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Systematic review a...
Systematic review and meta-analysis on the therapeutic reference range for escitalopram : Blood concentrations, clinical effects and serotonin transporter occupancy
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- Eichentopf, Luzie (author)
- Heidelberg Univ, Germany
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- Hiemke, Christoph (author)
- Univ Med Ctr Mainz, Germany; Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany
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- Conca, Andreas (author)
- Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany; Sanit Agcy South Tyrol, Italy
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- Engelmann, Jan (author)
- Johannes Gutenberg Univ Mainz, Germany
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- Gerlach, Manfred (author)
- Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany; Univ Hosp Wurzburg, Germany
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- Havemann-Reinecke, Ursula (author)
- Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany; Univ Gottingen, Germany
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- Hefner, Gudrun (author)
- Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany; Vitos Clin Forens Psychiat, Germany
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- Florio, Vincenzo (author)
- Comprensorio Sanitario Bolzano, Italy
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- Kuzin, Maxim (author)
- Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany; Univ Zurich, Switzerland
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- Lieb, Klaus (author)
- Univ Med Ctr Mainz, Germany
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- Reis, Margareta (author)
- Linköpings universitet,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Skane Univ Hosp, Sweden
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- Riemer, Thomas G. (author)
- Charite Univ Med Berlin, Germany; Free Univ Berlin, Germany; Humboldt Univ, Germany
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- Serretti, Alessandro (author)
- Univ Bologna, Italy
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- Schoretsanitis, Georgios (author)
- Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany; Univ Zurich, Switzerland; Zucker Hillside Hosp, NY USA; Zucker Sch Med Northwell Hofstra, NY USA
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- Zernig, Gerald (author)
- Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany; Med Univ Innsbruck, Austria; Psychotherapy & Court Certified Witness, Austria
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- Gruender, Gerhard (author)
- Heidelberg Univ, Germany; Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany
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- Hart, Xenia M. (author)
- Heidelberg Univ, Germany; Arbeitsgemeinschaft Neuropsychopharmakol & Pharma, Germany
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(creator_code:org_t)
- 2022-10-17
- 2022
- English.
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In: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 13
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Abstract
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- Introduction: A titration within a certain therapeutic reference range presupposes a relationship between the blood concentration and the therapeutic effect of a drug. However, this has not been systematically investigated for escitalopram. Furthermore, the recommended reference range disagrees with mean steady state concentrations (11-21 ng/ml) that are expected under the approved dose range (10-20 mg/day). This work systematically investigated the relationships between escitalopram dose, blood levels, clinical effects, and serotonin transporter occupancy.Methods: Following our previously published methodology, relevant articles were systematically searched and reviewed for escitalopram.Results: Of 1,032 articles screened, a total of 30 studies met the eligibility criteria. The included studies investigated escitalopram blood levels in relationship to clinical effects (9 studies) or moderating factors on escitalopram metabolism (12 studies) or serotonin transporter occupancy (9 studies). Overall, the evidence for an escitalopram concentration/effect relationship is low (level C).Conclusion: Based on our findings, we propose a target range of 20-40 ng/ml for antidepressant efficacy of escitalopram. In maintenance treatment, therapeutic response is expected, when titrating patients above the lower limit. The lower concentration threshold is strongly supported by findings from neuroimaging studies. The upper limit for escitaloprams reference range rather reflects a therapeutic maximum than a tolerability threshold, since the incidence of side effects in general is low. Concentrations above 40 ng/ml should not necessarily result in dose reductions in case of good clinical efficacy and tolerability. Dose-related escitalopram concentrations in different trials were more than twice the expected concentrations from guideline reports.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Allmänmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- General Practice (hsv//eng)
Keyword
- escitalopram; reference range; blood level; therapeutic drug monitoring; antidepressant response; clinical effects; adverse drug reaction; SERT occupancy
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- ref (subject category)
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- By the author/editor
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Eichentopf, Luzi ...
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Hiemke, Christop ...
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Conca, Andreas
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Engelmann, Jan
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Gerlach, Manfred
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Havemann-Reineck ...
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show more...
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Hefner, Gudrun
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Florio, Vincenzo
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Kuzin, Maxim
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Lieb, Klaus
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Reis, Margareta
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Riemer, Thomas G ...
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Serretti, Alessa ...
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Schoretsanitis, ...
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Zernig, Gerald
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Gruender, Gerhar ...
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Hart, Xenia M.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and General Practice
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Frontiers in Psy ...
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Linköping University