Importance Of Drug Monitoring

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The aims of therapeutic drug monitoring are to avoid therapeutic failures due to bad compliance or too low dose of a given drug, as well as adverse or toxic effects due to an excessive dose. For some of these drugs or for others, only patients at risk or belonging to particular sub-populations for a given drug, need therapeutic drug monitoring. A pre-analytical management is needed, comprising a correct information of the physician, concerning the nature of the sample to collect and the clinical data necessary to the interpretation, as well as their recording, the control of the sample routing and storing conditions. Nowadays, drug analyses are essentially performed using immunochemical techniques, rapid and easy to operate but limited to a…show more content…
Accurate and clinically meaningful drug concentrations are attainable only by complete collaboration by a therapeutic drug monitoring team, comprised of scientists, clinicians, nurses, and pharmacists. Excellent communication among team members is necessary to ensure that best practices in therapeutic drug monitoring are achieved. The appropriate indications for drug monitoring have widened to include efficacy, toxicity avoidance, drug-drug interactions, therapy cessation monitoring and compliance. Plasma drug concentration measurements alone may be helpful in several circumstances, although each indication may not apply equally to every drug measuring plasma concentrations may be helpful, however, as a low measurement reflects either poor recent compliance or under treatment. Poor compliance is implicated if the patient is prescribed a dose that is unlikely to be associated with a measured low concentration or if a previous measurement suggested that the plasma concentration should be higher for the given dose. When initiating drug therapy, the physician may find it useful to measure the plasma drug concentration and tailor the dosage to the individual. This directive applies to all drugs, although it is most important for those with narrow therapeutic ranges such as lithium and aminoglycoside…show more content…
This is why, measuring aminoglycoside plasma concentrations may help to distinguish between toxicity and infection. If possibilities for a drug interaction is suspected, then measurement of the plasma concentration may guide subsequent changes in dosage. For example, when giving a thiazide diuretic to a patient taking lithium, measuring the plasma lithium concentrations is helpful to avoid toxicity. When the patient's renal function remained stable, and he developed no signs or symptoms of digoxin toxicity. No case reports have associated significant fluctuations of digoxin plasma concentrations corresponding to the timing of oral amiodarone administration. However, clinicians should be aware that digoxin plasma concentrations may not correlate with digoxin tissue concentrations. When a loading dose of oral amiodarone is required in a patient receiving digoxin, the digoxin dosage should first be reduced, and digoxin therapy should be adjusted based on any signs and symptoms of digoxin toxicity. This approach also applies to theophylline when erythromycin is added to the regimen. Conversely, measuring the whole blood cyclosporine concentration will help to avoid under treatment if rifampicin is

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