Adverse drug reactions to the new triazole, voriconazole — the need for therapeutic drug monitoring

More than 80% of all adverse drug reactions are Type A reactions and dependent on drug concentrations. Therapeutic Drug Monitoring (TDM), Drug Interaction checking programs and pharmacogenetic tests are valuable instruments in elucidating or preventing Type A reactions. It stands for Quality Assurance in clinical practice. The TDMplus algorithm (Jaquenoud Sirot E et al 2006) is helpful in clinical practice and prevents unnecessary testing. This decision tree leads in several “stop/go” steps from the clinical situation of inefficacy or adverse reaction to measuring and interpreting plasma levels, checking for pharmacokinetic interactions and finally, if indicated, to pharmacogenetic tests with gentoyping and/or phenotyping. Genetic results are noted on a personal “pharmacogenetic card” for the patient's future treatments.The interplay of genetics, drug interactions, life style and other personal vulnerabilities like comorbidity make prediction of drug response very complex. The use of TDMplus has proven useful guiding the clinicians in difficult clinical situations and helping elucidating the causality of adverse drug reactions. Its practical benefit has been shown with pharmacovigilance cases from the AMSP program (Arzneimittelsicherheit in der Psychiatrie = Drug Safety in Psychiatry).

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SPCCTDM, a Catalogue for Analysis of Therapeutic Drug Monitoring Related Contents

Computational Knowledge Discovery for Bioinformatics Research ◽

10.4018/978-1-4666-1785-8.ch018 ◽

2013 ◽

pp. 319-328

Author(s):

Sven Ulrich ◽

Pierre Baumann ◽

Andreas Conca ◽

Hans-Joachim Kuss ◽

Viktoria Stieffenhofer ◽

...

Keyword(s):

Drug Therapy ◽

Therapeutic Drug Monitoring ◽

Text Mining ◽

Drug Monitoring ◽

Text Analysis ◽

Scientific Evidence ◽

Plasma Concentrations ◽

Therapeutic Drug ◽

Drug Reactions ◽

First Time

Therapeutic drug monitoring (TDM) has consistently been shown to be useful for optimization of drug therapy. For the first time, a method has been developed for the text analysis of TDM in SPCs in that a catalogue SPC-ContentTDM (SPCCTDM) provides a codification of the content of TDM in SPCs. It consists of six structure-related items (dose, adverse drug reactions, drug interactions, overdose, pregnancy/breast feeding, and pharmacokinetics) according to implicit or explicit references to TDM in paragraphs of the SPC, and four theory-guided items according to the information about ranges of plasma concentrations and a recommendation of TDM in the SPC. The catalogue is regarded as valid for the text analysis of SPCs with respect to TDM. It can be used in the comparison of SPCs, in the comparison with medico-scientific evidence and for the estimation of the perception of TDM in SPCs by the reader. Regarding the approach as a model of text mining, it may be extended for evaluation of other aspects reported in SPCs.

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SPCCTDM, a Catalogue for Analysis of Therapeutic Drug Monitoring Related Contents in the Drug Prescription Information

International Journal of Knowledge Discovery in Bioinformatics ◽

10.4018/jkdb.2010040101 ◽

2010 ◽

Vol 1 (2) ◽

pp. 1-11

Author(s):

Sven Ulrich ◽

Pierre Baumann ◽

Andreas Conca ◽

Hans-Joachim Kuss ◽

Viktoria Stieffenhofer ◽

...

Keyword(s):

Drug Therapy ◽

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Text Analysis ◽

Scientific Evidence ◽

Drug Prescription ◽

Plasma Concentrations ◽

Therapeutic Drug ◽

Drug Reactions ◽

First Time

Therapeutic drug monitoring (TDM) has consistently been shown to be useful for optimization of drug therapy. For the first time, a method has been developed for the text analysis of TDM in SPCs in that a catalogue SPC-ContentTDM (SPCCTDM) provides a codification of the content of TDM in SPCs. It consists of six structure-related items (dose, adverse drug reactions, drug interactions, overdose, pregnancy/breast feeding, and pharmacokinetics) according to implicit or explicit references to TDM in paragraphs of the SPC, and four theory-guided items according to the information about ranges of plasma concentrations and a recommendation of TDM in the SPC. The catalogue is regarded as valid for the text analysis of SPCs with respect to TDM. It can be used in the comparison of SPCs, in the comparison with medico-scientific evidence and for the estimation of the perception of TDM in SPCs by the reader. Regarding the approach as a model of text mining, it may be extended for evaluation of other aspects reported in SPCs.

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Therapeutic drug monitoring in special populations

Clinical Chemistry ◽

10.1093/clinchem/44.2.415 ◽

1998 ◽

Vol 44 (2) ◽

pp. 415-419 ◽

Cited By ~ 20

Author(s):

Philip D Walson

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Diagnostic Testing ◽

Drug Effects ◽

Special Populations ◽

Therapeutic Drug ◽

Drug Reactions ◽

Drug Concentrations ◽

Dosing Regimens ◽

Multiple Drugs

Abstract Therapeutic drug monitoring (TDM) is commonly used to maintain “therapeutic” drug concentrations. Even in compliant patients, with “average” drug kinetics, TDM is useful to identify the causes of unwanted or unexpected responses, prevent unnecessary diagnostic testing, improve clinical outcomes, and even save lives. TDM has greatest promise in certain special populations who are: (a) prone to under- or overrespond to usual dosing regimens, (b) least able to tolerate, recognize, or communicate drug effects, or who are (c) intentionally or accidentally misdosed. TDM is especially useful in patients at the extremes of age, in adolescents, and in patients who are either taking multiple drugs or expressing unusual pharmacokinetics as a result of physiological, environmental, or genetic causes. Less-well-appreciated uses of TDM include prevention of dangerousunderdosing of patients, investigation of adverse drug reactions, and identification of serious medication errors, even for a number of drugs that are not traditionally monitored. TDM can be useful for some drugs in any patient and for most drugs in some special populations.

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Therapeutic drug monitoring of teicoplanin in a patient with bloodstream infection by Enterococcus faecium

Pharmaceutical Care and Research ◽

10.5428/pcar20200513 ◽

2020 ◽

Vol 20 (5) ◽

pp. 377-379

Author(s):

Yifan LUO ◽

◽

Lixiang REN ◽

Mingyan JIANG

Keyword(s):

Therapeutic Drug Monitoring ◽

Bloodstream Infection ◽

Drug Monitoring ◽

Enterococcus Faecium ◽

Blood Concentration ◽

Blood Stream Infection ◽

Blood Stream ◽

Therapeutic Drug ◽

Pathogenic Microorganism ◽

Drug Reactions

Objective： To analyze the blood concentration，efficacy and adverse drug reactions（ADRs） of teicoplanin in treatment of bloodstream infection by Enterococcus faecium.Methods： Changes in physiological and pathological indexes of the patient were closely followed and recorded，and the treatment regimen was adjusted according to the results of therapeutic drug monitoring（TDM） of teicoplanin.Results： In the light of the results of therapeutic drug monitoring of teicoplanin，bloodstream infection was cured，pathogenic microorganism was effectively eliminated and no ADRs occurred.Conclusion： With TDM，teicoplanin could be safely and effectively used in the treatment of blood stream infection.

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Therapeutic Drug Monitoring Reduces Toxic Drug Reactions

Therapeutic Drug Monitoring ◽

10.1097/00007691-199001000-00013 ◽

1990 ◽

Vol 12 (1) ◽

pp. 72-78 ◽

Cited By ~ 26

Author(s):

L. Douglas Ried ◽

John R. Horn ◽

Dana A. McKenna

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Therapeutic Drug ◽

Drug Reactions ◽

Toxic Drug

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Diagnose und Monitoring bei chronisch-entzündlicher Darmerkrankung

Therapeutische Umschau ◽

10.1024/0040-5930/a001002 ◽

2018 ◽

Vol 75 (5) ◽

pp. 316-328

Author(s):

Christian Ansprenger ◽

Emanuel Burri

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Morbus Crohn ◽

Therapeutic Drug ◽

Körperliche Untersuchung

Zusammenfassung. Die Diagnose und auch die Überwachung von chronisch entzündlichen Darmerkrankungen ruht auf mehreren Säulen: Anamnese, körperliche Untersuchung, Laborwerte (im Blut und Stuhl), Endoskopie, Histologie und Bildgebung. Die Diagnose kann nicht anhand eines einzelnen Befundes gestellt werden. In den letzten Jahren hat sich das Therapieziel weg von klinischen Endpunkten hin zu endoskopischen und sogar histologischen Endpunkten entwickelt. Für einige dieser neuen Therapieziele existiert allerdings noch keine allgemein gültige Definition. Regelmässige Endoskopien werden von Patienten schlecht toleriert, weshalb Surrogat-Marker wie Calprotectin untersucht wurden und eine gute Korrelation mit der mukosalen Entzündungsaktivität nachgewiesen werden konnte. Entsprechend zeigte sich bei Morbus Crohn eine Algorithmus-basierte Therapiesteuerung – unter anderem basierend auf Calprotectin – einer konventionellen Therapiesteuerung überlegen. Die Überwachung der medikamentösen Therapie («Therapeutic Drug Monitoring» [TDM]) ist ein zweites Standbein des Monitoring von chronisch entzündlichen Darmerkrankungen. Mit zunehmendem Einsatz vor allem der Biologika-Therapien wurden sowohl reaktives TDM (in Patienten mit klinischem Rezidiv) als auch proaktives TDM (in Patienten in Remission / stabiler Erkrankung) untersucht und haben (teilweise) Eingang in aktuelle Richtlinien gefunden. Zukünftige Studien werden die vorgeschlagenen Therapieziele besser definieren und den Nutzen der medikamentösen Therapieüberwachung auf den Krankheitsverlauf weiter untersuchen müssen.

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