Erratum: Therapeutic drug monitoring of voriconazole helps to decrease the percentage of patients with off-target trough serum levels

We describe a 67-year-old man with medical history of focal post-stroke seizure and type 2 diabetes mellitus treated with carbamazepine, clobazam, gliclazide, insulin glargine, and omeprazole we visited for the onset in the last 7 days of asthenia, cough with mucus, breathing difficulty, chest pain, and weight loss. After clinical and laboratory tests, pulmonary tuberculosis was diagnosed, and a treatment with isoniazid, ethambutol, pyrazinamide rifampicin, and pyridoxine was started. Therapeutic drug monitoring of tuberculosis treatment documented that all drugs were in normal therapeutic range. Four days after the beginning of the treatment, we documented the improvement of fever, and three days later the patient showed sleepiness, visual disorder and asthenia. Clinical and pharmacological evaluation suggested a carbamazepine toxicity probably related to a drug interaction (Drug Interaction Probability Scale score = 6). The impossibility to switch carbamazepine for another antiepileptic drug, due to a resistant form of seizure, induced the discontinuation of tuberculosis treatment, resulting in the normalization of serum carbamazepine levels in one day (10 µg/ml) and in the worsening of fever, requiring a new clinical and pharmacological evaluation. The titration dosage of carbamazepine and its therapeutic drug monitoring allowed to continue the treatment with both antitubercular drugs and carbamazepine, without the development of adverse drug reactions. To date, tuberculosis treatment was stopped and clinical evaluation, radiology and microbiology assays documented the absence of tubercular infection and no seizures appeared (carbamazepine dosage 800 mg/bid; serum levels 9.5 µg/ml).

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Valganciclovir—Ganciclovir Use and Systematic Therapeutic Drug Monitoring. An Invitation to Antiviral Stewardship

Antibiotics ◽

10.3390/antibiotics10010077 ◽

2021 ◽

Vol 10 (1) ◽

pp. 77

Author(s):

Alicia Galar ◽

Maricela Valerio ◽

Pilar Catalán ◽

Xandra García-González ◽

Almudena Burillo ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

High Performance ◽

Initial Dosage ◽

Serum Levels ◽

Individual Variability ◽

Therapeutic Drug ◽

Drug Discontinuation ◽

Tertiary Institution ◽

Treatment Adequacy

Valganciclovir (VGCV) and ganciclovir (GCV) doses must be adjusted according to indication, renal function and weight. No specific therapeutic exposure values have been established. We aimed to evaluate the adequacy of VGCV/GCV doses, to assess the interpatient variability in GCV serum levels, to identify predictive factors for this variability and to assess the clinical impact. This is a prospective study at a tertiary institution including hospitalized patients receiving VGCV/GCV prophylaxis or treatment. Adequacy of the antiviral dose was defined according to cytomegalovirus guidelines. Serum levels were determined using High-Performance Liquid Chromatography. Blood samples were drawn at least 3 days after antiviral initiation. Outcome was considered favorable if there was no evidence of cytomegalovirus infection during prophylaxis or when a clinical and microbiological resolution was attained within 21 days of treatment and no need for drug discontinuation due to toxicity. Seventy consecutive patients [74.3% male/median age: 59.2 years] were included. VGCV was used in 25 patients (35.7%) and GCV in 45 (64.3%). VGCV/GCV initial dosage was deemed adequate in 47/70 cases (67.1%), lower than recommended in 7/70 (10%) and higher in 16/70 (22.9%). Large inter-individual variability of serum levels was observed, with median trough levels of 2.3 mg/L and median peak levels of 7.8 mg/L. Inadequate dosing of VGCV/GCV and peak levels lower than 8.37 or greater than 11.86 mg/L were related to poor outcome. Further studies must be performed to confirm these results and to conclusively establish if VGCV/GCV therapeutic drug monitoring could be useful to improve outcomes in specific clinical situations.

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Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital

Mental Health Clinician ◽

10.9740/mhc.2016.01.001 ◽

2016 ◽

Vol 6 (1) ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Kara R. Wong ◽

Leigh Anne Nelson ◽

Ellie S. R. Elliott ◽

Yifei Liu ◽

Roger W. Sommi ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Psychiatric Hospital ◽

Drug Monitoring ◽

Serum Levels ◽

Therapeutic Drug ◽

Daily Cost ◽

Laboratory Cost ◽

State Psychiatric Hospital ◽

Medication Costs ◽

State Psychiatric

Abstract Introduction This study assesses the utilization of antipsychotic therapeutic drug monitoring (TDM) and describes characteristics of appropriate and inappropriate TDM at a state psychiatric hospital. Methods A retrospective, descriptive review was conducted for antipsychotic TDM completed between December 1, 2009, and June 30, 2011, at a 65-bed adult inpatient extended-care and forensic state psychiatric hospital. Results One hundred thirty-three (n = 133) antipsychotic serum levels were collected from 44 patients during the study period. Sixty-nine percent (69%) of the TDM were deemed inappropriate, 28% were appropriate, and 3% could not be designated appropriate or inappropriate owing to the lack of information regarding steady-state conditions. The primary reason for inappropriate TDM was lack of documentation with regard to the indication for TDM (n = 79, 59.3%), the intervention following laboratory analysis (n = 88, 66%), or both. Appropriate TDM was associated with a lower laboratory cost for antipsychotic serum level ($48.98 ± $53.49 versus $72.06 ± $51.02, P < .05), lower daily cost of scheduled psychiatric medications ($17.72 ± $23.03 versus $32.26 ± $31.05, P < .05), lower daily cost of total medications ($19.28 ± $24.91 versus $33.82 ± $31.03, P < .05), fewer scheduled psychiatric medications (2.95 ± 1.90 versus 4.04 ± 2.19, P < .01), and fewer total scheduled medications (5.95 ± 3.60 versus 7.60 ± 3.29, P < .05). Inappropriate TDM led to approximately $6,753 in avoidable laboratory costs over a 20-month period. Discussion Therapeutic drug monitoring is a complex process with many points at which errors may occur. The majority of antipsychotic levels at this state psychiatric hospital were not documented in a way that was clinically useful. Inappropriate TDM was associated with increased laboratory and medication costs.

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SERUM INFLIXIMAB MEASUREMENT IN INFLAMMATORY BOWEL DISEASE PATIENTS IN REMISSION: A COMPARATIVE ANALYSIS OF TWO DIFFERENT METHODS IN A MULTICENTRIC BRAZILIAN COHORT

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-35 ◽

2018 ◽

Vol 55 (2) ◽

pp. 192-197 ◽

Cited By ~ 3

Author(s):

Fábio Vieira TEIXEIRA ◽

Ligia Yukie SASSAKI ◽

Rogerio SAAD-HOSSNE ◽

Julio Pinheiro BAIMA ◽

Daniéla Oliveira MAGRO ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Therapeutic Drug Monitoring ◽

Sensitivity And Specificity ◽

Bowel Disease ◽

Drug Monitoring ◽

Rapid Test ◽

Serum Levels ◽

Therapeutic Drug ◽

Elisa Assay ◽

Inflammatory Bowel

ABSTRACT BACKGROUND: Infliximab (IFX) therapeutic drug monitoring is an important tool to guide therapeutic decision in inflammatory bowel disease patients. Currently, there are two methods to measure trough levels of IFX, ELISA assays or rapid tests. Despite that the ELISA assay is the most used method in therapeutic drug monitoring, the results take long to be available for clinical use, and it needs to be performed by trained personnel. In contrary, the results of a rapid test take 20 to 30 minutes to be available and can be performed by non-trained lab personnel. OBJECTIVE: The aim of the study was to compare a rapid test (QB-IFX) for quantitative determination of IFX level to one ELISA assay in a cohort of inflammatory bowel disease patients. METHODS: Cross-sectional multicentric study with 49 inflammatory bowel disease patients on maintenance therapy with IFX. Blood samples for IFX serum levels were collected immediately before infusion. IFX serum levels were classified as undetectable, low (<3.0 μg/mL), adequate (3.1-7.0 μg/mL) or high (>7.1 μg/mL). A sensitivity and specificity of each test and a comparison between tests was based on ROC curves. RESULTS: Thirty-four Crohn’s disease patients and 15 ulcerative colitis patients in clinical remission were evaluated. The majority of patients had low or adequate serum levels of IFX. In relation to the serum levels proportions with the two methods, there was no significant difference (P=0.84). The ROC analysis identified a concentration threshold >2.9 μg/mL with the QB-IFX test (area under the ROC, 0.82; P<0.0001, sensitivity, 100%; specificity, 61.9%), and >3.83 μg/mL using the ELISA assay (area under the ROC, 0.96; P<0.0001, sensitivity, 100%; specificity, 92.9%). CONCLUSION: QB-IFX and ELISA assays to measure IFX levels were comparable. Both methods had accurate sensitivity and specificity to detect undetectable, low and adequate levels, but had showed low specificity for supra therapeutic levels of IFX.

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