Therapeutic drug monitoring of phenytoin using high performance liquid chromatography in a tertiary care hospital of Kashmir, India

Mohd., Adil; Farhat, Sameena; Rather, Mohd Younis

doi:10.18203/2319-2003.ijbcp20191590

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…High‐performance liquid chromatography HPLC, liquid chromatogram mass spectroscopy LC‐MS), fluorescence polarisation (FPIA), and enzyme‐mediated immunoassay (EMIT) techniques are the most commonly used techniques for performing TDM in India, with HPLC and LC‐MS being commonly used techniques 8,38,43 …”

Section: Resultsmentioning

confidence: 99%

Past, present and future perspectives of therapeutic drug monitoring in India

et al. 2021

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Therapeutic drug monitoring (TDM) is the clinical practice of performing drug assays and interpreting results to maintain constant therapeutic concentrations in patients' bloodstream. Conventional TDM was started way back in the 1960s and served to optimise pharmacotherapy by maximising therapeutic efficacy by evaluating efficacy failure and monitoring drug compliance, while minimising adverse events, in drugs with a narrow therapeutic range. Currently, the scope of TDM has been extended to additional indications which are of importance to India. Apart from the conventional indications, TDM can also help combat drug resistance amongst patients treated with antimicrobials, including anti-tubercular drugs and critically ill patients with compromised pharmacokinetics. TDM is also indicated for patients on antiretroviral drugs under specific clinical scenarios and is of high importance to India. Target concentration intervention (TCI) and apriori TDM (by merging TDM with pharmacogenomics) are emerging fields explored in developed nations. The authors sought to assess the evolution of TDM in India and evaluate the potential impact of newer indications in rationalising pharmacotherapy. In the mid-1980s, TDM was presented to India.Despite showing some initial progress, its use is limited to conventional indications.Its utility is also challenged by cost and higher reliance on conventional prescribing practices. However, the newer indications such as antimicrobial resistance, tuberculosis and HIV, with their high prevalence in developing nations, present an opportunity for the growth of TDM in these countries. Indian clinician's awareness and buoyant demands alongside expert contributions from clinical pharmacologists could widen its scope.

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Section: Resultsmentioning

confidence: 99%

Past, present and future perspectives of therapeutic drug monitoring in India

et al. 2021

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“…The existence of hepatic or renal sickness, which may modify discharge, treatment disappointment, or medication interactions are among the explanations given for portion changes. A few well-chosen recipes can be used to alter portions in addition to interpreting outcomes in light of the provided data [14]. A simple PK equation may be used to adjust the patient's share by using the purposeful PDC over an extended period of time.Reasons for the portion change include the possibility of a medication interaction, treatment failure, or the existence of a hepatic or renal infection that might affect discharge [15].…”

Section: Interpretationsmentioning

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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“…Currently, TDM requests for phenobarbitone are obtained mainly from neonates due to its exclusivity of service in this population for jaundice of prematurity and seizures. The TDM of valproic acid has increased in the last two decades among older antiepileptics 17,37 . This is attributable to the increased use of valproate in bipolar disorders and its use in seizures 38 .…”

Section: Strengthsmentioning

confidence: 99%

“…32 With emerging experience with the newer AEDs in our population, 35,36 many centres in India continue to provide TDM for older drugs in a cost-effective manner. 11,12,37 Nevertheless, TDM experts believe that over the last two decades, the volume of TDM requests at their centres for phenytoin, carbamazepine and phenobarbitone is on a declining trend, and this is attributable to a possible reduction in the frequency of usage. We must acknowledge that these experts are based in tertiary care teaching hospitals.…”

Section: Anti Epileptic Drugsmentioning

confidence: 99%

“…The TDM of valproic acid has increased in the last two decades among older antiepileptics. 17,37 This is attributable to the increased use of valproate in bipolar disorders and its use in seizures. 38 This could have been best assessed by pharmacoepidemiological data, such as a change in trend, for the ratio of daily drug use to the number of TDM requests received over the years.…”

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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Therapeutic drug monitoring of phenytoin using high performance liquid chromatography in a tertiary care hospital of Kashmir, India

Cited by 6 publications

References 9 publications

Past, present and future perspectives of therapeutic drug monitoring in India

Past, present and future perspectives of therapeutic drug monitoring in India

A Descriptive Analysis of Therapeutic Drug Monitoring In India

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

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