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Medication Exposure in Highly Adherent Psychiatry Patients
Jeffrey J Sutherland1, Thomas M Daly, Karen Jacobs
1Sano Laboratories , Sano Informed Prescribing , Franklin , Tennessee 37067 , United States.
ACS Chemical Neuroscience
|November 21, 2017
Summary
Highly adherent psychiatry patients often have low medication exposure, with most psychotropic drugs below reference ranges. This suggests underdosing may explain treatment issues in complex medication regimens.
Area of Science:
- Pharmacology
- Psychiatry
- Clinical Pharmacy
Background:
- Medication exposure is crucial for treatment efficacy.
- Assessing medication exposure in patients with comorbid polypharmacy presents unique challenges.
- Adherence is a key factor, but difficult to isolate in real-world settings.
Purpose of the Study:
- To empirically assess medication exposure in highly adherent psychiatry patients on multiple medications.
- To quantify the percentage of detected medications within, below, or above literature-derived reference ranges.
- To identify specific psychotropic medications with suboptimal exposure levels.
Main Methods:
- Enrolled 115 highly adherent psychiatry patients on five or more medications.
- Utilized a 59-medication multiplex assay panel to measure drug concentrations in blood.
- Reconciled electronic health records to confirm adherence and identify discrepancies.
Main Results:
- Patients were adherent to 91% of prescribed medications, but 13% of detected drugs were not in records.
- Only 53% of all detected medications were within reference ranges; 41% were below.
- Sertraline was the only psychotropic medication consistently within reference ranges at trough levels.
Conclusions:
- Low medication exposure is prevalent in adherent patients with polypharmacy.
- Suboptimal drug levels, rather than non-adherence, may contribute to treatment non-response.
- Clinical practice should consider extensive low medication exposure when addressing therapeutic issues.
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