TDM should include the active management of free drug concentrations in human body fluids using either chromatographic or immunoassay-based methods or on-site solutions (sensors and wearables) for the optimum benefit of each individual patient.
Clinical TDM currently targets various drugs, including anticonvulsants (phenytoin, carbamazepine phenobarbital, primidone, valproic acid, clonazepam), cardioactive drugs (digoxin, procainamide, quinidine), respiratory-acting drugs (theophylline, caffeine), psychotropic medications (clozapine), mood active drugs (lithium, nortriptyline, doxepin), immunosuppressants (cyclosporine, tacrolimus, mycophenolate, sirolimus, everolimus), antineoplastic (methotrexate), and anti-infectives (amikacin, gentamicin, tobramycin, vancomycin, piperacillin, cefuroxime, voriconazole, ganciclovir, meropenem, flucloxacillin)
(A) Current TDM workflow
(B) Currently available implementations for a partially decentralized management of TDM
(C) Envisaged workflow for point-of-care (POC) TDM
Background colors identify different locations (green 5 peripheral, blue 5 healthcare providers), and pink boxes indicate process intersections and unproductive times.