Therapeutic drug monitoring and pharmacogenomics: complementary tools in neuropsychopharmacology

Curr Opin Psychiatry. 2026 May 5. doi: 10.1097/YCO.0000000000001099. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Therapeutic drug monitoring (TDM) and pharmacogenomic testing (PGx) are increasingly important in optimizing psychopharmacological treatments. This review highlights the significance of integrating these tools to enhance pharmacological care in psychiatry.

RECENT FINDINGS: TDM has a longstanding tradition in managing psychiatric disorders, showcasing interindividual variability in drug metabolism and response. Recent studies demonstrate that TDM improves symptom control, reduces relapse rates, and decreases hospitalization for patients on psychotropic medications. The introduction of mini-invasive TDM procedures, including point-of-care testing and wearable devices, expands its applicability in real-world settings. Similarly, PGx testing, which assesses genetic variations affecting drug metabolism, has shown a significant increase in remission rates among depressed patients and emphasizes the importance of substrate-specific effects in pharmacogenomics. Recent findings indicate that phenoconversion can alter drug-gene interactions, necessitating careful consideration in treatment planning. Long-read sequencing allows more accurate genotyping results.

SUMMARY: The integration of TDM and PGx in clinical practice offers a more personalized approach to psychiatric care, improving treatment outcomes and reducing adverse effects. The development of new guidelines for both TDM and PGx enhances their utility, while emerging technologies may facilitate their implementation. Continuing research in this area is essential for refining these tools, ensuring that clinicians can effectively tailor neuropsychotropic treatments to individual patient needs.

PMID:42154514 | DOI:10.1097/YCO.0000000000001099