Therapeutic drug monitoring
Therapeutic drug monitoring ( TDM ) or drug level determination (also drug monitoring ) is a term commonly used in medicine for measuring the concentration of drugs in the blood or in blood compartments such as blood serum or plasma .
In everyday clinical practice, level determinations are used to improve the dosage of drugs with a narrow therapeutic range such as digoxin or aminoglycosides . Drug monitoring is particularly useful for drugs that can easily be over or underdosed, whose concentrations are easily influenced by other drugs or which have a toxic effect above a certain concentration , as well as with reduced kidney or liver function . The aim is always to achieve an optimal active level and to determine the necessary individual drug dose .
In addition, therapeutic drug monitoring is used to monitor e.g. B. to control the active level in the absence or undesired effect and to check patient compliance , z. B. in the use of psychotropic drugs . In rare cases, other body fluids such as: B. urine during substitution therapy with buprenorphine .
In pharmacology , TDM is used to research pharmacokinetic parameters of drugs such as absorption , elimination, etc.
In clinical toxicology , therapeutic drug monitoring is used to detect or exclude poisoning with drugs and to be able to assess their severity.
Routine TDM is possible for well over 100 drugs. Here are some examples:
- Aminoglycosides ( gentamicin , amikacin , tobramycin , netilmicin )
- Theophylline
- Vancomycin (and other glycopeptide antibiotics )
- lithium
- Carbamazepine
- phenobarbital
- Phenytoin
- Valproic acid
- Lamotrigine
- Amiodarone
- Flecainide
- Digitoxin
- Digoxin
- Cyclosporine
- Tacrolimus
- Everolimus
- Sirolimus
- Methotrexate
- Paracetamol
Individual evidence
- ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 334–337 ( mirror provisions ), here: pp. 334 f.
- ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. 2009, pp. 335-337.
