Medication exposure is dependent upon many factors, the single most important being if the patient took the prescribed medication as indicated. To assess medication exposure for psychotropic and other medication classes, we enrolled 115 highly adherent psychiatry patients prescribed five or more medications. In these patients, we measured 21 psychotropic and 38 nonpsychotropic medications comprising a 59 medication multiplex assay panel. Strict enrollment criteria and reconciliation of the electronic health record medication list prior to study initiation produced a patient cohort that was adherent with 91% of their prescribed medications as determined by comparing medications detected empirically in blood to the electronic health record medication list. In addition, 13% of detected medications were not in the electronic health record medication list. We found that only 53% of detected medications were within the literature-derived reference range with 41% below and 6% above the reference range specific to each medication. When psychotropic medications were analyzed near trough-level, only sertraline was found to be within the literature-derived reference range for all patients tested. Concentrations of the remaining medications indicated extensive exposure below the reference range. This is the first study to empirically and comprehensively assess medication exposure obtained in comorbid polypharmacy patients, minimizing the important behavioral factor of adherence in the study of medication exposure. These data indicate that low medication exposure is extensive and must be considered when therapeutic issues arise, including the lack of response to medication therapy.

中文翻译：

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高度依从性精神病患者的药物治疗

药物暴露取决于许多因素，最重要的是患者是否按照指示服用了处方药。为了评估精神药物和其他药物类别的药物暴露，我们招募了115位高度依从的精神病患者，开具了五种或更多药物。在这些患者中，我们测量了21种精神药物和38种非精神药物，其中包括59种药物多重分析组。严格的入组标准和研究开始前电子病历药物清单的核对产生了一个患者队列，该患者队列符合其处方药的91％，这是通过将根据经验从血液中检测到的药物与电子病历药物清单进行比较而确定的。此外，13％的检测药物不在电子健康记录药物清单中。我们发现，只有53％的检测药物在文献衍生的参考范围内，每种药物的参考范围分别低于41％和6％。当分析精神药物接近低谷水平时，对于所有接受测试的患者，仅舍曲林被发现在文献来源的参考范围内。其余药物的浓度表明在参考范围以下的大量暴露。这是第一项以经验和全面评估合并症的多药患者获得的药物暴露的研究，该研究最大程度地减少了药物暴露研究中依从性的重要行为因素。