Therapeutic drug monitoring an overview sciencedirect topics. The monitoring parameters cited are derived from a range of guideline sources, other. This book is a compilation of summarized analytical methods designed to serve the needs of pharmacologists, toxicologists, and other allied health professionals involved the development, use, or monitoring of pharmaceuticals. Theophylline fda prescribing information, side effects and uses.
Therapeutic drug monitoringfinal free download as powerpoint presentation. Therapeutic drug monitoring of theophylline, salicylates, and acetaminophen frederick a. Therapeutic serum concentrations and sampling guidelines 228 drug usual sample time therapeutic serum concentration physicians routine inpatient orders comments lithium pre level 30 min. The purpose of tdm is to optimize dosing to target a therapeutic plasma drug.
Saliva theophylline concentrations approximate unbound serum concentrations, but are not reliable for routine or therapeutic monitoring unless special techniques are used. Summary guideline for therapeutic drug monitoring tdm in adults. Therapeutic drug monitoring follows these changes and accommodates them. Therapeutic drug monitoring free download as powerpoint presentation. Hemodialysis clearance increased total body clearance cltb off dialysis by %, 387%, and 176% in the patients who had their theophylline serum clearance estimated off dialysis. Otherwise, tdm refers to the individualization of drug dosage by maintaining plasma or blood drug concentrations within a. Describe your approach to monitoring serum phenytoin levels for your patient. Therapeutic drug monitoring in most individuals, a plasmatheophylline concentration of 1020 mglitre 55110 micromollitre is required for satisfactory bronchodilation, although a lower plasmatheophylline concentration of 515 mglitre may be effective. Jan 04, 2015 therapeutic drug monitoring aims to promote optimum drug treatment by maintaining serum drug concentration within a therapeutic range. Therapeutic drug monitoring therapeutic drug monitoring tdm is the use of drug concentration measurements in body fluids as an aid to the management of drug therapy for the cure, alleviation or prevention of disease.
The most common tests necessitating therapeutic drug monitoring in neonates are those for aminoglycosides and vancomycin in suspected or proven sepsis, theophyllinecaffeine in neonatal apneas, digoxin in congestive heart failure and supraventricular arrhythmias, and phenobarbital in neonatal seizures and ischemic encephalopathy. Reassessing the therapeutic range for theophylline on laboratory report forms. Impact of therapeutic drug monitoring of intravenous. The combination of theophylline and ephedrine was described in a 1940 publication. The basic assumptions underlying therapeutic drug monitoring are that drug metabolism varies from patient to patient and that the plasma level of a drug is more closely related to the drug s therapeutic effect or toxicity than is the dosage. Theophylline bronchodilator 1020 gml 25 gml pulmonary literature suggest that concentrations 515 mgl may be as efficacious with less toxicity. Principles and practice of therapeutic drug monitoring.
Summary guideline for therapeutic drug monitoring tdm in. For 12day periods each patient received three separate diets with different proportions of protein and carbohydrate but with constant fat and caloric intake. It is easier to correlate the relationship between the drugs therapeutic or adverse effect on its. Studies utilizing hollow fiber systems the present study consistently yielded higher theophylline dialysis clearance values than those using coil systems 84. The utility of therapeutic drug monitoring was studied in children with apnea. Okay, and what we do, usually, with this, is we check the trough level. Also, the therapeutic drug monitoring tdm laboratory provides an electronic report of all completed serum drug concentrations of patients admitted to the hospital twice daily. Therapeutic drug monitoring involves not only measuring drug concentrations, but also the clinical interpretation of the result. Analytical methods for therapeutic drug monitoring and. Mar 21, 2017 key learning topics the concept of therapeutic drug monitoring pharmacological action and clinical use of lithum, digoxin and theophylline adverse toxic effects of lithium, digoxin and theophylline how blood values are used to optimise lithium, digoxin and theophylline dose this chapter is concerned with how laboratory measurement of drug concentration in blood helps in determining. Therapeutic drug monitoring tdm of both ami noglycoside antibiotics amikacin, gentamicin and vancomycin is special method of clinical. In general, predose concentration is measured, but better correlation exists between mycophenolic acid auc012 h and clinical efficacy as well as toxicity. Introduction therapeutic drug monitoring tdm is the clinical practice of measuring specific drugs at designated intervals to maintain a constant concentration in a patients bloodstream, thereby optimizing individual dosage regimens.
Theophylline has been demonstrated to be a useful agent in the therapy of chronic asthma. However, serum drug levels should only be taken when there is a clear indication to. Peter beresford page 1 of 2 drug half life approx hours time to steady state sample timing target range comments digoxin adults 3877 6 days at least 6 hours after last dose 0. Therapeutic drug monitoring is required for a small fraction of drugs used in pharmacotherapy, but for these drugs such monitoring is essential in order to achieve maximum efficacy of the drug as well as to avoid drug toxicity. Theophylline was first identified as having potential for asthma as a bronchodilator in 1921 and 1922, but general use as a bronchodilator was not seen until the 1930s. When an effect, such as changes in blood pressure, pain or serum cholesterol is readily measured, the. Patients receiving theophylline on hemodialysis should be closely monitored for bronchospasm during and after the hemodialysis procedure. Therapeutic monitoring of vancomycin in adult patients.
Certain drugs have a narrow therapeutic range in concentrations above the upper limit of the range, the drug can be toxic in concentrations below the lower limit of the range, the drug can be ineffective not all patients have the same response at similar doses 3 history. Guide for drug level monitoring of commonly used medications. When the therapeutic range is narrow, such as with digoxin 0. Therapeutic drug monitoring of mycophenolic acid using serum or plasma is useful for avoiding rejection as well as toxicity such as neutropenia. Phenytoin carbamazepine gentamicin vancomycin teicoplanin lithium digoxin aminophylline theophylline work through the case studies and answer the questions using information resources available to you in your clinical practice environment. Therapeutic drug monitoring tdm is commonly used to help physicians monitor and maintain drug levels within the therapeutic window. It is an easytoread source of information on intended use, pharmacokinetics, therapeutic range, and toxic. Aminophylline is 80% theophylline 100 mg aminophylline 80 mg theophylline. No interferences were found in the assay of ethosuximide, phenobarbital, phenytoin, valproic acid, digitoxin, digoxin, procainamide. Therapeutic drug monitoring litfl ccc pharmacology. Nhs grampian acute sector summary guideline for therapeutic drug monitoring tdm in adults version 2 antibiotic assays on the microbiology request card for serum levels, please supply details of the antibiotic level required, the time and date of the sample. Capitals indicate lifethreatening, underlines indicate most frequent.
Tdm of theophylline and digoxin as an indicator of the quality of. As soon after class as possible, formulate questions based onthe notes in the righthand. The serum hemodialysis clearance of theophylline was determined in 4 patients and compared to systemic serum clearance off dialysis in 3 patients. Background therapeutic monitoring of theophylline serum levels is required due to its narrow therapeutic range and marked interindividual pharmacokinetic variability. Suggestions for drug monitoring in adults in primary care. Drugs with a narrow therapeutic index where therapeutic drug levels do not differ greatly from levels. Metabolism chemical conversion of sctive drug to inactive metabolites. The therapeutic window is the concentration range in which a drug exerts its clinical effect with minimal adverse effects for most patients. Key learning topics the concept of therapeutic drug monitoring pharmacological action and clinical use of lithum, digoxin and theophylline adverse toxic effects of lithium, digoxin and theophylline how blood values are used to optimise lithium, digoxin and theophylline dose this chapter is concerned with how laboratory measurement of drug concentration in. Therapeutic levels can be lower when used in combination with other immunosuppressants. Therapeutic drug monitoring principles in the neonate. Accordingly, it is mandatory to monitor serum theophylline concentrations on a regular basis with any patient receiving maintenance therapy with theophylline.
Significant differences were detected for theophylline half. Therapeutic drug monitoring allows physicians to monitor and adjust the dosage of drugs with narrow therapeutic indices. Dose should be determined by theophylline serum level monitoring. A clinical pharmacist prospectively followed these initial patients, but did not intervene. Nov 20 page 1 of 10 medicines formulary therapeutic drug monitoring contents. Amitava dasgupta, in therapeutic drug monitoring, 2012. This requires knowledge of the pharmacokinetics, sampling time, drug history and the patients clinical condition. Patients with serum drug concentrations on noncovered services are identified on a daily basis utilizing sunrise clinical manager scm. Therapeutic drug monitoring tdm is generally defined as the clinical laboratory measurement of a chemical parameter that, with appropriate medical interpretation, will directly influence drug prescribing procedures.
Determination of the serum concentration of theophylline and of salicylate has gained widespread clinical acceptance as a therapeutic guide during the past decade. Therapeutic drug monitoring wirral medicines management. It identifies when a person does not take the medication regularly as prescribed patient noncompliance and the effect of drug interactions, which may cause drug concentrations that are higher or lower than expected at a given dosage, and helps to personalize a dose to. Theophylline interacts with a wide variety of drugs. Interaction between nutrition and theophylline metabolism. A concise guide, fourth edition serves as a ready resource of information on commonly monitored drugs that will help readers make decisions relating to the monitoring and interpretation of results. Therapeutic monitoring of theophylline serum levels is required due to its narrow therapeutic range and marked interindividual pharmacokinetic variability. Taking theophylline extendedrelease tablets immediately after ingesting a high fat content meal 45 g fat, 55 g carbohydrates, 28 g protein, 789 calories may result in a somewhat higher c max and delayed t max and a somewhat greater extent of absorption when compared to taking it in the fasting. Differences in reported hemodialysis clearances are probably related to. Therapeutic drug monitoring aims to promote optimum drug treatment by maintaining serum drug concentration within a therapeutic range. In phase 1 of the study, housestaff physicians determined the theophylline dosing regimen. Theophylline passes freely across the placenta, into breast milk and into the cerebrospinal fluid csf. It is an easytoread source of information on intended use, pharmacokinetics, therapeutic range, and toxic concentrations, as well as bioavailability.
Understand how drugs distribute and are cleared, and the equations will come naturally. Peak therapeutic ranges vary depending on the severity of infection i. We have undertaken this study to examine the effect of nutritional factors on theophylline pharmacokinetics in 14 asthmatic children receiving the drug on a chronic basis. Pdf background therapeutic monitoring of theophylline serum levels is required due to its narrow therapeutic range and marked interindividual. Therapeutic drug monitoring of phenytoin is carried out to ensure effective and safe levels. The summaries are structured monographs on 511 different drug entities detailing 964 different analytical methods, providing the reader with a. Therapeutic drug monitoring abbott core laboratory.
Principles and practice of therapeutic drug monitoring american. Do evacuated blood collection tubes interfere with. Theophylline is used in the treatment of asthma and chronic obstructive pulmonary disease. Once the decision to monitor the concentration of a therapeutic drug has been made, it is important that a biological sample is collected to provide a clinically meaningful measurement. Hemodialysis clearance of theophylline averaged 84. Nonsteadystate concentrations may be indicated in selected situations. Theophylline fda prescribing information, side effects. Therapeutic drug monitoring an overview sciencedirect. Information on therapeutic drug monitoring for the following drugs. Apr 14, 2019 therapeutic drug monitoring tdm is the individualization of drug dosage by maintaining plasma or blood drug concentrations within a target range the therapeutic window this helps address the two major sources of variability in drug responses between individuals, the relationships between. Therapeutic drug monitoring tdm the therapeutic window is the concentration range in which a drug exerts its clinical effect with minimal adverse effects for most patients. Pdf evaluation of theophylline therapeutic drug monitoring.
Evaluation of theophylline therapeutic drug monitoring. Pdf evaluation of theophylline therapeutic drug monitoring service. Therapeutic monitoring of theophylline springerlink. Loading dose should be decreased or eliminated if theophylline preparation has been used in preceding 24 hr. Therapeutic drug monitoring tdm is the individualization of drug dosage by maintaining plasma or blood drug concentrations within a target range the therapeutic window this helps address the two major sources of variability in drug responses between individuals, the relationships between. Reliability of antiarrhythmic drug plasma concentration monitoring. We evaluated therapeutic drug monitoring service for theophylline in slovenian clinical setting, which currently includes no pharmacokinetic evaluation of. Guidelines for therapeutic drug monitoring q pulse reference no. Therapeutic drug monitoringfinal dose biochemistry. Sep 14, 2015 practical issues in therapeutic drug monitoring ideally, a quality drug assay should be performed within a time frame that is clinically useful.
This information is used to individualise dosage so that drug concentrations can be maintained within a target range. Therapeutic drug monitoring is used for treatment as well as for diagnostic purposes. Therapeutic drug monitoring tdm refers to the clinical practice of measuring drugs andor metabolites in blood or serumplasma at a specific time point to determine if a patients drug concentrations are within the therapeutic range, and are neither subtherapeutic nor potentially toxic. The science of therapeutic drug monitoring grew out of the recognition that. Evaluation of theophylline therapeutic drug monitoring service.
Therapeutic drug monitoring tdm is the use of drug concentration measurements in body fluids as an aid to the management of drug therapy for the cure. Therapeutic drug monitoring is also useful in avoiding adverse drug events. Theophylline is a drug that is not given incredibly regularly nowadays, however, it is an important drug to know because it does have some serious side effects and its tested very often. Dont get lost in the equations, the math should naturally follow the principles. Monitoring should be done on trough specimens after steadystate has been reached. The monitoring of therapeutic drugs involves measuring drug concentrations in plasma, serum or blood. Updated with approvals from wirral drug and therapeutics committee. Therapeutic drug monitoring importance, guidelines. Bias may be present between immunoassay and lcms methods. Because of the therapeutic index of this drug, monitoring of theophylline concentrations in plasma is essential. The serum extraction ratio values obtained were compared to those of urea. Mar 06, 2009 pioneers of drug monitoring in the 1970s focused on adverse drug reactions and demonstrated clearly that by constructing therapeutic ranges, the incidence of toxicity to drugs such as digoxin, phenytoin, lithium, and theophylline could be reduced. Practical issues in therapeutic drug monitoring ideally, a quality drug assay should be performed within a time frame that is clinically useful.
We evaluated therapeutic drug monitoring service for theophylline in slovenian clinical setting, which currently includes no pharmacokinetic evaluation of measured theophylline serum concentrations. During the lecture, use the notetaking column to record the lecture using telegraphic sentences. Therapeutic effect and dosing strategies for theophylline in the treatment of chronic asthma. Some of the factors complicating phenytoin dosing include a narrow therapeutic window, high degree of protein binding, and nonlinear pharmacokinetics. These include research in numerous fields such as drug interactions, pharmacogenetics, and environmental and developmental factors that influence drug metabolism. Tdm is particularly useful for monitoring drugs that are used longterm. Oct 01, 2019 refer to precautions, drug interactions for information regarding table. Its use must be tempered with knowledge of its adverse effects and that these effects are related primarily to serum concentration. Accordingly, it is mandatory to monitor serum theophylline concentrations on a regular basis with any patient receiving maintenance therapy. Tdm is particularly useful for monitoring drugs that are used longterm or drugs that have a narrow therapeutic range. Patients in phase 2 received intravenous theophylline, with all dosing regimens being based on prospective therapeutic drug monitoring tdm by a clinical pharmacist. Such preparations, often with a mild sedative added, dominated the market for oral theophylline.
Therapeutic drug monitoring of theophylline, salicylates, and. Theophylline tdm service should be optimized and pharmacokinetic interpreta tion of theophylline serum levels should be inte. The use of theophylline has declined with the advent of potent steroid inhalants. Therapeutic drug monitoring of theophylline, salicylates. Monitoring the therapeutic range is no necessary if the drug is not considered highly toxic. To test your ability to monitor serum levels for drugs with a narrow therapeutic index. History the science of therapeutic drug monitoring grew out of the recognition that.
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