Protocol medicine.

1. Many drugs used to treat psychiatric disorders contain a chiral center or a center of unsaturation and are marketed as a mixture of the resultant enantiomers or geometric isomers, respectively. These enantiomers or geometric isomers may differ markedly with regard to their pharmacodynamic and/or pharmacokinetic properties. 2. Examples of the effects of chiral centers or geometric centers on such properties are given for drugs from the following classes: antidepressants (tricyclics, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, viloxazine, bupropion, trazodone, mianserin, venlaflaxine); benzodiazepines, zoplicone, and antipsychotics. 3. As described in this review, there are several notable examples of psychiatric drugs currently available where the individual enantiomers or geometric isomers differ considerably with regard to factors such as effects on amine transport systems, interactions with receptors and metabolizing enzymes, and clearance rates from the body. Indeed, relatively recent developments in analytical and preparative resolution of racemic and geometric drug mixtures and increased interest in developing new drugs which interact with specific targets, which have been described in detail at the molecular level, have resulted in increased emphasis on stereochemistry in drug development.

Drug Therapy↗

PubMed1999

Medication discussion groups in the Netherlands: five years of experience.

INTRODUCTION: Nation-wide implementation of medication discussion (MD) groups in the Netherlands was designed as a bottom-up approach and has been in progress for five years. This invites a review of what has been achieved in these structured discussions between general practitioners and pharmacists. CONTEXT: Early in 1997 the Dutch Foundation for Effective Use of Medication (DGV) initiated a fact-finding exercise among general practitioners and pharmacists representing MD groups all over the country. OBJECTIVE: Description of the setting up and the operation of medical discussion groups. Comparison of the quality of the consultations between the start of the project (1992) and 1997. METHODS: Two surveys of medical discussion groups in 1992 and 1997, respectively. RESULTS: The quality of the consultations was found to have improved in comparison with an evaluation shortly after the start of the project. CONCLUSION: The overwhelming majority of those interviewed were satisfied with the MD process, which they consider a useful effort. But there is also a wish for increased commitment to guidelines agreed in MD group consultations.

Drug Therapy↗