The Clinical Use of Antipsychotic Plasma Levels (Stahl's Handbooks)

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.

Clinicians recognize that monitoring psychotropic levels provides invaluable information to optimize therapy and track treatment adherence, 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.

• Contains detailed coverage of the appropriate sampling times for oral and long-acting injectable antipsychotics based on the kinetics of each agent and discusses the current thinking surrounding what defines an adequate antipsychotic trial, and how to using plasma levels to optimize psychiatric response and tolerability
• Provides a logical, evidence-based justification for the therapeutic threshold and the point of futility for 18 commonly used oral and long-acting injectable forms of first- and second-generation antipsychotics, allowing for a better understanding of the nuances and limitations of the data for each antipsychotic, instead of providing lists of therapeutic ranges with no explanation
• Offers detailed information on dose and plasma levels correlations for antipsychotics, providing clinicians with the tools to interpret the plasma level information obtained, and on the next steps to take when levels are markedly above or below those expected for a given dose

Jonathan M. Meyer, University of California, Riverside and San Diego
Jonathan M. Meyer is a Clinical Professor of Psychiatry at the University of California, San Diego, and a Psychopharmacology Consultant to the California Department of State Hospitals.

Stephen M. Stahl, University of California, San Diego
Stephen M. Stahl is Adjunct Professor of Psychiatry at the University of California, San Diego, Clinical Professor of Psychiatry and Neuroscience at the University of California, Riverside, and Honorary Visiting Senior Fellow in Psychiatry at the University of Cambridge.