3 Clinical psychopharmacology3.1 General pharmacology
3.1.4 Assessment methods and monitoring
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Written by Resident Doctor Committee · Published
Baseline before treatment
Baseline measures of symptoms, functioning and physical health are recorded so that later benefit and harm can be judged.
Drug-specific baselines include weight, blood pressure, metabolic tests, an electrocardiogram (ECG) and a movement assessment.
Agomelatine and the liver
Agomelatine can cause hepatotoxicity, so liver function tests are mandatory before the first dose.
Liver tests are repeated at around 3, 6, 12 and 24 weeks, and again after any dose increase.
Stop agomelatine if transaminases exceed three times the upper limit of normal or signs of liver injury appear.
Describing clinical course
Term | Meaning |
|---|---|
Improvement | Right direction, short of any defined threshold |
Response | Conventionally a 50 per cent fall on a validated scale |
Remission | Symptoms below threshold, vulnerability persists |
Recovery | Remission plus functional gain, sustained for a defined period |
Relapse | Deterioration within the same episode, before recovery |
Recurrence | New episode after recovery from the last |
Physical monitoring
Monitoring covers pulse and postural blood pressure, weight, waist, glucose, lipids, movement disorders, the corrected QT interval (QTc) on ECG, blood counts and drug-specific organ tests.
Lithium levels are taken 12 hours after the dose, but suspected toxicity needs an immediate level.
Steady state usually takes 4 to 5 half-lives.
Apparent poor efficacy
Before calling an illness treatment-resistant, check the diagnosis, whether an adequate dose was taken for long enough, whether adverse effects limited exposure, and whether smoking or enzyme induction lowered drug levels.