Research progress of liquid chromatography-mass spectrometry in therapeutic drug monitoring of antipsychotic drug: A review of the past decade

Antipsychotic drugs (AD) are important for managing psychiatric disorders like schizophrenia and bipolar disorder, however, their clinical use is often complicated by narrow therapeutic windows, variable pharmacokinetics, and potential adverse effects. Accurate and timely therapeutic drug monitoring (TDM) among patients is essential for optimizing efficacy while minimizing toxic effects. This paper aims to explore the recent advancements and applications of liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology in TDM of AD. LC-MS/MS is the powerful analysis tool because it is highly sensitive, specific and can simultaneously quantify multiple analytes in complex biological matrices. The methodological progress in LC-MS/MS techniques, including improvements in matrix choice, sample preparation, sensitivity and selectivity improvement are discussed. The clinical implications of LC-MS/MS-based TDM focus on individualized dosing regimens, improved patient compliance, reduced adverse drug reactions, enhanced pharmacokinetic understanding and integration with other individualized medication technologies like pharmacogenomics. Despite these advances, challenges such as standardization of protocols, cost-effectiveness, and accessibility in routine clinical settings remain. Future directions involve technical optimization and device miniaturization to expand clinical applications and incorporation of emerging artificial intelligence technologies to refine TDM practices. Overall, this study suggests that LC-MS/MS is important for advancing AD monitoring and its potential to transform psychiatric care through precision medicine.