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Does a plasma level of chlorpromazine help?

Published online by Cambridge University Press:  09 July 2009

Theodore van Putten ,
Philip R. A. May  and
Donald J. Jenden
Theodore van Putten*
Affiliation:
Veterans Administration Medical Center, Brentwood, California, USA, Neuropsychiatric Institute and the Department of Pharmacology, UCLA School of Medicine, California, USA
Philip R. A. May
Affiliation:
Veterans Administration Medical Center, Brentwood, California, USA, Neuropsychiatric Institute and the Department of Pharmacology, UCLA School of Medicine, California, USA
Donald J. Jenden
Affiliation:
Veterans Administration Medical Center, Brentwood, California, USA, Neuropsychiatric Institute and the Department of Pharmacology, UCLA School of Medicine, California, USA
*
1 Address for correspondence: Dr T. Van Putten, Veterans Administration Medical Center, Brentwood, Wilshire and Sawtelle Boulevards, Los Angeles, Ca 90073, USA.
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Synopsis

Forty-eight newly admitted schizophrenic patients were treated with a fixed, conservative (6·6 mg/kg) dose of chlorpromazine (CPZ) for 28 days. CPZ plasma levels were measured by a gas chromatography mass spectrometry method (GCMS) using 2H6-chlorpromazine as an internal standard. At the end of the fixed-dose period, ‘responders’ had the same plasma levels as ‘non-responders’, suggesting that lack of response is primarily a matter of the illness' sensitivity to CPZ, not to a plasma level below some therapeutic window. After the fixed-dose period, the dosage of CPZ was increased in the ‘non-responders’ by physician's choice. Improvement occurred over a wide range of 10–225 picomoles (3–72 ng)/ml. Above 300 picomoles (95 ng/ml) 4 inaccessible patients eventually became much worse, suggesting psychotoxicity. It is in the inaccessible patient whose illness is only minimally, or not at all, sensitive to CPZ that a plasma level might be especially useful.

Interpretation of plasma levels is complicated by the speed of response: some initial non-responders improved by the 56th day of treatment on very conservative plasma levels.

Type
Research Article
Information
Psychological Medicine , Volume 11 , Issue 4 , November 1981 , pp. 729 - 734
Copyright
Copyright © Cambridge University Press 1981

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References

REFERENCES

Astrachan, B. M., Harrow, M., Adler, D., Brauer, L., Schwartz, A., Schwartz, C. & Tucker, G. (1972). A checklist for the diagnosis of schizophrenia. British Journal of Psychiatry 121, 529–539.CrossRefGoogle ScholarPubMed
Bjorndal, N., Bjerre, M., Gerlach, J., Kristjansen, P., Magelund, G., Oestrich, I. H. & Woehrens, J. (1980). High dosage haloperidol therapy in chronic schizophrenic patients: a double-blind study of clinical response, side effects, serum haloperidol, and serum prolactin. Psychopharmacology 67, 17–23.CrossRefGoogle ScholarPubMed
Carpenter, W. T., Strauss, J. S. & Bartko, J. J. (1973). Flexible system for the diagnosis of schizophrenia: report from the WHO International Pilot Study of Schizophrenia. Science 182, 1275–1277.CrossRefGoogle ScholarPubMed
Curry, S. H., Marshall, J. H. L., Davis, J. M. & Janowsky, D. (1970). Chlorpromazine plasma levels and effects. Archives of General Psychiatry 22, 289–296.CrossRefGoogle ScholarPubMed
Davis, J. M., Erickson, S. & Dekirmenjian, H. (1978). Plasma levels of antipsychotic drugs and clinical response. In Psychopharmacology: A Generation of Progress (ed. Lipton, M. A., DiMascio, A. & Killam, K. F.), pp. 905–915. Raven Press: New York.Google Scholar
Ellsworth, R. B. & Clayton, W. H. (1959). Measurement of improvement in mental illness. Journal of Consulting psychology 23, 15–20.CrossRefGoogle ScholarPubMed
Garver, D. L., Dekirmenjian, H., Davis, J. M., Casper, R. & Erickson, S. (1977). Neuroleptic drug levels and therapeutic response: preliminary observations with red blood cell bound butaperazine. American Journal of Psychiatry 134, 304–307.Google ScholarPubMed
Honigfeld, G. & Klett, C. J. (1965). The Nurses' Observation Scale for Inpatient Evaluation: a new scale measuring improvement in chronic schizophrenia. Journal of Clinical Psychology 21, 65–71.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
May, P. R. A. & Van, Putten T. (1978). Plasma levels of chlorpromazine in schizophrenia: a critical review of the literature. Archives of General Psychiatry 35, 1081–1087.CrossRefGoogle ScholarPubMed
May, P. R. A., Van, Putten T., Jenden, D. J. & Cho, A. (1978). Test dose response in schizophrenia: chlorpromazinc blood and saliva levels. Archives of General Psychiatry 35, 1091–1097.CrossRefGoogle Scholar
May, P. R. A., Van Putten, T., Jenden, D. J., Yale, C.,& Dixon, W. J. (1981). Chlorpromazine blood and saliva levels and the outcome of treatment in schizophrenic patients. Archives of General Psychiatry 38, 202–207.CrossRefGoogle ScholarPubMed
National Institute for Mental Health, P.S.C. Collaborative Study Group (1964). Phenothiazine treatment in acute schizophrenia. Archives of General Psychiatry 8, 248–261.Google Scholar
Overall, J. E. & Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychological Reports 10, 799–812.CrossRefGoogle Scholar
Quitkin, F., Rifkin, A. & Klein, D. F. (1975). Very high dosage vs. standard dosage fluphenazine in schizophrenia. Archives of General Psychiatry 32, 1276–1281.CrossRefGoogle ScholarPubMed
Rivera-Calimlim, L., Nasrallah, H., Strauss, J. & Lasagna, L. (1976). Clinical response and plasma levels: effect dose, dosage schedule, and drug interactions on plasma chlorpromazine levels. American Journal of Psychiatry 133 646–652.Google ScholarPubMed
Shakow, D. (1969). On doing research in schizophrenia. Archives of General Psychiatry 22, 619–642.Google Scholar
Smith, R. C., Clayton, J., Dekirmenjian, H., Klass, D. & Davis, J. M. (1979). Blood levels of neuroleptic drugs non-responding chronic schizophrenic patients. Archives of General Psychiatry 36, 579–584.CrossRefGoogle Scholar
Stabenau, J. R., Pollin, W., Mosher, L. R., Frohman, C., Friedhoff, A. & Turner, W. (1969). Study of monozygotic twins discordant for schizophrenia: some biologic variables. Archives of General Psychiatry 20, 145–158.CrossRefGoogle ScholarPubMed
Van, Putten T., Mutalipassi, L. R. & Malkin, M. D. (1974). Phenothiazine induced decompensation. Archives of General Psychiatry 30, 102–105.Google Scholar
Wode-Helgot, B., Borg, S., Fyro, B. & Sedvall, G. (1978). Clinical effects and drug concentrations in plasma and cerebrospinal fluid in psychotic patients treated with fixed doses of chlorpromazine. Acta psychiatrica scandinavica 58, 149–173.CrossRefGoogle Scholar