A Descriptive Analysis of Therapeutic Drug Monitoring In India
DOI:
https://doi.org/10.22270/ajprd.v12i1.1338Abstract
Therapeutic drug monitoring (TDM) has evolved into therapeutic drug management throughout the past three to four decades, becoming a crucial facet of precision medicine. Even though India has one of the fastest-growing economies in the world, TDM is not widely used there. At the moment, it is restricted to a small number of teaching hospitals and academic medical institutes. Other therapeutic domains, such anticancer, antifungal, antibacterial, and antitubercular medications, have shown considerable promise to enhance patient outcomes in Indian settings, aside from immunosuppressive pharmaceuticals. The population of this subcontinent is unique in terms of the importance of TDM due to factors like the higher prevalence of nutritional deficiencies, tropical diseases, the widespread adoption of alternative medicines, unlike pharmacogenomics, and the scarcity of population-specific data on the therapeutic ranges of multiple drugs.TDM has not gotten the interest it merits in India, despite its vast applicability and influence on clinical science. This study aims to present a SWOT (strength, weakness, opportunity, and threats) analysis of TDM in India so that suitable measures for promoting TDM growth can be envisaged. Forming a collaborative group with all the stakeholders—including TDM experts, physicians, and the government—and coming up with a National Action Plan to support TDM are urgent needs. To determine the country's TDM focus areas, nodal TDM facilities should be formed, and pilot programmes should be launched. Capacity development and awareness rising are also important steps towards integrating TDM into traditional clinical practice.
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Ramamoorthy A, Pacanowski M, Bull J, Zhang L. Racial/ethnic differences in drug disposition and response: Review of recently approved drugs. ClinPharmacolTherapeut. 2015; 97(3): 263-273.
Harivenkatesh N, Haribalaji N, David DC, Kumar CM. Therapeutic drug monitoring of antiepileptic drugs in a tertiary care hospital in India. ClinNeuropharmacol. 2015; 38(1): 1-5.
Sonkar R, Udutha SJC, Kumar Rao RT. Readdressing the role of therapeutic drug monitoring for antiepileptic drugs – A tertiary care hospital experience. International Journal of Medical Research and Review. 2016; 4(1): 75-82.
Garg SKGM, Handu SS, Bhargava VK. Therapetic Drug Monitoring of Antiepileptic Drugs-A Preliminary Experience. Indian J Pharmacol. 2000; 32: 28-30.
Dahiya KBP, Ghalaut VS, Dhankhar R, Ghalaut PS. Therapeutic drug monitoring for antiepileptic drugs using HPLC: An experience at a tertiary care hospital in India. Neurology Asia. 2010; 15(3): 233-237.
Gunindro NKS, Devi YS, Joshila L, Hemantakumar N, Devi KP. Prescribing patterns of antiepileptic drugs in epilepsy patients: a picture from the therapeutic drug monitoring unit in a medical institute in Manipur. Int J Contemp Med Res. 2018; 5(1): 1-4.
Joshi MV, Pohujani SM, Mehta BC, Acharya VN, Kshirsasgar NA. Effect of iron deficiency anaemia and its treatment on single dose phenytoin bioavailability. Eur J ClinPharmacol. 1993; 45(4): 387-388.
Chowdhury D. New drugs for the treatment of epilepsy: a practical approach. J Assoc Physicians India. 2013; 61(8 Suppl): 19-39.
Taur SR, Kulkarni NB, Gogtay NJ, Thatte UM. An audit of therapeutic drug monitoring services of anticonvulsants at a tertiary care hospital in India. Ther Drug Monit. 2013; 35(2): 183-187.
Radhakrishnan A. Bridging the treatment gap in epilepsy-is there an emerging trend in the use of newer antiepileptic drugs? Neurol India. 2016; 64(6): 1140-1142.
Haroon A, Tripathi M, Khanam R, Vohora D. Antiepileptic drugs prescription utilization behavior and direct costs of treatment in a national hospital of India. Ann Indian Acad Neurol. 2012; 15(4): 289-293.
Magar YB, Hiray RS, Ghongane BB. Utilization pattern of antiepileptic drugs and their adverse effects in tertiary healthcare and teaching hospital. Int J Basic ClinPharmacol. 2018; 8(1): 8.
Mathew B, Fleming D, Thomas M, Prabha R, Saravanakumar K. An initial experience with therapeutic drug monitoring of levetiracetam as reported from a pediatric clinical setting in India. Neurol India. 2012; 60(2): 146-149.
Adil M, Farhat S, Rather Y. Therapeutic drug monitoring of phenytoin using high performance liquid chromatography in a tertiary care hospital of Kashmir. India Int J Basic ClinPharmacol. 2019; 8: 995.
Kumar SV RY, Vijayakumar G, Ravikumar Ch. Therapeutic Drug Monitoring of Valproic Acid in Pediatric Epileptic Patients. International Bulletin of Drug Research. 2011; 1(1): 11–8.
Vasudev K, Goswami U, Kohli K. Carbamazepine and valproate monotherapy: feasibility, relative safety and efficacy, and therapeutic drug monitoring in manic disorder. Psychopharmacology (Berl). 2000; 150(1): 15-23.
Levêque D, Becker G. The role of therapeutic drug monitoring in the management of safety of anticancer agents: a focus on 3 cytotoxics. Expert Opin Drug Saf. 2019; 18(11): 1009-1015.
Smita P, Narayan PA, J K, Gaurav P. Therapeutic drug monitoring for cytotoxic anticancer drugs: Principles and evidence-based practices. Front Oncol. 2022; 12:1015200.
Beumer JH, Chu E, Allegra C, et al. Therapeutic Drug Monitoring in Oncology: International Association of Therapeutic Drug Monitoring and Clinical Toxicology Recommendations for 5-Fluorouracil Therapy. ClinPharmacolTher. 2019; 105(3): 598-613.
Mueller-Schoell A, Groenland SL, Scherf-Clavel O, et al. Therapeutic drug monitoring of oral targeted antineoplastic drugs. Eur J ClinPharmacol. 2021; 77(4): 441-464.
Wong G, Sime FB, Lipman J, Roberts JA. How do we use therapeutic drug monitoring to improve outcomes from severe infections in critically ill patients? BMC Infect Dis. 2014; 14(1): 288.
Roberts JA, Abdul-Aziz MH, Lipman J, et al. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect Dis. 2014; 14(6): 498-509.
Hoo GSR, Liew YX, Kwa AL. Optimisation of antimicrobial dosing based on pharmacokinetic and pharmacodynamic principles. Indian J Med Microbiol. 2017; 35(3): 340-346.
Begg EJ, Barclay ML, Kirkpatrick CJ. The therapeutic monitoring of antimicrobial agents. Br J ClinPharmacol. 1999; 47(1): 23-30.
Roberts JA, Hope WW, Lipman J. Therapeutic drug monitoring of beta-lactams for critically ill patients: unwarranted or essential? Int J Antimicrob Agents. 2010; 35(5): 419-420.
Gumbo T. New susceptibility breakpoints for first-line antituberculosis drugs based on antimicrobial pharmacokinetic/pharmacodynamic science and population pharmacokinetic variability. Antimicrob Agents Chemother. 2010; 54(4): 1484-1491.
Calver AD, Falmer AA, Murray M, et al. Emergence of increased resistance and extensively drug-resistant tuberculosis despite treatment adherence, South Africa. Emerg Infect Dis. 2010; 16(2): 264-271.
Srivastava S. Minimum inhibitory concentration, pharmacokinetics/pharmacodynamics and therapeutic drug monitoring: An integrated approach for multidrug-resistant tuberculosis. Lung India. 2015; 32(4): 402-403.
Weiner M, Benator D, Burman W, et al. Association between acquired rifamycin resistance and the pharmacokinetics of rifabutin and isoniazid among patients with HIV and tuberculosis. Clin Infect Dis. 2005; 40(10): 1481-1491.
Akkerman OW, van Altena R, Klinkenberg T, et al. Drug concentration in lung tissue in multidrug-resistant tuberculosis. EurRespir J. 2013; 42(6): 1750-1752.
Ray J, Gardiner I, Marriott D. Managing antituberculosis drug therapy by therapeutic drug monitoring of rifampicin and isoniazid. Intern Med J. 2003; 33(5–6): 229-234.
Li J, Burzynski JN, Lee YA, et al. Use of therapeutic drug monitoring for multidrug-resistant tuberculosis patients. Chest. 2004; 126(6): 1770-1776.
Aronson JK, Hardman M. ABC of monitoring drug therapy increasing plasma drug concentration. BMJ. 1992;305(6861):1078-80.
Schumacher GE. Editor. Therapeutic drug monitoring. Publisher Pharmamed Press. Appleton and Lange, Medical, 1995.
Cristodorescu R, Deutsch G, Dragon S. Clinical utility of plasma digoxin measurement.MedInterne. 1989;27(1):25-32.
Zhou W, Jacq R, Aigrain E. Principles of Therapeutic drug monitoring. Handbook Exptl Pharmacol.2011;205:77-90.
Gross AS. Best practices in therapeutic drug monitoring. BrJClinPharmacol.2 001;52(Suppl.1):5S-10S.
Imam SS, Agarwal S. A Pragmatic Approach To Treat Lung Cancer Through LoadingTheaflavin -3,3’-Digallate And Epigallocatechin Gallate In Spanlastic. Asian J PharmClinRes. 2021 Nov 7;14(11):1-8.
Imam SS. The future of non-invasive ways to treat cancer. Int J Pharm Sci& Res2021;12(8):4684-96.
ImamSS,ImamST,Mdwasifathar,KumarR,AmmarMY.InteractionBetweenAce2 And Sars-Cov2, And Use Of EGCG And Theaflavin To Treat Covid 19 In InitialPhases. International Journal of Current Pharmaceutical Research. 2022 Mar; 14(2):5-10.
ImamSS,SharmaR.NaturalcompoundspromisingwaytotreatLungCancer.International Journal of Pharmaceutical Research and Applications. 2023; 8(2): 552-558.
ImamSS,SharmaS,KumariD,KhanS,PathakP,KatiyarD.AnExpedientApproach to Treat Asthma through Non-Steroidal, Natural Transferosomes AerosolSystem.Innovarejournalof medicalsciences. 2022;10(6):7-11.
Imam SS, Imam ST, Agarwal S, Kumar R, Ammar MY, Athar MW, Akthar A. LungCancer Therapy Using Naturally Occurring Products and Nanotechnology. Innovarejournalof medicalsciences. 2022;10(4):1-5.
Imam ST, Imam SS. The Cream which relieves the pain of Menstrual cramps withoutinterfering with the Hormones or Period Cycle. Research Journal of Pharmacy andTechnology.2023;16(3):1239-6.
Imam SS. Topical Formulation Constituted with Transferosomes for the Treatment OfNon-MelanomaSkin Cancer.Asian JPharmClin Res. 2023May 7;16(5):27-32.
Imam Ss. Nanoparticles: The Future Of Drug Delivery. Int J Curr Pharm Sci. 2023 Nov. 15;15(6):8-15.
McInnes GT. The value of therapeutic drug monitoring to the practicing physician. Br J ClinPharmacol. 1989;27(3):281-4.
Reynolds DJ, Aronson JK. ABC of monitoring drug therapy : making the most of plasma drug concentration measurements. BMJ.1993;306(6861):48-51.
Suthakaran C, Adithan C. Therapeutic drug monitoring –concept, methodology, clinical applications and limitations. Ch.7, Health Administrator, 2006;1:22-26.
Lawson G, Cocks E, Tanna S. Quantitative determination of atenelol in dried blood spot samples by LC-HRMS or potential method for assessing medication adherence. JChromatogr B Analyst Technol Biomed Life Sci. 2012;15:817:72-9.
Millership JS. Micro assay of drugs and modern measurement technique. PediatricAnaesth. 2011;21(3):197-205.
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