School of Pharmacy’s Stephanie Nichols publishes case study in journal Pharmacotherapy

Stephanie Nichols, Pharm.D., M.P.H., associate professor of pharmacy practice in the University of New England School of Pharmacy, is a co-author of a recent publication demonstrating the potential efficacy of using blood serum levels to inform changes in the dosage of certain antipsychotic medications.

The article, “Cross-Titration from Risperidone to Clozapine Utilizing Clozapine Serum Concentrations: A Case Report,” was published Jan. 21 in the journal Pharmacotherapy, a publication of the American College of Clinical Pharmacy (ACCP). The case study was written in collaboration with three providers affiliated with MaineHealth Maine Medical Center (MHMMC): lead author Nicolette Centanni, Pharm.D., a clinical pharmacist at MHMMC; Kayla Garvey, Pharm.D., a pharmacy practice resident; and Elizabeth Mullany, M.S.N., a psychiatric-mental health nurse practitioner.

The report discusses a complex case of a 68-year-old patient with schizophrenia who was being treated with a strong antipsychotic medication, risperidone. She was admitted to the hospital after a fall, which was linked to a new diagnosis of Parkinson’s disease that had been worsened by her medication. 

Through measuring the concentration of medications in her blood serum levels, the care team gradually, and successfully, switched the patient to clozapine — a different antipsychotic medication that is less likely to affect Parkinson’s symptoms but is still highly effective for schizophrenia — while mitigating potential drug interactions.

While monitoring clozapine levels isn’t standard practice, the authors said, the team used it to guide a safe switch between medications, balancing the need to treat schizophrenia without worsening the patient’s Parkinson’s symptoms, leading to a positive outcome.

Ultimately, the researchers found that utilizing serum clozapine levels may help guide dose changes during antipsychotic cross-titration — the practice of decreasing the dose of one drug while increasing the dose of another — especially when multiple drug interactions are involved. 

"I am especially proud to have published in the official journal of the American College of Clinical Pharmacy, an organization that has been one of my professional homes since the start of my career,” Nichols reflected. “Having been inducted as a distinguished fellow of the ACCP in 2018, it is a true honor to contribute to this high-impact journal in the field of pharmacy practice.”