scholarly journals Therapeutic Drug Monitoring of Newer Antiepileptic Drugs: A Randomized Trial for Dosage Adjustment

2019 ◽  
Vol 87 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Irene Aícua‐Rapún ◽  
Pascal André ◽  
Andrea O. Rossetti ◽  
Philippe Ryvlin ◽  
Andreas F. Hottinger ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Randomized Trial ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
Dosage Adjustment ◽  
Therapeutic Drug

scholarly journals A randomized trial of therapeutic drug monitoring of protease inhibitors in antiretroviral-experienced, HIV-1-infected patients

AIDS ◽  
2009 ◽  
Vol 23 (3) ◽  
pp. 357-368 ◽  
Author(s):  
Lisa M Demeter ◽  
Hongyu Jiang ◽  
A Lisa Mukherjee ◽  
Gene D Morse ◽  
Robin DiFrancesco ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Randomized Trial ◽  
Protease Inhibitors ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Hiv 1

Therapeutic Drug Monitoring of Antiepileptic Drugs in a Tertiary Care Hospital in India

2015 ◽  
Vol 38 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Natarajan Harivenkatesh ◽  
Natarajan Haribalaji ◽  
Darling Chellathai David ◽  
C. M. Prabu Kumar
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Therapeutic Drug ◽  
Care Hospital

scholarly journals Therapeutic Drug Monitoring of Second- and Third-Generation Antiepileptic Drugs: Insights From a College of American Pathologists Proficiency Testing Survey

2021 ◽  
Author(s):  
Matthew D. Krasowski ◽  
Thomas A. Long ◽  
Christine L. H. Snozek ◽  
Annabel Dizon ◽  
Barbarajean Magnani ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antiepileptic Drugs ◽  
Proficiency Testing ◽  
Drug Monitoring ◽  
First Generation ◽  
Therapeutic Drug ◽  
Third Generation ◽  
Enzyme Immunoassays ◽  
Steady Growth ◽  
Survey Results

Context.— Therapeutic drug monitoring has traditionally been widely used for first-generation antiepileptic drugs (AEDs) such as carbamazepine and phenytoin. The last 2 decades have seen the introduction of second- and third-generation AEDs (eg, lamotrigine, levetiracetam, and topiramate) into clinical practice. Objective.— To use data from the College of American Pathologists Therapeutic Drug Monitoring, Extended proficiency testing survey to determine the performance of assays used for therapeutic drug monitoring of newer AEDs, including comparison of enzyme immunoassay and chromatographic techniques. Design.— Six years of proficiency testing surveys were reviewed (2013–2018). Results.— Steady growth was seen in participant volumes for newer AEDs. The analytical performance of automated enzyme immunoassays for lamotrigine, levetiracetam, and topiramate was similar to that of chromatographic methods, consistent with published literature using patient samples for comparisons. The majority of participating laboratories now use enzyme immunoassays to measure levetiracetam. Conclusions.— Survey results reflect steadily growing interest in therapeutic drug monitoring of newer AEDs. The increasing availability of robust immunoassays for new AEDs should facilitate their clinical utility, especially for clinical laboratories that do not perform chromatographic assays for therapeutic drug monitoring.

Pharmacokinetic Properties of New Antiepileptic Drugs

2005 ◽  
Vol 18 (6) ◽  
pp. 444-460 ◽  
Author(s):  
Michele Y. Splinter
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Interactions ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
The United States ◽  
Therapeutic Drug ◽  
Kinetic Properties ◽  
New Antiepileptic Drugs ◽  
Drug Concentrations ◽  
Pharmacokinetic Properties

Eight new antiepileptic drugs (AEDs) have been approved for use within the United States within the past decade. They are felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, and zonisamide. These afford clinicians with more options to increase efficacy and tolerability in the treatment of patients with epilepsy. Pharmacokinetic properties and drug interactions with other AEDs and other medications taken for comorbidities are individually discussed for each of these new agents. Drug concentrations are not routinely monitored for these newer agents, and there have been few studies designed to investigate their concentration-effect relationships. For most of these medications, the concentrations observed in responders and nonresponders overlap considerably and levels associated with efficacy are often associated with adverse events, complicating the definition of target ranges. Also, epilepsy manifests itself sporadically causing difficulty in clinically monitoring efficacy of medications. Therapeutic drug monitoring provides for the individualization of treatment for these agents, which is important because they demonstrate significant variability in inter- and intraindividual pharmaco-kinetic properties. Therapeutic drug monitoring also allows for identification of noncompliance, drug interactions, and toxicity. Current knowledge of the relationships between efficacy, toxicity, and drug concentrations is discussed.

scholarly journals Population Pharmacokinetic Analysis of Therapeutic Drug Monitoring Data in Optimizing Pharmacotherapy of Antiepileptic Drugs

10.5772/20328 ◽  
2011 ◽  
Author(s):  
Katarina Vucicevic ◽  
Branislava Miljkovic ◽  
Sandra Vezmar ◽  
Zoran Todorovic ◽  
Milica Prostran ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
Population Pharmacokinetic Analysis ◽  
Monitoring Data ◽  
Pharmacokinetic Analysis ◽  
Therapeutic Drug ◽  
Population Pharmacokinetic

scholarly journals Optimum Use of Therapeutic Drug Monitoring and Pharmacokinetics-Pharmacodynamics in the NICU

2009 ◽  
Vol 14 (2) ◽  
pp. 66-74
Author(s):  
Peter Gal
Keyword(s):  
Drug Therapy ◽  
Therapeutic Drug Monitoring ◽  
Antiepileptic Drugs ◽  
Therapeutic Range ◽  
Drug Monitoring ◽  
Population Based ◽  
Pharmacokinetic Parameters ◽  
Therapeutic Drug ◽  
Patient Response ◽  
Drug Concentrations

Therapeutic drug monitoring is increasingly giving way to dosing drugs based on population-based pharmacokinetic parameters, even when pharmacokinetic values vary quite a bit in individual patients. Further, drug concentrations are often considered appropriate if they are within a defined therapeutic range, even if the patient response is suboptimal. This lecture discusses the limitations of therapeutic ranges in neonates, and proposes greater emphasis on pharmacodynamic curves to individualize drug therapy. Examples are provided using methylxanthines, indomethacin, antiepileptic drugs and aminoglycosides. The potential to use pharmacokinetic findings to describe physiologic changes and occasionally assist with diagnosis is also discussed.

scholarly journals 1101. Implementing a Beta-Lactam Therapeutic Drug Monitoring Program: Experience from a Large Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S642-S642
Author(s):  
Venugopalan Veena ◽  
Malva Hamza ◽  
Barbara A Santevecchi ◽  
Kathryn DeSear ◽  
Kartikeya Cherabuddi ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Dosage Adjustment ◽  
Total Serum ◽  
Therapeutic Drug ◽  
Beta Lactam ◽  
Dose Individualization ◽  
Material Support ◽  
Drug Concentrations ◽  
Drug Registry

Abstract Background Beta-lactams (BL) are the cornerstone of antimicrobial treatment for infections. Beta-lactam therapeutic drug monitoring (BL-TDM) optimizes drug concentrations to ensure maximal efficacy and minimal toxicity. The goals of this study were to describe the implementation process of a BL-TDM program and to further describe our experience using BL-TDM in clinical practice. Methods This was a retrospective review of adult patients with available BL-TDM between January 2016 and November 2019 at the University of Florida (UF) Health Shands Hospital. Total serum concentrations of BL were measured in the Infectious Diseases Pharmacokinetics Lab (IDPL) at UF, using a validated ultrahigh pressure liquid chromatography assay with triple quadrupole mass spectroscopy (LC-MS-MS). At our institution, TDM is available for 11 BLs and in-house assays are performed from Mon-Fri for most BLs. Results A total of 3,030 BL concentrations were obtained. An analysis was performed on the first BL-TDM encounter in 1,438 patients. The median age was 57 years (IQR, 41-69) and the median BMI was 27.5 kg/m2 (IQR, 22.5-34.5). On the day of BL-TDM, the median serum creatinine was 0.83 (IQR, 0.59-1.30). Fifty-one percent of patients (n=735) were in an ICU at the time of BL-TDM with a median SOFA score of 6 (IQR, 3-9). BL-TDM was most frequently performed on cefepime (61%, n=882), piperacillin (15%, n=218), and meropenem (11%, n=151). The BL was administered as a continuous infusion in 211 (15%) patients. An interim analysis of 548 patients showed that BL-TDM was performed a median of 2 days (IQR, 1-4) from the start of BL therapy and resulted in a dosage adjustment in 26% (n=145). Conclusion BL-TDM was performed in older, non-obese patients with normal renal function. Over half of the evaluated patients were in an ICU at the time of TDM. This finding emphasizes the value of BL-TDM in the ICU setting because altered pharmacokinetics during critical illness has been linked to enhanced BL clearance. Interestingly, BL-TDM resulted in dosage adjustment in 1 in 4 patients who were receiving licensed BL dosing regimens, thus highlighting the role of TDM in dose individualization. BL-TDM was performed most commonly within the 72-hours of therapy initiation. Early BL-TDM has been shown to improve patient outcomes and should be promoted. Disclosures Venugopalan Veena, PharmD, Melinta (Other Financial or Material Support, Received a stipend for participation in a drug registry)Merck (Other Financial or Material Support, Received a stipend for participation in a drug registry) Charles A. Peloquin, Pharm.D., Nothing to disclose

Revisiting clinical practice in therapeutic drug monitoring of first-generation antiepileptic drugs

2019 ◽  
Vol 35 (10) ◽  
pp. 500-517
Author(s):  
Shery Jacob ◽  
Anroop B. Nair ◽  
Jigar Shah
Keyword(s):  
Clinical Practice ◽  
Therapeutic Drug Monitoring ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
First Generation ◽  
Therapeutic Drug
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