Key result
The impact of comorbidities on antipsychotic dosage is hard to predict due to multilevel interactions, necessitating therapeutic drug monitoring in clinical practice.
Why the study?
Antipsychotic effects are dose-dependent with specific dose-response curves, justifying individualized dosing in large patient populations who may have comorbidities like renal and hepatic impairment.
In patients with comorbidities such as renal or hepatic impairment, antipsychotic dosing is complex and should be guided by therapeutic drug monitoring of plasma levels.
May support individualized antipsychotic dosing via PK review; leaves open prospective outcome validation in clinical practice.
INTRODUCTION: The effects of antipsychotic drugs are dose-dependent, which is particularly true for their efficacy, each antipsychotic having a specific dose-response curve. This may justify individualizing doses for these agents. AREAS COVERED: We review the pharmacokinetic profiles of seven oral antipsychotics: haloperidol, risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole. Their main indications are psychotic and affective disorders. They are prescribed in a very large population which may have comorbidities. Hence, we analyze the impact of the latter on the pharmacokinetic profiles of these antipsychotics, focusing on renal and hepatic impairment. Reviews and clinical trials were discussed based on a systematic literature search (PubMed) ranging from 1995 to 2022. EXPERT OPINION: Factors liable to impact antipsychotic dosage are numerous and their subsequent effects often hard to predict, due to multilevel interactions and compensatory phenomena. In clinical practice, physicians must be aware of these potential effects, but base their decisions on monitoring antipsychotic plasma levels.
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Simon et al. (2022) conducted a review in Psychotic and affective disorders. Oral antipsychotics (haloperidol, risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole) was evaluated. The impact of comorbidities on antipsychotic dosage is hard to predict due to multilevel interactions, necessitating therapeutic drug monitoring in clinical practice.
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