Comparing the pharmacology and pharmacokinetics of antipsychotics: Choosing an antipsychotic and dosing a long-acting injectable.

In this paper, we will discuss the pharmacologic properties of antipsychotics, including those that are the same in structure and those that differentiate one from another. We will bring to you how differential pharmacologic properties can explain differential efficacy and differential tolerability. We will review how to use plasma drug levels and long-acting injectables to enhance compliance early in the illness, and to manage both forms of treatment resistance (pharmacokinetic and pharmacodynamic failures). Through inadequate pharmacokinetic processes (poor absorption, rapid metabolism, enzymatic polymorphisms, etc.), antipsychotic plasma levels do not reach sufficient concentration. Pharmacodynamic treatment failure (receptor binding and sensitivity, post-receptor effects, etc.) is the inability to provide a significant effect on psychotic symptoms despite therapeutic plasma levels. Long-Acting Injectable (LAI) antipsychotics employ technology that can provide a useful treatment tool in the armamentarium of a modern psychopharmacologist. The pharmacologic properties of antipsychotics differentiate one from another and can help explain differences in efficacy and tolerability. Utilizing plasma drug levels can enhance understanding of treatment failures and lead to specific patient management strategies for best outcomes. This kind of personalized approach to antipsychotic dosage would mean a big shift in the treatment of psychiatric patients.

Informations de copyright

Copyright © 2023 Elsevier B.V. and ECNP. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest Conflict of interest Stahl M. Stephen, M.D., PhD, DSc (Hon) is an Adjunct Professor of Psychiatry at the University of California San Diego, Honorary Visiting Senior Fellow at the University of Cambridge, UK and Director of Psychopharmacology for California Department of State Hospitals. Over the past 12 months, Dr Stahl has served as a consultant to Acadia, Alkermes, Allergan, Arbor Pharmaceuticals, Axovant, Axsome, Celgene, Concert, Clearview, EMD Serono, Ferring, Intra-Cellular Therapies, Janssen, Lilly, Lundbeck, Merck, Otsuka, Pfizer, Servier, Shire, Sunovian, Takeda, Taliaz, Teva, Tonix and Vifopharma. He is board member of Genomind, he has served on speakers bureaus for Acadia, Lundbeck, Otsuka, Perrigo, Servier, Sunovion, Takeda and Vertex and he has received research and /or grant support from Acadia, Avanir, Braeburn Pharmaceuticals, Eli Lilly, Intra-Cellular therapies, Ironshore, ISSWSH, Neurocrine, Otsuka, Shire, Sunovian, and TMS NeuroHealth Centres. Conflict of interest Djokic Gorica, M.D., MSc, PhD is founder of Meliora Medica Clinic. Over the past 12 months Dr Djokic has served as a consultant to Abela Pharm, and Oktal Pharma, and as a consultant of various Media companies. She serves as a consultant to Erasmus + WeCare project on mental health of the healthcare professionals.