The Clinical Use of Antipsychotic Plasma Levels
Stahl's Handbooks

A comprehensive and accessible guide to using antipsychotic levels for optimizing effectiveness and monitoring oral antipsychotic adherence.

Jonathan M. Meyer (Author), Stephen M. Stahl (Author)

9781009009898, Cambridge University Press

Paperback / softback, published 2 September 2021

400 pages
18.6 x 12.5 x 2 cm, 0.44 kg

'Drs. Jonathan Meyer and Stephen M. Stahl provide a comprehensive review of the state of the knowledge on the use of antipsychotic plasma levels for the management of patients with schizophrenia, as well as useful practical information for practicing clinicians. The handbook is written and organized in a manner that facilitates the learning of new concepts and its use as a reference tool. It should be an invaluable resource for clinicians facing the frequent scenario of patients exhibiting poor response or poor tolerance to the prescribed antipsychotic drug. It is to be hoped that this handbook and other dissemination efforts expand the use of therapeutic drug monitoring of antipsychotic treatment.' Marcela Horvitz-Lennon, Senior Physician Scientist, RAND Corporation; Associate Professor, Cambridge Health Alliance and Harvard Medical School

Clinicians recognize that monitoring psychotropic levels provides invaluable information to optimize therapy and track treatment adherence, but they lack formal training specifically focused on the use of plasma antipsychotic levels for these purposes. As new technologies emerge to rapidly provide these results, the opportunity to integrate this information into clinical care will grow. This practical handbook clarifies confusing concepts in the literature on use of antipsychotic levels, providing clear explanations for the logic underlying clinically relevant concepts such as the therapeutic threshold and the point of futility, and how these apply to individual antipsychotics. It offers accessible information on the expected correlation between dosages and trough levels, and also provides a clear explanation of how to use antipsychotic levels for monitoring oral antipsychotic adherence, and methods to help clinicians differentiate between poor adherence and variations in drug metabolism. An essential resource for psychiatrists, psychiatric nurse practitioners, and mental health professionals worldwide.

Preface
Introduction
1. Sampling times for oral and long-acting injectable agents
2. The therapeutic threshold and the point of futility
3. Level interpretation including laboratory reporting issues, responding to high plasma levels, special situations (hepatic dysfunction, renal dysfunction and hemodialysis, bariatric surgery)
4. Tracking oral antipsychotic adherence
5. What is an adequate antipsychotic trial – using plasma levels to optimize psychiatric response and tolerability
6. Important concepts about first generation antipsychotics
7. Haloperidol and haloperidol decanoate
8. Fluphenazine and fluphenazine decanoate
9. Perphenazine and perphenazine decanoate
10. Zuclopenthixol and zuclopenthixol decanoate
flupenthixol and flupenthixol decanoate
11. Chlorpromazine, loxapine, thiothixene, trifluoperazine
12. Important concepts about second generation antipsychotics
13. Clozapine
14. Risperidone oral and long-acting injectable, paliperidone oral and long-acting injectable
15. Olanzapine and olanzapine pamoate
16. Aripiprazole, aripiprazole monohydrate and aripiprazole lauroxil
17. Amisulpride, asenapine, lurasidone, brexpiprazole, cariprazine
Appendix Therapeutic threshold, point of futility, AGNP/ASCP laboratory alert level, and average oral concentration-dose relationships.

Subject Areas: Psychiatry [MMH], Pharmacology [MMG]