Drug levels, monitoring

After transplantation, immunosuppression must be used to prevent host rejection of the graft liver, usually with prednisone and tacrolimus or cyclosporine. Tacrolimus and cyclosporine are calcineurin inhibitors and require drug level monitoring because of a narrow therapeutic range and significant toxicity, including renal failure and neurotoxicity. 

Smoking and charcoal-broiled food may decrease drug level Monitoring Parameters... 

Oxcarbazepine is a keto derivative of carbamazepine but offers several advantages over carbamazepine. Oxcarbazepine does not require blood cell count, hepatic, or serum drug level monitoring. It causes less cytochrome P450 enzyme induction than does carbamazepine (but may decrease effectiveness of oral contraceptives containing ethinyl estradiol and levonorgestrel). As opposed to carbamazepine, oxcarbazepine does not induce its own metabolism. These properties, combined with its similarity to carbamazepine, led many clinicians to use this medication for the treatment of bipolar disorder. Randomized controlled trials suggested efficacy in the treatment of acute mania compared with lithium and haloperidol, but these trials were quite small and did not include a placebo control (Emrich 1990). 

R.J. Tindula, et al., Aminoglycoside inactivation by penicillins and cephalosporins and its impact on drug-level monitoring. Drug Intell. Clin. Pharmacol. 17 906-908, 1983. 

Nortriptyline low doses (often 10-50 mg/day) with drug level monitoring. 

S. Honda, T. Konishi, and H. Chiba, Evaluation of Dual-Wavelength Spectrophotometry for Drug Level Monitoring. Anal. Chem., 56 (1984) 2352. 

Sadee, W. and Beelen, G. C. M., Drug Level Monitoring, John Wiley Sons, New York, 1980. 

Since unspeciUc routine performance of serum level measurements in aU theo-phylUne-treated patients is cost-prohibitive, drug level monitoring should only be performed where clearly indicated. TheophyUine serum concentration measurements... 

Although MMF has less effect on the bone marrow than other cytotoxic agents, bone marrow suppression occurs. Therefore, complete blood counts should be performed on a regular basis. Since the disposition of MMF is by both the liver and kidney, renal and hepatic functions should be monitored. To reduce GI toxicity, drug level monitoring has been used in some patients (175). The peak level may not be as important as the area under the curve (182). 

Chan, K. and Beran, R. G. (2008) Value of therapeutic drug level monitoring and unbound (free) levels , S azMre, 17,572-575. 

Drug level monitoring is required for gentamicin f used. 

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