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| One case of off-label drug use under the guidance of therapeutic drug monitoring |
| NIU Mengxi1,2,3,4 GUO Wei1,2,3,4 |
1.Department of Pharmacy, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;
2.Beijing Key Laboratory of Mental Disorders, Beijing 100088, China;
3.the National Clinical Research Center for Mental Disorders, Beijing 100088, China;
4.Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China |
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Abstract A 71-year-old man with bipolar disorder had taken various antidepressants intermittently for many years, but the curative effect is not good. On March 21, 2018, the symptoms were slightly relieved and no adverse reactions occurred after the prescriptions of Escitalopram, Mirtazapine and Oxazepam were given in the outpatient clinic of Beijing Anding Hospital, Capital Medical University ("our hospital" for short). On April 11, 2018, the patient was hospitalized for further therapeutic effects. After admission, Lithium Carbonate, Sodium Valproate and Escitalopram were administered. Based on the actual treatment of the patient, and combined with pharmacokinetics and pharmacodynamics, the clinical pharmacist and doctors decided to give off-label dose of Escitalopram under the therapeutic drug monitoring. Escitalopram reached a steady-state valley concentration of 51.5 ng/mL (the concentration range of reference therapeutic was 15-80 ng/mL) after 2 weeks. After that, the patient′s plasma drug concentration remained stable, and the symptoms continued to relieve. Finally the patient achieved clinical improvement and discharged. In this case, based on Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017, the clinical pharmacist developed individualized doses for elderly patients with poor conventional dose therapy. Therapeutic drug monitoring in the case of overdosing ensured patient safety as well as efficacy.
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