Abstract
Therapeutic drug monitoring has evolved from simple concentration measurements to estimating the level of exposure of to the drug and making dosage recommendations. Optimal sampling strategies are commonly used in therapeutic drug monitoring to optimize drug therapy. Optimal sampling strategies aim to determine the sampling times which will produce the most accurate estimation of pharmacokinetic parameters or exposure indices. The methodology used to create optimal sampling strategies is diverse and heterogeneous. Multiple regression analysis has been surpassed by Maximum A Posteriori Bayesian (MAPB) estimation in terms of accuracy and flexibility. An optimal sampling strategy using MAPB estimation is created by either selecting sampling times from a predetermined set of sampling times or using Fisher information to calculate times with the most information on the parameters to be estimated. Validation of the strategy is required, preferably by resampling statistics for its efficient use of data.
Highlights
Therapeutic drug monitoring (TDM) is commonly used to individualize drug therapy
Some examples of drugs therapeutically monitored in clinical practice are: cyclosporine [1,2], sirolimus, tacrolimus, mycophenolic acid [3], anti-cancer agents [4], aminoglycosides [5], vancomycin [5] and antifungal agents [6]
We describe the methodology used in the literature for determining optimal sampling times
Summary
The goal of therapeutic drug monitoring is to optimize treatment efficacy and minimize toxicity or side effects, using measured drug concentrations. Exposure indices are used which correlate well with the exposure to the target These were single blood concentration levels of the drug. Therapeutic drug monitoring has evolved from the simple measuring of drug levels (peak and trough) to the practice of estimating an exposure index and hereby predicting subsequent levels of exposure and making dosage recommendations. In neonates even to reduce morbidity due to the negative effect of repeated skin breaking and taking a relatively large amount of blood [16,17] This minimization of the number of measurements, or samples, needed has a diverse nomenclature in the literature [18]. We describe the methodology used in the literature for determining optimal sampling times
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