Amiodarone is the most effective agent in the therapy of arrhythmias. However, the clinical effect of acute and chronic treatment is unclear and there are differences irrespective of comparable plasma/myocardial amiodarone and its metabolite desethylamiodarone concentations as well. Its unusual pharmacokinetics results in interindividual variation in plasma levels. The association between amiod...

It has been long recognized that large inter-individual variability is commonly observed in response to drug administration. The large response variability of certain drugs with narrow margin of safety may induce toxicity. To avoid this and to optimize the result of drug treatment, therapeutic drug monitoring (TDM) service has been routinely applied in hospitals in well-developed countries. For...

The use of therapeutic drug monitoring (TDM) in the treatment of HIV-infection is gaining momentum in resource-rich countries. However, data justifying its use is still in short supply. In this manuscript we review the necessary components of TDM before it should be implemented in widespread clinical use. In addition, we provide specific examples of clinical situations where TDM is likely to us...

PURPOSE OF REVIEW Recent studies suggest that contemporary antibiotic dosing is unlikely to achieve best outcomes for critically ill patients because of extensive pharmacokinetic variability and altered pharmacodynamics. Dose adaptation is considered quite challenging because of unpredictable dose-exposure relationships. Consequently, individualization of antibiotic dosing has been advocated. H...

To study the appropriateness of phlebotomy for digoxin therapeutic drug monitoring (TDM) in outpatients, we conducted a retrospective chart review, a computer search of all previous TDM testing, and a questionnaire of all outpatients (n = 86) who had serum digoxin determinations between April 10 and April 28, 1992 (585 tests). In patients who took digoxin at the same time daily (40 patients, 30...

BACKGROUND Therapeutic drug monitoring of mycophenolic acid (MPA) is usually performed with a limited sampling strategy (LSS), which relies on a limited number of blood samples and subsequent extrapolation of the global exposure to MPA. LSS is usually performed successfully with mycophenolate mofetil (MMF), but data on enteric-coated mycophenolate sodium (EC-MPS) are scarce. Here, we evaluated ...

BACKGROUND Voriconazole is a broad-spectrum, second-generation triazole antifungal agent with demonstrated efficacy in the treatment of invasive fungal infections caused by Aspergillus spp. and Candida spp. Given the characteristically poor prognosis of patients with invasive fungal infections and the protracted duration of treatment required, therapeutic monitoring of voriconazole is, in theor...

Therapeutic drug monitoring (TDM) of immunosuppressive drugs has evolved over the last few decades. The use of liquid chromatography–tandem mass spectrometry, for example, now provides robust and highly specific quantification in the clinical laboratory. Nevertheless, the measurement of immunosuppressive drug concentrations, even if carried out accurately and precisely, does not sufficiently re...

Surface-Enhanced Raman Spectroscopy (SERS) is a label-free technique that enables quick monitoring of substances at low concentrations in biological matrices. These advantages make it an attractive tool for the development of point-of-care tests suitable for Therapeutic Drug Monitoring (TDM) of drugs with a narrow therapeutic window, such as chemotherapeutic drugs, immunosuppressants, and vario...

BACKGROUND The aim of drug treatment for epilepsy is to prevent seizures without causing adverse effects. To achieve this, drug dosages need to be individualised. Measuring antiepileptic drug levels in body fluids (therapeutic drug monitoring) is frequently used to optimise drug dosage for individual patients. OBJECTIVES To review the evidence regarding the effects of therapeutic drug monitor...