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Comorbidities and the right dose: antipsychotics
Nicolas Simon1, Romain Torrents1, Jean-Michel Azorin2
1Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Department of Clinical Pharmacology, CAP, Marseille, France.
Expert Opinion on Drug Metabolism & Toxicology
|August 18, 2022
Summary
Antipsychotic drug efficacy is dose-dependent, necessitating personalized dosing. This review examines how comorbidities, particularly renal and hepatic impairment, affect antipsychotic pharmacokinetics, guiding clinical practice.
Area of Science:
- Pharmacology
- Psychiatry
- Clinical Pharmacy
Background:
- Antipsychotic drug effects are dose-dependent, with unique dose-response curves for each agent.
- Individualizing antipsychotic dosages is crucial for optimizing efficacy and managing side effects.
Purpose of the Study:
- To review the pharmacokinetic profiles of seven oral antipsychotics.
- To analyze the impact of comorbidities, specifically renal and hepatic impairment, on these pharmacokinetic profiles.
Main Methods:
- Systematic literature search of PubMed (1995-2022).
- Review of clinical trials and existing literature on haloperidol, risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole pharmacokinetics.
Main Results:
- Comorbidities significantly influence antipsychotic pharmacokinetics.
- Renal and hepatic impairment can alter drug metabolism and elimination, affecting plasma concentrations.
Conclusions:
- Understanding pharmacokinetic variations due to comorbidities is essential for safe and effective antipsychotic prescribing.
- Monitoring plasma levels aids clinicians in adjusting doses for patients with impaired renal or hepatic function.
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