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Pharmacopsychiatry 2020; 53(01): 30-35
DOI: 10.1055/a-0869-8053
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Pathological Concentration of C-reactive Protein is Correlated to Increased Concentrations of Quetiapine, But Not of Risperidone, Olanzapine and Aripiprazole in a Naturalistic Setting

Maike Scherf-Clavel
1   Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
,
Anne Weidner
1   Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
,
Jürgen Deckert
1   Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
,
Andreas Menke
1   Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
,
Stefan Unterecker
1   Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
› Author Affiliations
Further Information

Publication History

received 15 January 2019
revised 22 February 2019

accepted 04 March 2019

Publication Date:
26 March 2019 (online)

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Abstract

Introduction Infections can alter drug clearance, but the impact of inflammation-induced changes is still not well known. The aim of the investigation was to examine the effect of pathological C-reactive protein (CRP) values (≥0.5 mg/dL) and leukocyte count on the metabolism of 4 different atypical antipsychotics.

Methods Steady-state serum concentrations of individual patients under therapy with risperidone (n=45), aripiprazole (n=30), olanzapine (n=24), and quetiapine (n=166) were retrospectively analyzed during a period of inflammation by Spearman’s Rho correlation analysis. Mann-Whitney U test was applied for comparison of patients with serum concentrations above and below the upper limit of the therapeutic reference range of each target drug with regard to CRP concentration and leukocyte count. Linear regression analysis was applied to correct for confounding parameters age and sex.

Results Pathological concentrations of CRP were significantly associated with elevated values of C/D of quetiapine (n=166, Spearman’s Rho: r=0.269, p<0.001; linear regression: p<0.001). Among patients with quetiapine serum concentrations below 500 ng/mL, CRP concentrations were significantly (p=0.006) lower compared to patients with quetiapine concentrations above 500 ng/mL. A trend for a positive correlation between CRP and serum concentration was found for olanzapine (n=24, Spearman’s Rho: r=0.385, p=0.063; linear regression: p=0.086).

Conclusion During a period of inflammation in patients taking quetiapine, according to our results, attention in dosing strategies is required to prevent toxic plasma concentrations.

Key words

atypical antipsychotics - pharmacokinetics - inflammation - drug metabolism - therapeutic drug monitoring
 

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