Clinical Therapeutics and the Recognition of Drug-Induced Disease

Table 2:
Therapeutic Drug Monitoring

For certain drug classes, pharmacokinetic variability together with a narrow therapeutic index have led to a standard dosing strategy utilizing TDM to ensure safe use and avoid excessive toxicity, to the degree possible. Drugs that should be routinely monitored include digoxin, lithium, lidocaine, amino-glycosides, aminophylline, phenytoin, cyclosporine and tacrolimus.

Doses need to be individualized (adjusted up and down) to get patients within the desired therapeutic range. For many of these agents, clinical/laboratory monitoring of relevant pharmacodynamic endpoints is also recommended in conjunction with TDM (e.g., monitoring renal function in an aminoglycoside-treated patient.)

Return to the Table of Contents