Clinical pharmacokinetics: a comprehensive system for therapeutic drug monitoring and prescribing.

TLDR

Clinical pharmacokinetics is an expanding discipline that can improve treatment across many medical specialties. The study aimed to develop a rapid drug assay system, report results, evaluate clinical factors affecting pharmacokinetics, and use a computer to optimize dosing. The Stobhill clinical pharmacokinetics laboratory serves all hospital departments and local general practitioners. Assessment of digoxin, theophylline, and phenytoin revealed that only about a third of initial samples were therapeutic, but reporting improved ranges, the computer program’s predictive accuracy rose with one or two concentration feedbacks, and early testing enabled dose adjustments that may encourage the establishment of similar laboratories.

Abstract

Clinical pharmacokinetics is an expanding scientific discipline which can make an impact on treatment in coronary care, intensive care, paediatrics, general medicine and surgery, and general practice. The aim of this study was to establish a rapid system of drug assay, to report the result, to assess the influence of pathological and clinical factors on the pharmacokinetics of certain drugs, and to use a computer to determine the optimum dosage of drugs. The clinical pharmacokinetics laboratory in Stobhill is available to all clinical departments and to general practitioners in the area. Digoxin, theophylline, and phenytoin have been assessed. Initial samples of these drugs showed that only about a third were in the therapeutic range; samples obtained after the issue of the laboratory report showed an improvement. The predictive performance of the computer program improved with feedback of one or two drug concentrations. Dosages of drugs chosen on an empirical basis may not lead to optimum treatment, and by testing samples early the dosage of the drug can be adjusted. It is hoped that the results achieved will encourage other clinical, pharmaceutical, and scientific colleagues to develop laboratories along similar lines.