TDM for all drugs?

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The page below is a sample from the LabCE course Pharmacology in the Clinical Lab: Therapeutic Drug Monitoring and Pharmacogenomics (retired 10/15/2012). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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TDM for all drugs?

Can all drugs benefit from TDM? Not really. For TDM to be effective and useful, one or more of the following should apply:

  • The effective concentration and toxic concentrations must be well-defined.
  • The pharmacokinetics of the drug are known to be variable.
  • The drug is given chronically.
  • There is the potential for drug-to-drug interactions.
  • The drug exhibits high protein binding.
  • The toxicity will mimic the indication for the drug; toxicity may not be visible during an exam but will only be revealed with TDM.
  • The patient is pregnant, very young, or elderly.
  • Compliance or history with the drug is poor.