On an episode of the Psychiatry & Psychotherapy Podcast, psychiatrist, psychopharmacologist, and author Dr. Jonathan Meyer discusses using antipsychotic plasma levels to assess treatment response, safety, and oral medication adherence. Antipsychotic nonadherence is common in patients with schizophrenia and, unfortunately, clinicians are poor estimators of nonadherence.

When prescribing antipsychotics to people with schizophrenia, most clinicians use their experience and training when approaching the ideal dose of an antipsychotic medication rather than drawing an antipsychotic level. Clinicians assess the need for dose adjustments clinically, and oftentimes this approach to medication titration is not enough to achieve symptomatic response.

Plasma levels offer providers an objective marker to assess a patient’s response to an antipsychotic medication, inform mental health providers if the patient is adhering to their regimen, and conclude how the patient is breaking down the medication. Mental health providers can use therapeutic thresholds clinically to assess if the patient is receiving minimally effective antipsychotic exposure when there appears to be a lack of response and if a patient has a high level when they are experiencing adverse effects.

Reference: Episode 127: Using Antipsychotic Plasma Levels-Therapeutic Threshold. David Puder, M.D. Psychiatry & Psychotherapy. Accessed July 8, 2022. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-127-using-antipsychotic-plasma-levels-therapeutic-threshold