Audit of Therapeutic Drug Monitoring

Hallworth, Mike

doi:10.1177/000456328802500201

Cited by 9 publications

(4 citation statements)

References 33 publications

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“…Other conditions in which TDM may be especially rewarding include the check for compliance and the management of patients in whom AED pharmacokinetics is likely to be altered by developmental factors, associated disease, or drug interactions. The setting of precise indications for TDM is important in view of the evidence that serum drug levels are often requested inappropriately (6,12,13,18). Misinterpretation of the results (for example, increasing dos-age despite evidence that a patient is well controlled at a level below the usually quoted optimal range) also seems to be a common problem leading to potentially harmful clinical decisions (14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…In epilepsy, the wave of overenthusiasm for TDM subsided many years ago (6), partly because of the observation that there is considerable variation in the serum level at which individual patients achieve optimal re-sponses (7-1 1), and the realization that inadequate use of the service may result in unacceptable waste of resources (6,12,13) and even harm to patients' health (14)(15)(16). Even though precise criteria for the optimal use of TDM have been formulated (8,9,11,(17)(18)(19)(20) and the usefulness of a correctly applied service has been suggested on the basis of retrospective surveys (21,22), there has been a paucity of studies in which the impact of serum AED determinations has been evaluated prospectively (1 1,23, 24).…”

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confidence: 99%

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A Multicenter Randomized Controlled Trial on the Clinical Impact of Therapeutic Drug Monitoring in Patients with Newly Diagnosed Epilepsy

Cian²,

et al. 2000

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Summary:Purpose: To assess the clinical impact of monitoring serum concentrations of antiepileptic drugs (AEDs) in patients with newly diagnosed epilepsy.Methods: One-hundred eighty patients with partial or idiopathic generalized nonabsence epilepsy, aged 6 to 65 years, requiring initiation of treatment with carbamazepine (CBZ), valproate (VPA), phenytoin (PHT), phenobarbital (PB), or primidone (PRM) were randomly allocated to two groups according to an open, prospective parallel-group design. In one group, dosage was adjusted to achieve serum AED concentration within a target range (10-20 p,g/ml for PHT, 1 5 4 0 pg/ml for PB, 4-11 pg/ml for CBZ, and 40-100 pg/ml for VPA), whereas in the other group, dosage was adjusted on clinical grounds. Patients were followed up for 24 months or until a change in therapeutic strategy was clinically indicated.Results: Baseline characteristics did not differ between the two groups. Most patients with partial epilepsy were treated with CBZ, whereas generalized epilepsies were most commonly managed with PB or VPA. PHT was used only in a small minority of patients. A total of I16 patients completed 2-year follow-up, and there were no differences in exit rate from any cause between the monitored group and the control group. The proportion of assessable patients with mean serum drug levels outside the target range (mostly below range) during the first 6 months of the study was 8% in the monitored group compared with 25% in the control group (p < 0.01). There were no significant differences between the monitored group and the control group with respect to patients achieving 12-month remission (60% vs. 61 %), patients remaining seizure free since initiation of treatment (38% vs. 41%), and time to first seizure or 12-month remission. Frequency of adverse effects was almost identical in the two groups.Conclusions: Only a small minority of patients were treated with PHT, the drug for which serum concentration measurements are most likely to be useful. With the AEDs most commonly used in this study, early implementation of serum AED level monitoring did not improve overall therapeutic outcome, and the majority of patients could be satisfactorily treated by adjusting dose on clinical grounds. Monitoring the serum levels of these drugs in selected patients and in special situations is likely to he more rewarding than routine measurements in a large clinic population.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Multicenter Randomized Controlled Trial on the Clinical Impact of Therapeutic Drug Monitoring in Patients with Newly Diagnosed Epilepsy

Cian²,

et al. 2000

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“…Based on the understanding that incorrect use of a service (e.g., TDM) may result in intolerable waste of funds 5,19,20 and even harm to patient health, 21 –23 the study aims to assess the practices associated with the application of TDM services for AEDs in the management of children with structural–metabolic epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Practices Associated with Serum Antiepileptic Drug Level Monitoring at a Pediatric Neurology Clinic

Salih

Bahari

Shafie

et al. 2012

Journal of Pharmacy Practice

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Objectives: To assess the practices associated with the application of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) in the management of children with structural–metabolic epilepsy. Methods: It was a retrospective chart review and included children aged ≥2 years old with structural–metabolic epilepsy, treated with AEDs, and received TDM. The data were extracted from the medical records. Results: Thirty-two patients were identified with 50 TDM assays. In two thirds of the assays, “check level” and “recheck level” were the reasons behind the requesting of serum level monitoring of AEDs. Knowledge of serum AED levels led to alterations in the management in 60% of the assays. Thirty-two (76%) pediatrician’s actions were consistent with the recommendation of TDM pharmacist. Forty-nine (98%) levels were appropriately indicated. In relation to the appropriateness of sampling time, 9 (18%) levels were not assessed due to missing data. Twenty-seven (54%) levels were appropriately sampled. Conclusions: More studies should be designed to improve the component of the current TDM request form, especially in the reason section. By the same token, the number of pointless assays and the costs to the health care system can be reduced both by enhancing and improving the educational standards of the requesting neurologists

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“…Hence, a good understanding of the physiological processes as well as the pharmacokinetics (PK) [what the body does to the drug] and pharmacodynamics (PD) [what the drug does to the body]) of the drugs is necessary to appreciate the differences, so that this knowledge can be utilised in the decision-making processes regarding the choice of OAC [3,4]. Hence, this review article aims to provide a detailed review of these characteristics of the commonly used VKAs (warfarin (Coumadin®), phenprocoumon (Marcoumar®) and acenocoumarol (Sinthrome®)) as well as NOACs (dabigatran (Pradaxa®), rivaroxaban (Xarelto®), apixaban (Eliquis®) and edoxaban (Lixiana®) .…”

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confidence: 99%

Pharmacokinetics and pharmacodynamics of oral anticoagulants used in atrial fibrillation

Fawzy

Lip

2019

Expert Opinion on Drug Metabolism & Toxicology

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Introduction:The availability of non-vitamin K antagonist oral anti-coagulants alongside vitamin K antagonists has offered a variety of options for anti-coagulation, but has also necessitated a good understanding of the pharmacological properties of each of these drugs prior to their use, to maximise the therapeutic benefit and minimise patient harm Areas covered: This review article outlines the pharmacokinetic and pharmacodynamic profiles of the currently licensed NOACs and VKAs that are most commonly used in clinical practice, with the aim of demonstrating how variations in these processes contribute to their use in clinical practice. A literature search was conducted on PubMed using keywords and relevant articles published by the 31 st of December 2018 were included. Expert opinion:The effect of a drug is determined by a combination of elements which include patient characteristics and external influences, in addition to its pharmacokinetic and pharmacodynamic properties. A good understanding of this is essential. Despite the wealth of information available, particularly on VKAs, our knowledge on the pharmacology responsible for certain drug effects and inter-individual variations is still limited. Increasing efforts are being made to uncover these and includes focus on pharmacogenomics and drug transporter proteins.

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Audit of Therapeutic Drug Monitoring

Cited by 9 publications

References 33 publications

A Multicenter Randomized Controlled Trial on the Clinical Impact of Therapeutic Drug Monitoring in Patients with Newly Diagnosed Epilepsy

A Multicenter Randomized Controlled Trial on the Clinical Impact of Therapeutic Drug Monitoring in Patients with Newly Diagnosed Epilepsy

Practices Associated with Serum Antiepileptic Drug Level Monitoring at a Pediatric Neurology Clinic

Pharmacokinetics and pharmacodynamics of oral anticoagulants used in atrial fibrillation

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