Therapeutic Drug Monitoring of Selected Drugs: An Approach to Drug Therapy Optimization

Siraj, Sundaran (2012) Therapeutic Drug Monitoring of Selected Drugs: An Approach to Drug Therapy Optimization. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.


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Therapeutic drug monitoring (TDM) is the process by which the treatment is optimized by ensuring that the plasma/blood drug concentrations lie within a therapeutic range, above which toxicity occurs and below which the drug is ineffective3. In other words it refers to the individualization of drug dosage, by maintaining plasma or blood drug concentrations within a targeted therapeutic range. The notion of a therapeutic range is more a probabilistic concept then an absolute entity which represents a range of drug concentrations within which the probability of a desired clinical response is relatively high and the probability of unacceptable toxicity is relatively low4. The concentrations above a previously determined target or therapeutic range are considered toxic or potentially toxic and levels below are subtherapeutic. The appropriate medical interpretation by TDM has a direct influence on drug prescribing procedures. The close relationship between plasma levels of the drug and the clinical effects is the basis of the concept of TDM. The measurement of plasma level is justified only when the information provided is of potential therapeutic benefit. Therefore, in TDM the drug levels are an adjunct to the clinical picture and doses should be modified according to the individual’s pharmacodynamic response (based on sound clinical judgement) using pharmacokinetic principles to aid titration of the dose to achieve the appropriate therapeutic end point or in other words optimal patient benefit. TDM demands knowledge of pharmacokinetics and the influencing factors and a knowledge of pharmacodynamic to assess the side effects and drug interactions which can result in apparent toxicity or lack of effect. In a nutshell the principle is that a stronger relationship exists between plasma concentration and effect (Ferguson principle) than between the dose and effect. TDM blends the knowledge of therapeutics, pharmacology, pharmacokinetics, laboratory technology, and clinical medicine and applies it to certain drugs that require determination of patient specific dosage regimens to maximize therapeutic effectiveness while minimizing toxicity.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Therapeutic Drug Monitoring, Selected Drugs, Drug Therapy Optimization.
Subjects: PHARMACY > Pharmaceutical Chemistry
Depositing User: Subramani R
Date Deposited: 18 Jun 2017 13:45
Last Modified: 24 Oct 2022 14:09

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