scholarly journals TRICYCLIC ANTIDEPRESSANTS;

2012 ◽  
Vol 19 (02) ◽  
pp. 197-201
Author(s):  
Shah KHALID ◽  
MOWADAT HUSSAIN RANA ◽  
NAJAM AKHTAR
Keyword(s):  
Side Effects ◽  
Therapeutic Drug Monitoring ◽  
Study Design ◽  
Drug Monitoring ◽  
Lower Incidence ◽  
Tricyclic Antidepressant ◽  
Military Hospital ◽  
Therapeutic Drug ◽  
Control Group ◽  
Treatment Of Depression

Introduction: Despite advancements in the treatment of depression and availability of newer compounds, TCAs likeamitriptyline remain to be the cornerstone of antidepressive therapy for more than three decades, however significantly more patients receivinga tricyclic withdraw from treatment mainly because of side effects. Higher response, lower incidence of side effects and improved compliancecan be enhanced by the optimal use of Therapeutic Drug Monitoring (TDM). No research data is currently available on the therapeutic drugmonitoring of TCAs in Pakistan. Objectives: To compare the relative efficacy of Tricyclic antidepressant in the treatment of depression, with andwithout Therapeutic Drug Monitoring Main Outcome Measures: Changes in HAMD scores in patients on TCAs. Study Design: A Quasiexperimental study design was used. Setting: The study was conducted at Department of Psychiatry, Military Hospital Rawalpindi. Subjects:34 patients completed the study in the monitored group (with TDM) and 33 in control group (without TDM). Methods: Serum TCA levels andHAMD scores at baseline and subsequently at sixth, eighth and tenth week of treatment were collected. In all the subjects, all the blood sampleswere drawn as a fasting sample in early morning. Results: The mean age of the monitored group was 31.97 years (SD=10.432) while that of thecontrol group was 33.52 years (SD=9.385). in the monitored group 20 (58.82 %) of the patients were males while 14 (41.17%) were females, inthe control group 22 (66.66%) were males and 11(33.33%) were female patients. A significant reduction in HAMD scores was noted at 8 weeksof treatment. The groups did not differ in terms of efficacy of TCAs, however the monitored group had fewer dropouts than the control group.Conclusions: Lower incidence of side effects and improved compliance can be enhanced by the optimal use of Therapeutic Drug Monitoring(TDM) of TCAs.

scholarly journals Impact on Antibiotic Resistance, Therapeutic Success, and Control of Side Effects in Therapeutic Drug Monitoring (TDM) of Daptomycin: A Scoping Review

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 263
Author(s):  
Carolina Osorio ◽  
Laura Garzón ◽  
Diego Jaimes ◽  
Edwin Silva ◽  
Rosa-Helena Bustos
Keyword(s):  
Side Effects ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Bacterial Resistance ◽  
Plasma Concentrations ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Therapeutic Success ◽  
Favorable Clinical Outcome ◽  
And Control

Antimicrobial resistance (AR) is a problem that threatens the search for adequate safe and effective antibiotic therapy against multi-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE) and Clostridium difficile, among others. Daptomycin is the treatment of choice for some infections caused by Gram-positive bacteria, indicated most of the time in patients with special clinical conditions where its high pharmacokinetic variability (PK) does not allow adequate plasma concentrations to be reached. The objective of this review is to describe the data available about the type of therapeutic drug monitoring (TDM) method used and described so far in hospitalized patients with daptomycin and to describe its impact on therapeutic success, suppression of bacterial resistance, and control of side effects. The need to create worldwide strategies for the appropriate use of antibiotics is clear, and one of these is the performance of therapeutic drug monitoring (TDM). TDM helps to achieve a dose adjustment and obtain a favorable clinical outcome for patients by measuring plasma concentrations of an administered drug, making a rational interpretation guided by a predefined concentration range, and, thus, adjusting dosages individually.

scholarly journals Is Computer-Assisted Aminoglycoside Dosing Managed by a Pharmacist a Safety Tool of Pharmacotherapy?

2019 ◽  
pp. S87-S96
Author(s):  
E. DVOŘÁČKOVÁ ◽  
P. PÁVEK ◽  
B. KOVÁČOVÁ ◽  
J. RYCHLÍČKOVÁ ◽  
O. SUCHOPÁR ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapy Monitoring ◽  
Therapeutic Drug ◽  
Control Group ◽  
Computer Assisted ◽  
Clear Trend ◽  
Cost Avoidance ◽  
Aminoglycoside Therapy ◽  
Group 1

This pilot prospective study verified the hypothesis that use of computer-assisted therapeutic drug monitoring of aminoglycosides by pharmacists leads to better safety therapeutic outcomes and cost avoidance than only concentration measurement and dose adjustments based on a physician’s experience. Two groups of patients were enrolled according to the technique of monitoring. Patients (Group 1, n=52) underwent monitoring by a pharmacist using pharmacokinetic software. In a control group (Group 2, n=11), plasma levels were measured but not interpreted by the pharmacist, only by physicians. No statistically significant differences were found between the groups in factors influenced by therapy. However, the results are not statistically significant but a comparison of the groups showed a clear trend towards safety and cost avoidance, thus supporting therapeutic drug monitoring. Safety limits were achieved in 76 % and 63 % of cases in Groups 1 and 2, respectively. More patients achieved both concentrations (peak and trough) with falling eGFR in Group 1. In present pilot study, the pharmacist improved the care of patients on aminoglycoside therapy. A larger study is needed to demonstrate statistically significantly improved safety and cost avoidance of aminoglycoside therapy monitoring by the pharmacist using pharmacokinetic software.

Therapeutic drug monitoring of non-tricyclic antidepressant drugs

2004 ◽  
Vol 42 (11) ◽  
Author(s):  
Philip B. Mitchell
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Antidepressant Drugs ◽  
Tricyclic Antidepressant ◽  
Therapeutic Drug ◽  
Cytochrome P450 Enzymes ◽  
Clinical Value ◽  
Major Benefit

AbstractTherapeutic drug monitoring (TDM) of many of the tricyclic antidepressants (TCAs) has been demonstrated to be of clear clinical value. This article reviews studies of TDM for the selective serotonin reuptake inhibitors (SSRIs) and other non-tricyclic antidepressants such as venlafaxine, nefazodone, trazodone, mianserin and bupropion. No definitive therapeutic concentrations have been demonstrated for these agents, nor have levels indicative of toxicity been reported. The major benefit of TDM for these agents would appear to be in the assessment of the apparently treatment-refractory depressed patient, to determine whether such lack of response is related to inadequate levels that would suggest either poor compliance, ultra-rapid metabolism, or drug interactions leading to induction of metabolising enzymes. Potential future applications of TDM, in conjunction with genotyping of cytochrome P450 enzymes and pharmacogenomic evaluations, are discussed.

The relationship between ritonavir plasma levels and side-effects: implications for therapeutic drug monitoring

AIDS ◽  
1999 ◽  
Vol 13 (15) ◽  
pp. 2083-2089 ◽  
Author(s):  
Giorgio Gatti ◽  
Antonio Di Biagio ◽  
Rosetta Casazza ◽  
Cleta De Pascalis ◽  
Matteo Bassetti ◽  
...  
Keyword(s):  
Side Effects ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Plasma Levels ◽  
Therapeutic Drug ◽  
The Relationship

Asymptomatic tricyclic toxicity associated with diltiazem

1996 ◽  
Vol 13 (4) ◽  
pp. 168-169 ◽  
Author(s):  
Paul A Cotter ◽  
Peter W Raven ◽  
Marina Hudson
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Tricyclic Antidepressants ◽  
Channel Blocker ◽  
Tricyclic Antidepressant ◽  
Therapeutic Drug ◽  
Cytochrome P450 3A ◽  
Recurrent Depression ◽  
Metabolic Interaction ◽  
Routine Therapeutic Drug Monitoring

AbstractTherapeutic drug monitoring of tricyclic antidepressants is a controversial issue. A case is reported in which a patient with recurrent depression developed asymptomatic tricyclic toxicity while on trimipramine, a tricyclic antidepressant, and diltiazem, a calcium channel blocker. A metabolic interaction involving cytochrome P450 3A (CYP3A) is postulated. It is suggested that routine therapeutic drug monitoring of tricyclic levels should be an essential part of the management of depression.

Therapeutic Drug Monitoring of Tipranavir: About 2 Cases of Adverse Side Effects

Drug Safety ◽  
2007 ◽  
Vol 30 (10) ◽  
pp. 919-990
Author(s):  
A S Lemaire-Hurtel ◽  
L Masson ◽  
L Hary ◽  
H Masson ◽  
M Andrejak
Keyword(s):  
Side Effects ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Adverse Side Effects

scholarly journals Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement

2021 ◽  
Vol 12 ◽  
Author(s):  
Fabrizio Buffolo ◽  
Elisa Sconfienza ◽  
Jacopo Burrello ◽  
Isabel Losano ◽  
Giulio Mengozzi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Therapeutic Drug Monitoring ◽  
Arterial Hypertension ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Control Group ◽  
Ratio Measurement ◽  
Adherence Assessment ◽  
Raas Inhibitors

Reduced or absent compliance to anti-hypertensive treatment is a major obstacle to the achievement of blood pressure target in patients with arterial hypertension. Current available methods for therapeutic adherence assessment display low accuracy, limited applicability in clinical practice and/or high costs. We designed a prospective study to evaluate the accuracy of serial measurement of ARR to assess the therapeutic compliance to RAAS inhibitors. We prospectively enrolled 80 subjects: 40 patients with arterial hypertension and 40 normotensive controls. The ARR was evaluated at baseline and 2 and 8 week after initiation of a RAAS inhibitor in patients with hypertension, and at baseline and 2 weeks for the control group. Adherence to the prescribed therapy was confirmed by therapeutic drug monitoring. We observed a significant increase of renin levels and reduction of aldosterone levels after RAAS inhibitors initiation, with consequent reduction of ARR. Delta ARR (ΔARR), defined as relative change in ARR before and after treatment initiation, provided high accuracy for determination of therapeutic compliance, with an AUC of 0.900 at 2 weeks and 0.886 at 8 weeks. A cut-off of −48% of ΔARR provided 90% sensitivity and 75% specificity, at 2 and 8 weeks. In conclusion, the measurement of ΔARR is a powerful test, cheap and widely available to accurately identify the non-adherence to RAAS inhibitors treatment. Herein we propose the implementation of ΔARR in clinical practice through a multi-step flow-chart for the management of patients with uncontrolled blood pressure, with identification of those suspected of non-adherence, reserving therapeutic drug monitoring for non-adherence confirmation.

scholarly journals Therapeutic drug monitoring of infliximab compared to standard clinical treatment with infliximab: study protocol for a randomised, controlled, open, parallel-group, phase IV study (The NOR-DRUM study)

2019 ◽  
Author(s):  
Silje Watterdal Syversen ◽  
Guro Løvik Goll ◽  
Kristin Kaasen Jørgensen ◽  
Inge Christoffer Olsen ◽  
Øystein Sandanger ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Treatment Strategy ◽  
Inflammatory Diseases ◽  
Therapeutic Drug ◽  
Control Group ◽  
Drug Concentrations ◽  
Immune Mediated ◽  
Parallel Group ◽  
Phase Iv

Abstract Background Infliximab (INX) and other TNF-inhibitors (TNFi) have revolutionised the treatment of several immune mediated inflammatory diseases. Still, many patients do not respond sufficiently to therapy or loose efficacy over time. The large individual variation in serum drug concentrations on standard doses and the development of anti-drug antibodies are thought to be major reasons for treatment failures. Therapeutic drug monitoring (TDM), an individualised treatment strategy based on systematic assessments of serum drug concentrations, has been proposed as a clinical tool to optimise efficacy of INX treatment. TDM seems reasonable both from a clinical and an economical point of view, but the effectiveness of this treatment strategy has not yet been demonstrated in randomised clinical trials. The NORwegian DRUg Monitoring study (NOR-DRUM) aims to assess the effectiveness of TDM, both with regard to achieve remission in patients starting INX treatment (part A) as well as to maintain disease control in patients on INX treatment (part B). Methods The NOR-DRUM study is a randomised, open, controlled, parallel-group, comparative, multi-centre, national, superiority, phase IV study with two separate parts, NOR-DRUM A and NOR-DRUM B. Patients with rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, ulcerative colitis, Crohn’s disease and psoriasis are included. In both study parts participants are randomised 1:1 to either TDM of infliximab (intervention group) or to standard treatment with infliximab without knowledge of drug levels or ADAb status (control group). 400 patients starting INX therapy will be included in NOR-DRUM A. The primary outcome is remission at 30 weeks. In NOR-DRUM B, 450 patients on maintenance treatment with INX will be included. The primary endpoint is occurrence of disease worsening during the 52 weeks study period. Discussion As the first trial to assess the effectiveness, safety and cost-effectiveness of TDM in patients receiving TNFi for a range of immune mediated inflammatory diseases, we hope that the NOR-DRUM study can contribute to the advancement of evidence based personalised treatment with biological medicines.

scholarly journals ß-endorphins as Possible Markers for Therapeutic Drug Monitoring

2007 ◽  
Vol 7 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Radivoj Jadrić ◽  
Emina Kiseljaković ◽  
Sabaheta Hasić ◽  
Mira Winterhalter-Jadrić
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapy Monitoring ◽  
Patient Treatment ◽  
Therapeutic Drug ◽  
Control Group ◽  
Psychoactive Drugs ◽  
Antidepressive Drugs ◽  
Beta Endorphins

This study was performed in order to investigate possible role of brain beta-endorphins as markers of antidepressive drugs therapy monitoring. Experiment was done using amitriptyline and trazodone as antidepressants. For quantification of brain beta-endorphins we used RIA technique. Our results showed significant decrease of brain beta-endorphins concentration in drug-pretreated animals, vs. those in of control group treated with 0,95% NaCl. The lower values were obtained in trazodone pre-treated animals. This study shows that use of psychoactive drugs have influence on brain beta-endorphins concentration. beta-endorphins could be of great importance, used as markers for evaluation of patient treatment.

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