Therapeutic Drug Monitoring: Psychotropic Drugs

1989 ◽  
Vol 2 (6) ◽  
pp. 403-415 ◽  
Author(s):  
Randall D. Seifert
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Antipsychotic Drugs ◽  
Practical Knowledge ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Clinical Use ◽  
Careful Patient ◽  
Recovery Expectations ◽  
Positive Results

The therapeutic monitoring of patients who take antipsychotic drugs can be both challenging and rewarding. Antipsychotics have been in clinical use for over 30 years; yet, their complex pharmacology is not fully understood and parallels our infant knowledge of human brain chemistry. The art of successful therapeutic drug monitoring depends on the clinician's knowledge of basic pharmacology, an understanding of psychiatric disorders, and a sensitivity for careful patient observation. In addition, a thorough history, well thought out goals, and reasonable recovery expectations are essential. Antipsychotic drugs are never curative and should be used judiciously for indications where positive results outweigh the risks of adverse effects. This article will provide the reader with sound, practical knowledge of how to monitor these drugs in any clinical setting. © 1989 by W.B. Saunders Company.

scholarly journals Evidence-based Implementation of Free Phenytoin Therapeutic Drug Monitoring

2000 ◽  
Vol 46 (8) ◽  
pp. 1132-1135 ◽  
Author(s):  
Martha Burt ◽  
David C Anderson ◽  
Julie Kloss ◽  
Fred S Apple
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Medical Center ◽  
Clinical Findings ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Clinical Indicator ◽  
Interindividual Variations ◽  
Data Points ◽  
Pharmacologically Active

Abstract Background: The majority of laboratories measure total phenytoin concentration for therapeutic drug monitoring. However, there are substantial interindividual variations in free phenytoin concentrations, the pharmacologically active component. Methods: We describe the process and data used to implement monitoring of free phenytoin only in an urban medical center. Over a 6-week period, total and free phenytoin concentrations were measured, clinical charts reviewed, and indications for alterations in the percentage of free phenytoin fraction were determined. Results: Of the 189 phenytoin requests from 139 patients, 136 data points were analyzed. Free phenytoin concentrations were 6.8–35.3%, with 50% outside the expected range of 8–12%. Clinical indications likely responsible for variations were hypoalbuminemia, drug interactions, uremia, pregnancy, and age. Overall, 30% of patients demonstrated a discrepancy between therapeutic, subtherapeutic, or supratherapeutic concentrations between free and total phenytoin concentrations. The largest discordance (53%) occurred in the patient group with free phenytoin <8% or >12%. Conclusions: This study supports previous clinical findings that monitoring total phenytoin is not as reliable as free phenytoin as a clinical indicator for therapeutic and nontherapeutic concentrations. Thus, we recommend that therapeutic monitoring should use free phenytoin concentrations only.

scholarly journals A Moving Target—Vancomycin Therapeutic Monitoring

2020 ◽  
Vol 9 (4) ◽  
pp. 474-478
Author(s):  
Alaina N Burns ◽  
Jennifer L Goldman
Keyword(s):  
Clinical Practice ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Clinical Care ◽  
Area Under The Curve ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Moving Target ◽  
Efficacy And Safety ◽  
Vancomycin Trough

Abstract Therapeutic drug monitoring (TDM) has been a common practice to optimize efficacy and safety of vancomycin. While vancomycin trough-only TDM has widely been integrated into pediatric clinical practice since 2009, recently updated vancomycin TDM guidelines published in March 2020 recommend area under the curve (AUC) based TDM for vancomycin instead of trough-only TDM. In this review, we discuss the rationale behind the change in TDM recommendations, describe two approaches for calculating vancomycin AUC in clinical practice, and address considerations for integrating vancomycin AUC TDM into pediatric clinical practice. Our primary goal is to provide pediatric clinicians with a resource for implementing vancomycin AUC monitoring into clinical care.

Plasma vs whole blood for therapeutic drug monitoring of patients receiving FK 506 for immunosuppression

1994 ◽  
Vol 40 (12) ◽  
pp. 2247-2253 ◽  
Author(s):  
M Winkler ◽  
B Ringe ◽  
J Baumann ◽  
M Loss ◽  
K Wonigeit ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Enzyme Immunoassay ◽  
Drug Monitoring ◽  
Whole Blood ◽  
Plasma Concentrations ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Fk 506 ◽  
Blood Samples ◽  
The Matrix

Abstract By retrospective analysis of 13,000 blood samples obtained from 248 patients receiving FK 506 therapy, we compared the suitability of plasma with that of whole blood as the matrix for therapeutic drug monitoring of FK 506. The plasma concentrations did not correlate with the concentrations in whole blood (r = 0.56). In contrast to plasma samples (analyzed by enzyme immunoassay), FK 506 was detectable in all whole-blood samples (analyzed by enzyme immunoassay/microparticle enzyme immunoassay). The inter- and intraindividual variations of FK 506 measurements were greater in plasma than in whole blood. Moreover, plasma concentrations correlated only poorly with clinical events. There was a tendency to greater plasma concentrations being measured during episodes of toxicity, but no clear difference was evident between stable course and rejection. In whole-blood specimens, a correlation between reduced or increased FK 506 concentrations and rejection or toxicity, respectively, was observed. The discriminatory power of whole-blood values was greater for the differentiation between toxicity and stable course than between rejection and stable course. We therefore recommend whole blood rather than plasma as the matrix for therapeutic monitoring of FK 506 concentrations.

scholarly journals Population Pharmacokinetics of Gentamicin and Dosing Optimization for Infants

2014 ◽  
Vol 59 (1) ◽  
pp. 482-489 ◽  
Author(s):  
Susanna E. Medellín-Garibay ◽  
Aída Rueda-Naharro ◽  
Silvia Peña-Cabia ◽  
Benito García ◽  
Silvia Romano-Moreno ◽  
...  
Keyword(s):  
Body Weight ◽  
Therapeutic Drug Monitoring ◽  
Population Pharmacokinetics ◽  
Drug Monitoring ◽  
Pediatric Population ◽  
External Validation ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Time Data ◽  
Age Related

ABSTRACTThe aim of this study was to characterize and validate the population pharmacokinetics of gentamicin in infants and to determine the influences of clinically relevant covariates to explain the inter- and intraindividual variabilities associated with this drug. Infants receiving intravenous gentamicin and with routine therapeutic drug monitoring were consecutively enrolled in the study. Plasma concentration and time data were retrospectively collected from 208 infants (1 to 24 months old) of the Hospital Universitario Severo Ochoa (Spain), of whom 44% were males (mean age [± standard deviation], 5.8 ± 4.8 months; mean body weight, 6.4 ± 2.2 kg). Data analysis was performed with NONMEM 7.2. One- and two-compartment open models were analyzed to estimate the gentamicin population parameters and the influences of several covariates. External validation was carried out in another population of 55 infants. The behavior of gentamicin in infants exhibits two-compartment pharmacokinetics, with total body weight being the covariate that mainly influences central volume (Vc) and clearance (CL); this parameter was also related to creatinine clearance. Both parameters are age related and different from those reported for neonatal populations. On the basis of clinical presentation and diagnosis, a once-daily dosage regimen of 7 mg/kg of body weight every 24 h is proposed for intravenous gentamicin, followed by therapeutic drug monitoring in order to avoid toxicity and ensure efficacy with minimal blood sampling. Gentamicin pharmacokinetics and disposition were accurately characterized in this pediatric population (infants), with the parameters obtained being different from those reported for neonates and children. These differences should be considered in the dosing and therapeutic monitoring of this antibiotic.

scholarly journals Therapeutic Drug Monitoring and Genotypic Screening in the Clinical Use of Voriconazole

2015 ◽  
Vol 9 (2) ◽  
pp. 74-87 ◽  
Author(s):  
Brad Moriyama ◽  
Sameer Kadri ◽  
Stacey A. Henning ◽  
Robert L. Danner ◽  
Thomas J. Walsh ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Clinical Use

Therapeutic monitoring of methotrexate in chemotherapy

2017 ◽  
Vol 53 (4) ◽  
pp. 241-246
Author(s):  
Ewelina Szpak ◽  
Krzysztof Lewandowski ◽  
Robert Kowalski ◽  
Barbara Bogomas-Woźnicka ◽  
Ninela Irga-Jaworska
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Rescue Therapy ◽  
Elimination Rate ◽  
Toxic Effects ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Cytostatic Drug ◽  
Renal Elimination ◽  
Forced Diuresis

Methotrexate is a cytostatic drug, folic acid antagonist, used in chemotherapy and immunosuppression in adults and in children. Its use in high doses is an absolute indication for therapeutic drug monitoring. Methotrexate is a highly toxic drug and requires dosage of specific antidote, calcium folinate. This rescue therapy helps to prevent methotrexate toxic effects and bone marrow suppression. Monitoring methotrexate concentration also helps to diagnose patients with decreased MTX elimination rate, who would benefit from glucarpidase treatment, an enzyme which degrades methotrexate molecules or theophylline, which is neuroprotective and increases renal elimination. Based on methotrexate serum concentration also time of forced diuresis and urine alkalinization is appointed in order to prevent acute nephrotoxicity. Of great importance is the fact that delayed elimination may be result of drug-drug interaction, part of which may be prevented. The purpose of this paper is to highlight the role of therapeutic drug monitoring in the prevention of methotrexate toxic effects.

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