Therapeutic drug monitoring refers to the measurement of drug concentration in biological fluids with the purpose of optimizing a patient’s drug therapy. For the TDM to be useful, there must be a relationship between dose, plasma or blood drug concentration and pharmacodynamic effects. Many medications and their metabolites are eliminated through the kidney. Thus, adequate renal function is important to avoid toxicity. Patients with renal impairment often have alterations in their pharmacokinetic and pharmacodynamic parameters. The clearance of drugs eliminated primarily by renal filtration is decreased by renal disease. Therefore, special consideration should be taken when these drugs are prescribed to patients with impaired renal function. Physicians and pharmacists can work together to accomplish safe drug prescribing. This task can be complex and require a stepwise approach to ensure effectiveness, minimize further damage and prevent drug nephrotoxicity. Therapeutic drug monitoring aims to promote optimum drug treatment by maintaining serum drug concentration within a “therapeutic range”. The determination of individual drugs have shown benefit of therapeutic drug monitoring, depending on the specific study, through one or more of the following indices: improved effectiveness, reduced toxicity, decreased length of stay, fewer hospital admissions, more patients with serum levels within the appropriate therapeutic range, and more rational use of serum concentration measurements.
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