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Related Concept Videos

Therapeutic Drug Monitoring: Drug Analysis Methods01:26

Therapeutic Drug Monitoring: Drug Analysis Methods

276
Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood or body tissues to tailor drug therapy effectively. This monitoring is critical for managing drugs with narrow therapeutic indices like digoxin and phenytoin, ensuring they are both safe and effective. For instance, monitoring theophylline levels in asthma patients involves precision and sensitivity to adjust doses according to individual responses to therapy, ensuring efficacy and...
276
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

316
Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
316
Therapeutic Drug Monitoring: Overview and Classification01:16

Therapeutic Drug Monitoring: Overview and Classification

493
Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood at designated intervals to ensure the drug concentration stays within a therapeutic range. This monitoring is crucial for optimizing individual dosage regimens, enhancing therapeutic efficacy, and minimizing drug-related toxicity. TDM is vital for drugs with narrow therapeutic windows, significant variability in pharmacokinetics, and a clear correlation between plasma levels and...
493
Psychosis: Goals of Pharmacotherapy01:26

Psychosis: Goals of Pharmacotherapy

653
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
653
Drug Therapy01:28

Drug Therapy

376
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
376
Dosage Regimen: Multiple Oral Dosage01:25

Dosage Regimen: Multiple Oral Dosage

336
Understanding how a drug's concentration fluctuates within the body over time is crucial in pharmacokinetics, particularly with multiple oral doses. A graphical representation of multiple oral dosages provides insight into these dynamics. Typical accumulation curves of a drug's concentration in the body reveal a sawtooth pattern, indicating periodic peaks and troughs correlating with each dose administration and the drug's subsequent elimination.The plasma concentration at any time during an...
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Therapeutic Clozapine Monitoring Using Dose-Related Reference Range.

Khouloud Ferchichi1,2, Syrine Ben-Hammamia1,2,3, Mouna Ben Sassi1,2,3

  • 1Department of Clinical Pharmacology, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia.

Therapeutic Drug Monitoring
|March 18, 2026
PubMed
Summary
This summary is machine-generated.

The dose-related reference range (DRR) better reflects clozapine plasma concentrations than the therapeutic reference range (TRR) in patients with schizophrenia. The DRR may improve clozapine dosing accuracy and therapeutic decisions.

Keywords:
efficacy predictionreference rangesafety predictionschizophreniatherapeutic drug monitoring

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Area of Science:

  • Pharmacology
  • Psychiatry
  • Clinical Chemistry

Background:

  • Therapeutic drug monitoring (TDM) enhances clozapine dosing safety and accuracy for treatment-resistant schizophrenia.
  • Two frameworks, therapeutic reference ranges (TRR) and dose-related reference ranges (DRR), were evaluated for clozapine monitoring.
  • Comparison focused on differences in measured clozapine trough plasma concentrations (C0).

Purpose of the Study:

  • To assess the relevance and applicability of TRR and DRR monitoring frameworks for clozapine.
  • To compare clozapine trough plasma concentrations (C0) against TRR and DRR.
  • To determine which framework better guides clozapine dosing decisions.

Main Methods:

  • Retrospective analysis of 755 steady-state clozapine C0 values from 427 Tunisian patients (2011-2021).
  • TRR defined as 350-600 ng/mL per Arbeitsgemeinschaft für Neuropsychopharmakology und Pharmakopsychiatrie guidelines.
  • DRR calculated using the dose-related concentration (DRC) from the 2017 AGNP consensus update.

Main Results:

  • 31.9% of C0 values were within TRR; 48.7% subtherapeutic, 19.3% supratherapeutic.
  • 66.8% of C0 values were within DRR; 16.3% subtherapeutic, 16.9% supratherapeutic.
  • Strong positive correlation between C0 and dose (r=0.81, P<0.001).

Conclusions:

  • Clozapine plasma levels aligned better with DRR than TRR, especially with individual dosing.
  • DRR may provide higher precision for therapeutic decisions and dose adjustments.
  • Prospective studies are needed to optimize DRR use and validate its predictive value for efficacy and safety.