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Published on: August 30, 2018
Approaches for dosage individualisation in critically ill patients
M del Mar Fernández de Gatta1, Ana Martin-Suarez, Jose M Lanao
1University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy , Avda. Licenciado Méndez Núñez, 37007 Salamanca , Spain +0034 923 294 536 ; +0034 923 294 515 ; gatta@usal.es.
Expert Opinion on Drug Metabolism & Toxicology
|August 1, 2013
Summary
Dosage individualisation strategies are crucial for critically ill patients due to pharmacokinetic variability. Therapeutic drug monitoring (TDM) and pharmacogenomics can optimize drug exposure and improve treatment outcomes.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Pharmacokinetics
Background:
- Critically ill patients exhibit significant pharmacokinetic variability due to complex pathophysiological and clinical factors.
- Standard drug dosages may lead to unpredictable drug exposure, impacting treatment efficacy and safety.
- Dosage individualisation is essential in critical care settings to optimize therapeutic outcomes.
Purpose of the Study:
- To review and discuss various approaches for drug dosage individualisation in critically ill patients.
- To highlight the role of therapeutic drug monitoring (TDM) and pharmacogenomics in optimizing drug therapy.
- To explore the application of population pharmacokinetic models and Bayesian forecasting for improved drug dosing.
Main Methods:
- Review of established and innovative methods for dosage individualisation.
- Focus on therapeutic drug monitoring (TDM) and pharmacogenomics.
- Summary of population pharmacokinetic models and Bayesian forecasting techniques.
- Consideration of Monte Carlo simulations for dosage strategy selection.
Main Results:
- Pharmacokinetic/pharmacodynamic (PK/PD) modelling and individualised dosing strategies improve pharmacologic treatment in critically ill patients.
- Integration of pharmacogenomics into critical care practice requires substantial effort.
- Therapeutic drug monitoring (TDM) remains valuable due to the lack of target biomarkers for dosage adjustment.
Conclusions:
- Mathematical and statistical methods for dosage individualisation enhance pharmacologic treatment in critical care.
- Further research and integration efforts are needed for pharmacogenomics in critical care.
- Therapeutic drug monitoring (TDM) is a key strategy for controlling treatment outcome variability in critically ill patients.
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