Problem solving in psychopharmacotherapy using pharmacokinetic and pharmacogenetic tests
Pierre Baumann
Switzerland 
Disclosure : I got sponsoring from almost all psychologic drug companies in Switzerland, but also member of advisory boards, financial help for research projects, organization of meetings, etc.
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33 slide(s) – 00:27:54 – English – 2009-01-24
Many problems such as non-response, pharmacokinetic interactions with clinical consequences and adverse effects (pharmacovigilance) may be observed in patients submitted to psychopharmacotherapy. These risks are increased in patients belonging to the category of “special populations”: elderly patients, children and adolescents, patients with a genetic particularity of metabolism or suffering from somatic or psychic comorbidities. Pharmacokinetic and pharmacogenetic tests are useful to solve problems in psychopharmacotherapy and thus improve efficacy and safety. The aim of this course is first to briefly summarize some basic knowledge on the pharmacogenetics and pharmacokinetics of psychotropic drugs. Psychiatrists who already have experience in this field will have their knowledge updated: recent progress will be illustrated by clinical situations, which will be discussed in an interactive way. Especially, clinical situations encountered in elderly patients will be considered. A consensus paper with recommendations on the optimal use of pharmacokinetic and pharmacogenetic tests will be summarized and submitted for discussion, by speakers (clinicians, clinical psychopharmacologists) from Switzerland, Sweden and Germany.
A widely introduced pharmacokinetic test in psychopharmacotherapy is therapeutic drug monitoring (TDM). It is especially recommended in patients who are non-compliant, who poorly tolerate, or who do not respond to a medication. It is also useful in patients belonging to the category of “special populations”, i.e. somatically ill patients, who are comedicated with a variety of drugs and who suffer from a liver or renal disease, as well as in elderly or very young patients. Increasingly, the use of generics has been shown to represent a source of unexpected treatment outcomes, and TDM may help to explain pharmacokinetic particularities after switching from an original to a generic preparation (or vice versa). Finally, the increasing knowledge of the metabolism of psychotropic drugs allows taking account of the pharmacogenetic status (e.g. cytochrome P-450, P-glycoprotein) of the patients not only in adapting their medication, but also for interpreting pharmacokinetic interactions with clinical consequences. In this respect, pharmacokinetic and pharmacogenetic tests have now also to be considered as a tool in pharmacovigilance.
As an Introduction, P. Baumann will present a recently published consensus paper on the optimal use of TDM (and pharmacogenetic tests) as well as a general presentation of the pharmacokinetics of psychotropic drugs (including drugs used for the treatment of dementia!) in elderly patients. F. Bengtsson and C. Hiemke will show the advantages of TDM and pharmacogenetics in clinical situations presented above and encountered in patients treated with antidepressants or antipsychotics. E. Jaquenoud will show the usefulness of TDM and pharmacogenetic tests in situations of “pharmacovigilance”, with some emphasis on situations encountered with psychogeriatric patients.
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