Therapeutic drug monitoring (TDM) is the clinical practice of measuring
specific drugs at designated intervals to maintain a constant concentration in
a patient's bloodstream, thereby optimizing individual dosage regimens.
TDM is used mainly for monitoring biological and chemical drugs with narrow
therapeutic ranges, drugs with marked pharmacokinetic variability, medications for
which target concentrations are difficult to monitor and drugs known to cause
therapeutic and adverse effects.
New approaches allow to test drug trough levels using
chemical analyzers (instead of HPLC) and recently by new Point-of Care devices
producing results within a few minutes e.g. :
- TDM of anti-TNF drugs for IBD and rheumatology
- Monitoring of Immunosuppressive drugs (ISD) to predict transplant rejection and
immune-mediated diseases
- Monitoring of Antipsychotic drugs (e.g. clozapine)
- Epilepsy
- Chemotherapies (like 5FU), Immunotherapies (Keytruda)
The goal of TDM is to use appropriate concentrations of difficult-to-manage
medications. It allows to optimize clinical outcomes in patients with various
clinical situations especially when there is a strong correlation between drug
blood levels and efficacy. Furthermore, TDM can improve patient responses to
important life-sustaining drugs and to decrease adverse events due to toxicity.
Dose optimization is correlated to decreased hospitalizations and cost saving.