THERAPEUTIC DRUG MONITORING
Therapeutic drug monitoring is used to optimise drug regimens for the individual patient by increasing efficacy and avoiding drug-related toxicity. Prospective surveys suggest 20% patients in clinic have sub-therapeutic plasma concentrations of PIs and NNRTIs, while the inter-individual variability in plasma concentrations is immense (≥100-fold difference) despite standard dosing.
The BHIVA Guidelines recommend the use of TDM in the following clinical scenarios:
"TDM has been shown to be beneficial in particular clinical scenarios where drug concentrations are difficult to predict, such as the management of drug interactions, the settings of pregnancy and paediatrics, salvage therapy settings when TDM and resistance test results can be integrated, cases of patients with renal or hepatic impairment and transplant patients, cases of toxicity, and the use of alternative dosing regimens whose safety and efficacy have not been established."
British HIV Association. HIV Medicine (2006) 7, 487-503
This site will shortly host a review of the latest evidence for TDM in a searchable format.
To review Liverpool HIV Pharmacology Group drug interactions web-site: LHPG
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Therapeutic drug monitoring is sponsored by the following pharmaceutical companies for the drugs / patient categories listed. Please contact your pharmaceutical company representative for full details. The pharmaceutical company will be invoiced directly for the cost of the analysis.
| Roche Products Ltd: |
Saquinavir and Nelfinavir |
| Merck Sharpe & Dohme: |
Indinavir in cases of suspected toxicity |
| Abbott Laboratories: |
Lopinavir for adult patients receiving Amprenavir and/or an NNRTI and all pregnant and paediatric patients |
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Delphic is developing a matrix of evidence for the clinical utility of therapeutic drug monitoring for HIV antiretroviral drugs (PIs and NNRTIs).
There will be a registration facility enabling you to retrieve your previous searches and you will have the option of receiving email alerts to advise you of new research affecting the balance of evidence.
Available November 2008 |
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