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Multicyclic antidepressant serum drug assays: a utilization review
Hospital Formulary
|March 11, 1987
Summary
Clinical interpretation of multicyclic antidepressant (MCA) serum levels is challenging. A review found poor adherence to guidelines for MCA assay use and documentation in a psychiatric hospital, prompting new recommendations.
Area of Science:
- Pharmacology
- Clinical Chemistry
- Psychiatry
Background:
- Multicyclic antidepressants (MCAs) exhibit complex pharmacokinetics, complicating serum concentration interpretation.
- Effective therapeutic drug monitoring of MCAs requires adherence to established clinical guidelines.
Purpose of the Study:
- To evaluate the actual utilization of multicyclic antidepressant serum assays.
- To assess compliance with established criteria for MCA assay ordering and interpretation.
- To identify areas for improvement in MCA therapeutic drug monitoring.
Main Methods:
- Retrospective review of MCA serum assay utilization over one year.
- Comparison of actual use against criteria derived from contemporary medical literature.
- Assessment of documentation quality for assay indications and treatment decisions.
Main Results:
- Overall compliance with established criteria for MCA assay utilization was poor.
- Documentation regarding the rationale for ordering MCA assays was inadequate.
- Records of subsequent therapy decisions based on MCA assay results were also insufficient.
Conclusions:
- Current practices for MCA serum assay utilization in the reviewed institution do not consistently meet established guidelines.
- Improved adherence to guidelines and better documentation are necessary for effective MCA therapeutic drug monitoring.
- Implementation of institutional guidelines and continuing medical education are recommended to enhance MCA assay utility.
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