Therapeutic drug monitoring: Fundamentals and optimization

Abstract

Background: Therapeutic drug monitoring (TDM) is a clinical pharmacokinetic service aimed to optimize the pharmacotherapy of certain drugs such as those with a narrow therapeutic range and complicated pharmacokinetics. It involves the determination of serum drug concentration (SDC) in samples taken at the appropriate time from the patient. Factors to consider when interpreting SDC include pharmacokinetic and pharmacodynamic drug characteristics, patient response, specific lab results and the desired therapeutic target. To be cost-effective the service should be optimized. Area covered: This review highlights TDM fundamentals and provides suggestions for its optimization. It covers the rationale of requesting drug level, the design of the request form, optimal sampling and analytical tools. It provides guidelines for the appropriate interpretation of drug levels. Conclusion: TDM should be optimized by conducting relevant research; using PK software and integrating TDM with pharmacogenomics.