Therapeutic Drug Monitoring

Therapeutic Drug Monitoring

Newer Drugs and Biomarkers

1st Edition - June 7, 2012

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  • Editor: Amitava Dasgupta
  • Hardcover ISBN: 9780123854674
  • eBook ISBN: 9780123854681

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Therapeutic Drug Monitoring: Newer Drugs and Biomarkers features timely topics such as the monitoring of classical and newer drugs, pharmacogenomics and the application of biomarkers in therapeutic drug monitoring. This reference also discusses the limitations of current commercially available immunoassays for therapeutic monitoring. It presents new and sophisticated techniques used for proper determination of blood levels and the clinical utility of therapeutic drug monitoring of contemporary drugs. Written by leading international experts and geared toward clinical pathologists, toxicologists, clinical chemists, laboratory professionals and physicians, this book is an essential resource on the current practice of therapeutic drug monitoring in improving patient safety.

Key Features

  • Includes both the technical and clinical issues associated with therapeutic drug monitoring
  • Discusses the utility of therapeutic drug monitoring of newer drugs such as antiretroviral agents, anticonvulsants, antidepressants etc.
  • Provides up-to-date information on issues in pharmacogenomics and personalized medicine with emphasis on therapy with warfarin, certain anticancer drugs and antidepressants
  • Covers important content on the limitations of commercially available immunoassays (chemical tests) for therapeutic drug monitoring and additional analytical techniques


Clinical pathologists, toxicologists, pharmacologists, laboratory professionals and clinical chemists

Table of Contents

  • Dedication



    Chapter 1. Introduction to Therapeutic Drug Monitoring: Frequently and Less Frequently Monitored Drugs


    Drugs that Require Therapeutic Drug Monitoring

    Benefits of Therapeutic Drug Monitoring

    Pathophysiological Conditions and other Factors that Affect Drug Concentrations

    Therapeutic Drug Monitoring of Various Drug Classes



    Chapter 2. Effects of Pre-analytical Variables in Therapeutic Drug Monitoring


    Specimen Type

    Factors that Affect Therapeutic Drug Monitoring Results

    Protein Binding Alteration: In Vivo and In Vitro

    Specimen Collection Site

    Volume of Specimen Collected

    Glass versus Plastic Tubes for Collection of Blood

    Serum versus Plasma Specimen for Therapeutic Drug Monitoring

    Suitability of Serum Separator Collection Tubes for Specimen Collection for Drug Monitoring

    Sample Preparation Steps



    Chapter 3. Analytical Techniques used in Therapeutic Drug Monitoring


    A General Classification of Analytical Methods

    Understanding and Minimizing Measurement Uncertainty in the Clinical Laboratory


    Gas and Liquid Chromatography

    Mass Spectrometry and LC-MS/MS Application to TDM



    Chapter 4. Clinical Utility of Free Drug Monitoring


    Free Concentrations versus Total Concentrations

    Pharmacokinetic Consequences of Drug–Protein Binding

    Monitoring Free Concentrations of Classical Anti-Epileptics

    Monitoring Free Concentrations of Antibiotics, Antimalarials and Antiretrovirals

    Monitoring Free Concentrations of Immunosuppressants

    Monitoring Free Concentrations of Other Drugs

    Applications and Methods for Monitoring Free Drug Concentrations

    Alternative Methods



    Chapter 5. Current Practice of Therapeutic Drug Monitoring: Dose Adjustment of Drugs using Pharmacokinetic Models


    Bayesian Estimation

    Examples of Clinical Transferability



    Chapter 6. An Introduction to Personalized Medicine


    Overview of Classical Sequence Variation Profiling Techniques

    Recent Molecular Profiling Technologies

    Select Biomarkers in Pharmacogenomics

    Translational Approaches Associated with Pharmacogenomics and Personalized Medicine



    Chapter 7. Application of Ultra-High Throughput Sequencing and Microarray Technologies in Pharmacogenomics Testing


    DNA Microarray

    Pharmacogenetic Testing and Healthcare

    DNA Microarray Platforms

    Microarrays and Genotype

    Microarrays in Clinical Diagnosis

    Sequencing Technologies – The First Generation

    Sequencing Technologies – Next Generation

    Exon Capture and Oligonucleotide-Based Genomic Selection

    Microarray Technology versus Deep Sequencing

    Sequencing and Implications for Pharmacogenomics Testing



    Chapter 8. Pharmacogenomics and Warfarin Therapy


    The Potential of Pharmacogenetics for Warfarin


    Non-Genetic Factors Affecting Warfarin Dosing

    Clinical Relevance

    Cost-Effectiveness of Pharmacogenomics Testing in Warfarin Therapy

    New Medications to Replace Warfarin



    Chapter 9. Applications of Pharmacokinetic and Pharmacodynamic Principles to Optimize Drug Dosage Selection: Example of Antibiotic Therapy Management


    Pharmacokinetics and Pharmacodynamics

    Applied Pharmacokinetic/Pharmacodynamic Modeling



    Chapter 10. Guidelines for the Monitoring of Vancomycin, Aminoglycosides and Certain Antibiotics


    Vancomycin: Overview

    Aminoglycosides: Overview

    Therapeutic Drug Monitoring of Beta-Lactam Antibiotics

    Therapeutic Drug Monitoring of Sulfonamides and Trimethoprim

    Therapeutic Drug Monitoring of Chloramphenicol and Tetracycline

    Therapeutic Drug Monitoring of Quinolones

    Therapeutic Drug Monitoring of Macrolides

    Therapeutic Drug Monitoring of Antimycobacterial Agents



    Chapter 11. Challenges in Therapeutic Drug Monitoring of Digoxin and Other Anti-Arrhythmic Drugs


    Challenges in Therapeutic Drug Monitoring of Digoxin

    Therapeutic Drug Monitoring of Other Anti-Arrhythmic Drugs

    Challenges in Monitoring Class IV Anti-Arrhythmic Drugs

    Chromatographic Methods for Determining Multiple Anti-Arrhythmic Drugs Simultaneously



    Chapter 12. Therapeutic Drug Monitoring of Classical and Newer Anticonvulsants


    Pathophysiology of Epilepsy

    Anti-Epileptic Drug Monitoring

    Indications for Measuring a Drug Level

    Therapeutic Drug Monitoring of Classical AEDs

    Newer Anticonvulsants

    Therapeutic Drug Monitoring of Eslicarbazepine Acetate

    Therapeutic Drug Monitoring of Felbamate

    Monitoring of Gabapentin

    Therapeutic Drug Monitoring of Lacosamide

    Therapeutic Drug Monitoring of Lamotrigine

    Therapeutic Drug Monitoring of Levetiracetam

    Therapeutic Drug Monitoring of Oxcarbazepine

    Therapeutic Drug Monitoring of Pregabalin

    Therapeutic Drug Monitoring of Rufinamide

    Therapeutic Drug Monitoring of Stiripentol

    Therapeutic Drug Monitoring of Tiagabine

    Therapeutic Drug Monitoring of Topiramate

    Therapeutic Drug Monitoring of Vigabatrin

    Therapeutic Drug Monitoring of Zonisamide

    Analytical Methods for Monitoring of AEDs



    Chapter 13. Challenges in Therapeutic Drug Monitoring of Classical Tricyclic and Newer Antidepressants: Analytical and Pharmacogenetics Considerations


    Tricyclic Antidepressants

    Newer Antidepressants

    Pharmacogenetics Considerations in TDM of Antidepressants



    Chapter 14. Therapeutic Drug Monitoring of Selected Anticancer Drugs: Pharmacogenomics Issues


    Traditional Therapeutic Drug Monitoring for Anticancer Drugs

    Newer Approaches to Personalized Dosing and Treatment with Anticancer Agents: Pharmacogenetics

    Pharmacogenetic Considerations for Specific Anticancer Agents

    Anti-EGFR Tyrosine Kinase Inhibitors



    Chapter 15. Immunosuppressive Drug Monitoring: Limitations of Immunoassays and the Application of Liquid Chromatography Mass Spectrometry


    Application of Immunoassays and LC-MS to Immunosuppressive Drug Monitoring

    Therapeutic Drug Monitoring of Calcineurin Inhibitors (Cyclosporine and Tacrolimus)

    Therapeutic Drug Monitoring of Mammalian Target of Rapamycin (MTOR) Inhibitors (Sirolimus and Everolimus)

    Therapeutic Drug Monitoring of Mycophenolic Acid



    Chapter 16. Biomarkers: The Link between Therapeutic Drug Monitoring and Pharmacodynamics of Immunosuppressants


    Specific Pharmacodynamic Markers

    Global Markers of Response to Immunosuppressants

    Biomarker Signatures Related to Tolerance



    Chapter 17. Therapeutic Drug Monitoring of Antiretroviral Drugs in the Management of Human Immunodeficiency Virus Infection


    Therapeutic Targets of Therapeutic Drug Monitoring (TDM) in HIV-infected Patients

    Current Approach to TDM in the Management of Therapy in HIV-infected Patients

    Current Methodologies in TDM of Antiretroviral Drugs

    TDM of Antiretroviral Drugs by Classes

    Challenges in Practical Application of TDM in Managing Patients with HIV



    Chapter 18. Drug Testing in Pain Management


    Use of Opioids in Pain Management

    Analytical Methods for Drug Testing

    Specimen Tampering

    Metabolism of Opioid Analgesics

    Challenges in Drug Testing in Pain Management



    Chapter 19. Effect of Herbal Supplement–Drug Interactions on Therapeutic Drug Monitoring


    Herbal Supplements and Pharmacokinetics

    Pharmacokinetic Interactions Involving Herbal Supplements

    Contamination of Herbal Supplements

    Analytical Interferences Caused by Some Herbal Supplements




Product details

  • No. of pages: 468
  • Language: English
  • Copyright: © Academic Press 2012
  • Published: June 7, 2012
  • Imprint: Academic Press
  • Hardcover ISBN: 9780123854674
  • eBook ISBN: 9780123854681

About the Editor

Amitava Dasgupta

Amitava Dasgupta
Dr. Amitava Dasgupta received his Ph.D degree in Chemistry from Stanford University and received his medical training in Toxicology and Clinical Chemistry from the Laboratory Medicine Department of the University of Washington School Of Medicine at Seattle. He is board certified in both Toxicology and Clinical Chemistry by the American Board of Clinical Chemistry. He is a tenured Full Professor of Pathology and Laboratory Medicine at the University of Texas Health Sciences Center located at the Texas Medical Center at Houston. He is also the Director of Clinical Chemistry and Toxicology Laboratory of Memorial-Hermann Laboratory Services, the major clinical teaching hospital of the University of Texas. In addition, he is also the Medical Director of Memorial-TIRR Hospital laboratory services. Dr. Dasgupta has published over 235 scientific papers and edited, co-edited, authored or co-authored 20 books including books published by Elsevier. He is on the Editorial Board of five major medical journals including American Journal of Clinical Pathology, Archives of Pathology and Laboratory Medicine, Therapeutic Drug Monitoring, Clinica Chimica Acta and Journal of Clinical Laboratory Analysis. He lectures both nationally and internationally on drug and alcohol testing and acts as an expert witness for the State of Texas for alcohol and drug related criminal prosecutions.

Affiliations and Expertise

Professor, Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas, Houston, TX, USA

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