Scientific article
OA Policy
English

Pediatric Therapeutic Drug Monitoring for Selective Serotonin Reuptake Inhibitors

Published inFrontiers in pharmacology, vol. 12, 749692
First online date2021-10-01
Abstract

Therapeutic drug monitoring (TDM) is uncommon in child and adolescent psychiatry, particularly for selective serotonin reuptake inhibitors (SSRIs)-the first-line pharmacologic treatments for depressive and anxiety disorders. However, TDM in children and adolescents offers the opportunity to leverage individual variability of antidepressant pharmacokinetics to shed light on non-response and partial response, understand drug-drug interactions, evaluate adherence, and characterize the impact of genetic and developmental variation in pharmacokinetic genes. This perspective aims to educate clinicians about TDM principles and examines evolving uses of TDM in SSRI-treated youths and their early applications in clinical practice, as well as barriers to TDM in pediatric patients. First, the impact of pharmacokinetic genes on SSRI pharmacokinetics in youths could be used to predict tolerability and response for some SSRIs (e.g., escitalopram). Second, plasma concentrations are significantly influenced by adherence, which may relate to decreased efficacy. Third, pharmacometric analyses reveal interactions with proton pump inhibitors, oral contraceptives, cannabinoids, and SSRIs in youths. Rapid developments in TDM and associated modeling have enhanced the understanding of variation in SSRI pharmacokinetics, although the treatment of anxiety and depressive disorders with SSRIs in youths often remains a trial-and-error process.

Keywords
  • Anxiety disorder
  • Child and adolescent psychiatry
  • Depressive disorder
  • Pediatric
  • Selective serotonin reuptake inhibitor
  • Therapeutic drug monitoring
  • Tolerability
Citation (ISO format)
STRAWN, Jeffrey R et al. Pediatric Therapeutic Drug Monitoring for Selective Serotonin Reuptake Inhibitors. In: Frontiers in pharmacology, 2021, vol. 12, p. 749692. doi: 10.3389/fphar.2021.749692
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ISSN of the journal1663-9812
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Creation10/03/2022 11:57:14 AM
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