Today’s question is: how helpful are antipsychotic plasma levels? Here is a summary of this episode:

• Plasma level is the best proxy for antipsychotic CNS action. Getting levels can detect nonadherence, the point of futility and kinetic issues. Plasma levels can tell you whether you have room for further dose increases.
• We can measure levels at the start of antipsychotic treatment, in nonresponders and in patients with a change in clinical status. It is also an essential part of clozapine therapy.
• If a patient’s antipsychotic plasma levels are above the reference range and they are stable, measure again and document. Do not reflexively reduce the dose.

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