Role of Pharmacist in TDM

Role of Pharmacist in TDM

Therapeutic drug monitoring (TDM) refers to the measurement and interpretation of principally blood or plasma drug concentration measurements to optimize a patient’s drug therapy and clinical outcome while minimizing the risk of drug-induced toxicity. TDM involves tailoring a dosing regimen to a patient by maintaining the plasma or blood concentration within a particular range. To achieve optimal  drug therapy 3 objectives should be met: 

To attain the desired pharmacological effect of the drug. 

To reach the maximal effect in the shortest possible time. 

To decrease the risk of toxicity. 

Therapeutic drug monitoring (TDM) is helpful in drugs: 

With a narrow therapeutic index. 

Which is highly protein bound. 

Which are liable to interact. 

In which the metabolite might be toxic. 

Role of Pharmacist in TDM: 

A reliable and responsive TDM service depends on teamwork between nurses, doctors, pharmacists, scientists, and technical staff. The clinical pharmacist should provide advice to medical staff on the appropriate use and timing of TDM and assist with the interpretation of results. In addition, the pharmacist may be involved in: 

Initial selection of drug regimen. This may involve decisions about drug choice, dose,  dosing interval, route of administration, and dosage form of the drug, taking into account factors such as sex, age, body weight, race, metabolism status, renal function,  plasma albumin concentration, use of other drugs and laboratory results.


Adjustment of the dosage regimen based on TDM results and the patient’s clinical response. 

Assessment of possible causes for unexpected results, such as non-compliance,  bioavailability problems, medication errors, drug interactions, or pharmacogenetic variability. 

Dose adjustment for patients on hemodialysis or peritoneal dialysis. 

Provision of poison information. 

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