Abstract
IntroductionIn order to assess the significance of drug levels measured in intensive care medicine, clinical and forensic toxicology, as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available. Therefore, it makes sense to offer a carefully referenced compilation of therapeutic and toxic plasma concentration ranges, as well as half-lives, of a large number of drugs and other xenobiotics for quick and comprehensive information.MethodsData have been abstracted from original papers and text books, as well as from previous compilations, and have been completed with data collected in our own forensic and clinical toxicology laboratory. The data presented in the table and corresponding annotations have been developed over the past 20 years and longer. A previous compilation has been completely revised and updated. In addition, more than 170 substances, especially drugs that have been introduced to the market since 2003 as well as illegal drugs, which became known to cause intoxications, were added. All data were carefully referenced and more than 200 new references were included. Moreover, the annotations providing details were completely revised and more than 100 annotations were added.ResultsFor nearly 1,000 drugs and other xenobiotics, therapeutic ("normal") and, if data were available, toxic and comatose-fatal blood-plasma concentrations and elimination half-lives were compiled in a table.ConclusionsIn case of intoxications, the concentration of the ingested substances and/or metabolites in blood plasma better predicts the clinical severity of the case when compared to the assumed amount and time of ingestion. Comparing and contrasting the clinical case against the data provided, including the half-life, may support the decision for or against further intensive care. In addition, the data provided are useful for the therapeutic monitoring of pharmacotherapies, to facilitate the diagnostic assessment and monitoring of acute and chronic intoxications, and to support forensic and clinical expert opinions.
Highlights
In order to assess the significance of drug levels measured in intensive care medicine, clinical and forensic toxicology, as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available
For nearly 1,000 drugs and other xenobiotics, therapeutic ("normal”) and, if data were available, toxic and comatose-fatal plasma concentrations and elimination half-lives were compiled in one table
To the best of our knowledge, this compilation is the most current and comprehensive single source of data necessary to support clinical decision making in case of acute or chronic intoxications with drugs and other xenobiotics
Summary
In order to assess the significance of drug levels measured in intensive care medicine, clinical and forensic toxicology, as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available. The total encounters showed a 7.7% decline from 2009, human exposures with more serious outcomes increased 4.5%. It is recommended that plasma concentrations of drugs having a narrow therapeutic range or with a highly variable response (such as in psychiatry) have to be measured. This accounts for anti-epileptics, cardiac glycosides, aminoglycosides, antiarrhythmics, theophylline, immunosuppressants, lithium, antipsychotics and antidepressants, and antiretrovirals, as well as for an increasing number of cytostatics and antimycotics, among others. Apart from acute and chronic intoxications, it is indicated to draw blood samples for the following reasons: if doses are high and borderline, if signs of overdosage occur the dose is within normal range (for example, genetic polymorphism), if there is no efficacy the dose is correct or if nonadherence can be expected
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