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Yıl:2016; Cilt: 6; Sayı: 1>> Özet
Psikiyatride Güncel; 2016;6(1):69-75
Psikotrop İlaç Düzeyi İncelemeleri veToksikoloji
V Altınyazar
Adnan Menderes Üniversitesi, Aydın
İlaç tedavisine yanıt, toksisite ve aynı doz uygulanmış olsa bile kan düzeylerinde bireyler arasında görülen büyük farklılıklar genetik, fizyolojik, patolojik süreçler ve çevresel etkenler olmak üzere pek çok etmen tarafından belirlenmektedir. İlaçların absorbsiyonu, dağılımı ve metabolizmasının yanı sıra diğer ilaçlarla gelişebilecek etkileşimler de genetik farklılıklarla belirlenen etmenlerdir. Psikotrop ilaç düzeyi incelemeleri, ilaç tedavisinin bireyler arasındaki farmakokinetik karakteristiklerini belirlemede ve buna göre doz ayarlama, tedavinin izlenmesi ve toksisitenin araştırılmasında değerli bir araçtır. Şu an için psikotrop ilaç düzeyi incelemeleri ülkemizdeki çoğu merkez için lityum, valproik asit ve karbamazepin gibi bazı duygudurum dengeleyicileri ile sınırlıdır. Dünyada da henüz gelişme aşamasında olan bu alanda günlük rutin uygulamada, özellikle terapötik indeksi dar ilaçlar olan başlıca trisiklikler olmak üzere bazı antidepresanlar ve başlıca klozapin olmak üzere bazı antipsikotiklerle psikotrop ilaç düzeyi incelemeleri sınırlıdır. Halbuki özgül endikasyonlar ve farklı klinik problemler psikotrop ilaç düzeyi incelemelerinin kullanımıyla çoğunlukla çözülebilir ve neredeyse tüm psikotrop ilaçlar için tedavi bireyselleştirilebilir. Psikiyatri ve nörolojide ilaç düzeyi incelemelerinin potansiyel endikasyonlarının geliştirilmesi ve klinik tedavi prosesine entegrasyonu için oluşturulan bir uzman grubu mevcuttur (Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie; AGNP). İlki 2004 yılında olmak üzere 2011 yılında ve şu an güncellenme aşamasında olan kılavuzları yayınlanmıştır. İlaç kan düzeyi ölçümleri, dar terapötik indeksi olan ilaçlarda tedavi güvenliği sağlamanın yanı sıra, hastanın tedavi sırasında monitörizasyonu ile tedavi uyumunu arttırmakta, özellikle şizofreni olmak üzere tekrarlayan yatışları azaltmakta, toksisite riskini ve aşırı doz ilaç uygulamalarını azaltarak tedavi maliyetini düşürülmesine katkı sağlayabilmektedir.
Psychotropic Drug Monitoring and Toxicology
Large differences in response to the drug treatment, toxicity, and blood levels even application of the same dosage could be determined by many factors such as genetic, physiological, pathological processes and environmental factors. Absorption, distribution and metabolism of drugs as well as interactions with other drugs are mainly determined by genetic differences. Psychotropic drug monitoring (PDM) is a valuable tool for determining the pharmacokinetic characteristics between individuals and dose adjustments accordingly, monitoring the treatment and toxicity. The use of PDM is mostly limited for many centers in our country to some mood stabilizers, especially lithium, valproic acid, and carbamazepine. Daily routine practice in this field is still in the development stage in the world, the use of PDM is mostly limited to especially drugs with a narrow therapeutic index, like some antidepressants especially tricyclics and some antipsychotics primarily clozapine. However, the use of PDM for specific indications and different levels of clinical problems can often be convenient for individualized treatment for almost all psychotropic drugs. The expert group is available for consensus of potential indications of therapeutic drug monitoring and for integration to clinical treatment practice of therapeutic drug monitoring in psychiatry and neurology (Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie; AGNP). AGNP issued consensus guidelines the first version published in 2004, extended in 2011, and it is currently being updated. PDM is providing treatment safety especially in narrow therapeutic index medicines, increases treatment compliance with the monitoring during treatment, reducing repetitive hospitalization especially in schizophrenia, reduce toxicity risks and overdose which can contribute to reduce the cost of treatment by reducing excessive drug administration.

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