Readdressing the role of therapeutic drug monitoring for antiepileptic drugs – A tertiary care hospital experience

Sutariya, Bharat; Patel, Amit; Desai, Ankit D.; Shaikh, Sadik I

doi:10.17511/ijmrr.2016.i01.012

Cited by 3 publications

(5 citation statements)

References 32 publications

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“…In addition, there is a significant prevalence of nutritional deficiencies and tropical infectious diseases due to parasitic infestations such as malaria, kala‐azar, filaria and amoebiasis and the widespread presence of tuberculosis (TB) and HIV, which are expected to alter the clinical response profile to drugs due to altered pharmacokinetics (PK) and pharmacodynamics (PD) 1 . Therefore, it has been recognized that the therapeutic window for many drugs may differ in this part of the world compared to others 18,19 . A few sporadic incidence reports suggest that available drugs may not be of standard quality or spurious.…”

Section: Strengthsmentioning

confidence: 99%

“…Phenytoin, phenobarbitone and carbamazepine have been the classical agents for TDM since its inception worldwide. In India, TDM started with these drugs and has proven immensely useful for the older anti epileptic drugs (AED) in patients 19‐22 . Even in resource‐constrained settings like ours, TDM of older AED has proven to be pharmacoeconomically rewarding, providing an increased likelihood of remission with better control of seizures and reduced adverse events 15 .…”

Section: Strengthsmentioning

confidence: 99%

“…1 Therefore, it has been recognized that the therapeutic window for many drugs may differ in this part of the world compared to others. 18,19 A few sporadic incidence reports suggest that available drugs may not be of standard quality or spurious. Moreover, there may be varied PK interactions resulting from the widespread use of alternative systems of medicine (Ayurveda, Unani, Siddha and others) with modern medications, which adds another level of complexity.…”

Section: Strengthsmentioning

confidence: 99%

“…In India, TDM started with these drugs and has proven immensely useful for the older anti epileptic drugs (AED) in patients. [19][20][21][22] Even in resource-constrained settings like ours, TDM of older AED has proven to be pharmacoeconomically rewarding, providing an increased likelihood of remission with better control of seizures and reduced adverse events. 15 Several important effect modifiers are unique to the Indian setting, such as protein-energy malnutrition 12 and iron deficiency anaemia, 23 which have been characterized.…”

Section: Anti Epileptic Drugsmentioning

confidence: 99%

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Therapeutic drug monitoring in India: A strength, weakness, opportunity and threats analysis

Pattanaik

Gota

Tripathi

et al. 2023

Brit J Clinical Pharma

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Over the last three to four decades, Therapeutic Drug Monitoring (TDM) has shaped itself as therapeutic drug management, an integral component of precision medicine. The practice of TDM is not extensive in India, despite being one of the fastest‐growing economies in the world. It is currently limited to a few academic medical centres and teaching hospitals. Apart from the immunosuppressive drugs, several other therapeutic areas, such as anticancer, antifungal, antibiotic and antitubercular, have demonstrated great potential to improve patient outcomes in Indian settings. Factors such as the higher prevalence of nutritional deficiencies, tropical diseases, widespread use of alternative medicines, unalike pharmacogenomics and sparse population‐specific data available on therapeutic ranges of several drugs make the population of this subcontinent unique regarding the relevance of TDM. Despite the impact of TDM in clinical science and its widespread application, TDM has failed to receive the attention it deserves in India. This review intends to bring out a strength, weakness, opportunity and threats (SWOT) analysis for TDM in India so that appropriate steps for fostering the growth of TDM could be envisioned. The need of the hour is the creation of a cooperative group including all the stakeholders, such as TDM professionals, clinicians and the government and devising a National Action Plan to strengthen TDM. Nodal TDM centres should be established, and pilot programmes should be rolled out to identify the thrust areas for TDM in the country, capacity building and creating awareness to integrate TDM into mainstream clinical medicine.

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Section: Strengthsmentioning

confidence: 99%

Section: Strengthsmentioning

confidence: 99%

Section: Strengthsmentioning

confidence: 99%

Section: Anti Epileptic Drugsmentioning

confidence: 99%

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Therapeutic drug monitoring in India: A strength, weakness, opportunity and threats analysis

Pattanaik

Gota

Tripathi

et al. 2023

Brit J Clinical Pharma

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“…Depending on the patient's health and state of illness, different responses occur to the same dosage [1,2]. The results of the assessment may be either acceptable or unpleasant for the patient, or they could have therapeutic or unbearable consequences [3]. The medication monitoring will let the doctor customise the patient's dose schedule, which is based on the patient's medical history and includes elements like age, food, smoking, and illnesses that affect the kidney, liver, heart, and thyroid gland.…”

Section: Introductionmentioning

confidence: 99%

A Descriptive Analysis of Therapeutic Drug Monitoring In India

Khan,

Uz Zaman

2024

Asian J Pharm Res Dev

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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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Therapeutic Drug Monitoring as a Tool for Therapy Optimization

Babu

Pavithran

2022

DMBL

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The use of pharmacotherapy for improving healthcare in society is increasing. A vast majority of patients have either received subtherapeutic treatment (which could result from low pharmacokinetic) or experienced adverse effects due to the toxic levels of the drug. The medicines used to treat chronic conditions, such as epilepsy; cardiovascular diseases; and oncological, neurological, and psychiatric disorders, require routine monitoring. New targeted therapies suggest an individualized treatment that can slowly move practitioners away from the concept of a one-size-fits-all-fixed-dosing approach. Therapeutic drug use can be monitored based on pharmacokinetic, pharmacodynamic, and pharmacometric methods. Based on the experiences of therapeutic drug monitoring of various agents across the globe, we can look ahead to the possible developments of therapeutic drug monitoring in India.

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Readdressing the role of therapeutic drug monitoring for antiepileptic drugs – A tertiary care hospital experience

Cited by 3 publications

References 32 publications

Therapeutic drug monitoring in India: A strength, weakness, opportunity and threats analysis

Therapeutic drug monitoring in India: A strength, weakness, opportunity and threats analysis

A Descriptive Analysis of Therapeutic Drug Monitoring In India

Therapeutic Drug Monitoring as a Tool for Therapy Optimization

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