Research

Drug monitoring in child and adolescent psychiatry for improved efficacy and safety of psychopharmacotherapy

Claudia Mehler-Wex¹ , Michael Kölch¹ , Julia Kirchheiner² , Gisela Antony³ , Jörg M Fegert¹ and Manfred Gerlach⁴

¹  Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr 5, 89075 Ulm, Germany

²  Institute of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, Helmholtzstr 20, D-89081 Ulm, Germany

³  IT-Cenre, Competence Network on Parkinson's Disease, University of Marburg, Rudolf-Bultmann-Str 8, D-35039 Marburg, Germany

⁴  TDM Laboratory, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstr 5, 97080 Wuerzburg, Germany

author email corresponding author email

Child and Adolescent Psychiatry and Mental Health 2009, 3:14doi:10.1186/1753-2000-3-14

Published:	9 April 2009

Abstract

Most psychotropic drugs used in the treatment of children and adolescents are applied "off label" with a direct risk of under- or overdosing and a delayed risk of long-term side effects. The selection of doses in paediatric psychiatric patients requires a consideration of pharmacokinetic parameters and the development of central nervous system, and warrants specific studies in children and adolescents. Because these are lacking for most of the psychotropic drugs applied in the Child and Adolescent and Psychiatry, therapeutic drug monitoring (TDM) is a valid tool to optimise pharmacotherapy and to enable to adjust the dosage of drugs according to the characteristics of the individual patient. Multi-centre TDM studies enable the identification of age- and development-dependent therapeutic ranges of blood concentrations and facilitate a highly qualified standardized documentation in the child and adolescent health care system. In addition, they will provide data for future research on psychopharmacological treatment in children and adolescents, as a baseline for example for clinically relevant interactions with various co-medications. Therefore, a German-Austrian-Swiss "Competence Network on Therapeutic Drug Monitoring in Child and Adolescent Psychiatry" was founded [1] introducing a comprehensive internet data base for the collection of demographic, safety and efficacy data as well as blood concentrations of psychotropic drugs in children and adolescents.