Contact

Secretary´s office:

Competence network
"TDM KJP e.V."
Kristina Münkel
Clinic for child and youth psychiatry/ psychotherapy University of Ulm
Steinhövelstr. 5
89075 Ulm


Tel.: (+49) 0731-500-61604
Email: kristina.muenkel@uniklinik-ulm.de

Introduction

The psychopharmacotherapy of children and adolescents is a developmental therapy that is different from that of adults in many aspects:

  • Pharmacokinetic factors
    • Gastro-intestinal function (for example, hydrochloric acid production, bile acid secretion, intestinal and body length)
    • Metabolic capacity (liver size, activites of CYP450 enzymes etc.)
    • Renal function
    • Distribution sites (total body water, extracellular water, body fat)
  • Pharmacodynamic factors
    • Number of synapses
    • Density of neurotransmitter receptors
    • Activity of neurotransmitter metabolising enzymes
    • Number of transporter for the re-uptake of neurotransmitters
    • Sensitivity of signal transduction pathways
  • lack of RCT-related empirical data, therefore off-label use
  • increased vulnerability of minors concerning unwanted side effects

Thus, the criteria for efficacy and safety, guaranteed for the use in adults, do not exist for the administration in children and adolescents. Therefore, therapeutic drug monitoring (TDM) is a general indication for the administration of psycho­pharmaca in children and adolescents.

Driven by an incentive of the German Society of Child and Adolescent Psychiatry and Psychotherapy, in December 2007 a “Competence Network on Therapeutic Drug Monitoring in Child and Adolescent Psychiatry” was founded in order to implement a multicenter data base for TDM.