Therapeutic Drug Monitoring (TDM)

Contents

  • Introduction

  • UMMC Therapeutic Drug Monitoring Manual

  • Drugs Dosages for Adults and Paediatrics

  • Drugs Sampling and Steady-State Time

  • Manual of Electronic Therapeutic Drug Monitoring Requests

  • Clinical Pharmacokinetics Formulae

Contacts

Ext. 2926

Introduction

TDM: Plasma drug concentrations measured to determine whether therapeutic or toxic concentration has been produced

Importance of sampling time:

  • Accuracy crucial to ensure that drug distribution at steady state

  • Large errors in interpretation can occur if sampling time is wrongly stated

  • Except to check for toxicity, send sample for monitoring only after the drug level achieved steady state.

Beneficial for:

  • Extreme age (extremely young or old)

  • Altered pharmacokinetics (renally, hepatically impaired, burns and ICU patients)

  • Not responding to therapy as expected after adequate doses have been given

  • Exhibit adverse effects at normal dosages

Indicated to:

  • confirm effective doses

  • monitor compliance

  • investigate possible toxicity

  • monitor drugs with narrow therapeutic range

UMMC Therapeutic Drug Monitoring Manual

Second Edition, Revision Date: June 2021

TDM manual 2021 updated.docx

Drugs Dosages for Adults and Paediatrics

Drugs Sampling and Steady-State Time

Electronic Therapeutic Drug Monitoring Request

Effective from 7 January 2019 onwards, all TDM requests from wards and clinics MUST be submitted via electronic through LMD order, iPesakit system. Blood samples are to be sent to Laboratory Medicine Division, Pathology Department as usual.

Please ensure electronic TDM request form is filled completely prior submission. Electronic requests and blood samples have to be submitted to Laboratory Medicine Division before 4.00 pm on working days. Any blood sample which comes after 4.00 pm will be refrigerated and processed on the following day (except weekends and public holidays). Recommendation pertaining drug doses by pharmacists will only be made after getting the results of the analysed samples.


Please refer to the attached manual for your reference:

Clinical Pharmacokinetics Formulae

Updated: 30 June 2021