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Related Concept Videos

Therapeutic Drug Monitoring: Drug Analysis Methods01:26

Therapeutic Drug Monitoring: Drug Analysis Methods

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...
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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

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.
Drug Concentrations: Measurements01:23

Drug Concentrations: Measurements

Drug concentration is the quantity of a drug present in a biological sample. Measuring drug amounts in biological samples allows the clinician to understand how a drug is absorbed, distributed, metabolized, and excreted. Samples can be obtained through invasive or non-invasive methods. Invasive techniques involve surgical or parenteral interventions to gather blood, cerebrospinal fluid, or tissue biopsy. Conversely, non-invasive approaches provide samples like urine, feces, and saliva.
Plasma —...
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Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations

Gentamicin, an aminoglycoside antibiotic, is commonly administered via intermittent intravenous infusion to treat severe infections. An intermittent one-hour infusion of gentamicin, administered at eight-hour intervals, allows for precise control of plasma drug concentrations, minimizing toxicity while ensuring therapeutic efficacy. Pharmacokinetic principles govern the dynamics of plasma concentrations and can be mathematically described using specific equations.The plasma drug concentration...
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Drug Concentration Versus Time Correlation

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Validated LC-MS/MS Panel for Quantifying 11 Drug-Resistant TB Medications in Small Hair Samples
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Published on: May 19, 2020

Evaluating Patient Medians for Laboratory Quality Control Using Long-Term Carbamazepine Monitoring Data.

Anders Larsson1, Mats B Eriksson2,3, Emmanuel Bäckryd4,5

  • 1Department of Medical Sciences, Clinical Chemistry and Pharmacology, Uppsala University, Uppsala, Sweden.

The Journal of Applied Laboratory Medicine
|July 9, 2026
PubMed
Summary

Carbamazepine levels in patients steadily increased over two decades, despite fewer tests being performed. Patient-derived medians are reliable for quality control in therapeutic drug monitoring (TDM).

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Published on: May 19, 2020

Area of Science:

  • Clinical Chemistry
  • Pharmacokinetics
  • Laboratory Medicine

Background:

  • Carbamazepine is a critical antiepileptic and mood-stabilizing drug requiring precise therapeutic drug monitoring (TDM) due to its narrow therapeutic index.
  • The established therapeutic range for carbamazepine is 20-40 µmol/L (4.7-9.4 mg/L).
  • Analyzing long-term laboratory data can reveal population trends, demographic variations, and seasonal effects, aiding quality assurance.

Purpose of the Study:

  • To analyze long-term trends in serum carbamazepine concentrations.
  • To investigate potential seasonal or demographic variations in drug levels.
  • To assess the utility of patient-derived medians as a quality-assurance tool and evaluate analytical method transitions.

Main Methods:

  • Retrospective analysis of 12,577 serum carbamazepine results from 3147 individuals (May 2007-December 2025).
  • Inclusion of demographic data (age, sex) and sampling dates for trend and variation analysis.
  • Evaluation of long-term trends using yearly percentiles, seasonal effects via monthly variation, and analytical method agreement during platform transition.

Main Results:

  • Serum carbamazepine concentrations showed a steady increase, with median values rising from 25.2 µmol/L in 2007 to 31.2 µmol/L in 2025.
  • Annual test volumes decreased significantly after peaking in 2010, yet drug concentrations continued to rise.
  • No significant seasonal variation in drug levels was observed, and the transition between analytical platforms demonstrated strong agreement.

Conclusions:

  • Carbamazepine concentrations have gradually increased over two decades, irrespective of declining test frequency.
  • Patient-derived medians proved stable and sensitive to method changes, validating their use as internal quality-control measures.
  • Long-term TDM data databases offer significant value for clinical interpretation and laboratory quality assurance.