data. RESULTS The results showed that the proportion of one TDM in outpatients was significantly higher than that in inpatients (P<0.01). Conversely, the proportion of monitoring frequency more than 2 times was higher in inpatients than that in outpatients (P<0.01). A higher plasma concentration was observed in female patients than in male patients (P<0.05) through the nonparametric Mann-Whitney U test, including olanzapine, amisulpride, and risperidone+paliperidone, but the plasma concentration of quetiapine+desethylquetiapine was found to be lower in female patients compared to male patients (P<0.01). Furthermore, a higher plasma concentration exposure (including amisulpride, quetiapine+norethylquetiapine, and aripiprazole+dehydroaripiprazole) was identified in patients over or equal to 60 years of age compared to those under 60 years of age (P<0.05), whereas, the olanzapine, risperidone+paliperidone, and clozapine+norclozapine concentrations had no statistically significant differences between the two different age groups (P>0.05). Among all the monitored samples, the blood concentration of olanzapine had the highest proportion in the therapeutic window by 74.98%, and that of clozapine showed the lowest proportion (20.53%). Moreover, the blood concentrations of amisulpride, aripiprazole and aripiprazole+dehydroaripiprazole were dramatically higher than the reference ranges recommended by the consensus, while those of clozapine and norethylquetiapine were significantly lower than the recommended reference ranges. CONCLUSION In clinical practice, it is essential to monitor drug concentrations for both outpatients and inpatients, so as to enhance the implementation of individualized drug administration, and ensure the safety and effectiveness of clinical medication.