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Multicyclic antidepressant serum drug assays: a utilization review.

Multicyclic antidepressant (MCA) kinetics are complex and influenced by many factors, making clinical interpretation of serum concentration data difficult. To assess the effectiveness of MCA serum assay utilization in a private, university-affiliated psychiatric hospital, actual use over a 1-year period was reviewed retrospectively against criteria derived from the contemporary literature. Overall, compliance with the criteria was poor. Documentation of reasons for ordering MCA assays and subsequent therapy decisions were also poor. As a result, guidelines for the appropriate use of this clinical tool have been accepted by the institution's P & T Committee and will be reinforced through a continuing medical education program.