Professional Documents
Culture Documents
Monitoring
Sandeep.B,
M.Pharm, II Semester,
Department of Pharmacy Practice
Contents:
Introduction
Necessity of TDM
Objectives
Sampling
Examples
Limitations
References
Introduction:
Therapeuti
c Range
MEC
Subtherapeut
ic Level
Time
Objectives:
1.
2.
3.
4.
5.
6.
7.
2.
3.
4.
5.
6.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
Carbamazepin
Cardiotonics- Digoxin
Immunosupressants- Cyclosporin, Tacrolimus
Antibiotics- Ampicilline, Vancomycin
Antiarrythmics- Amiadarone, Lidocaine
Sampling:
Drug
Therapeutic
range
Half-life in
Adults
Average time
taken to reach
steady state
concentration
Digoxin
0.5-2 mcg/l
30-50 hrs
7-12 days
Phenytoin
10-20 mg/l
10-30 hrs
8-21 days
Carbamazepine
5-12 mg/l
l0-30 hrs
3-5 days
Lithium
0.5-1 mmol/l
14-30 hrs
5-8 days
Amiodarone
1-2.5 mg/l
27-105 days
3-6 months
Cyclosporin
100-200 mcg/l
19 hrs
3-4 days
Theophylline
7-15 mg/l
Smokers (7-11
hrs)
Nonsmokers (3-5
hrs)
24-36 hrs
Gentamycin
<0.5 mg/l
2-5 hrs
<24 hrs
Vancomycin
5-15 mg/l
3-8 hrs
24-48 hrs
Patient characteristics
Patient compliance
Dosage regimen and Duration of therapy
Time of sampling
Alteration in Protein binding
Alteration in elimination of drugs
Pathological characteristics
Drug interactions
Smoking and alcohol consumption
Sampling and Laboratory errors
Within
TR
Check
the
follow up
of
therapy
If required
Above
TR
Change or
re consider
drug
therapy
a small
change in dose should
be considered
Satisfactory Clinical
response
Below
TR
Other
possible
reasons for
signs of
toxicity
should be
considered.
Laboratory
errors should
Within
TR
Other possible
reasons for
signs of
toxicity should
be considered.
Lower dose
can be given if
result
indicates the
Above
TR
Discontin
ue the
therapy
and
restart
with a low
dose
1.
2.
3.
4.
5.
Limitations of TDM:
References
1.
2.
3.
4.
5.
THANK YOU