Therapeutic drug monitoring in the neurocritical care unit

Current Opinion in Critical Care

Volumn 16, Issue 2, 2010, Pages 128-135

  Loh, Gabriel W ^a,b   Mabasa, Vincent H ^a,c   Ensom, Mary H H ^a,d  

^a UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^b VANCOUVER GENERAL HOSPITAL   (Canada)

^c BURNLEY GENERAL HOSPITAL   (United Kingdom)

^d CHILDREN S AND WOMEN S HEALTH CENTRE OF BRITISH COLUMBIA   (Canada)

Author keywords

Critical care; Neurocritical care; Sedation; Status epilepticus; Therapeutic drug monitoring; Traumatic brain injury

Indexed keywords

BARBITURIC ACID DERIVATIVE; CARBAMAZEPINE; ETIRACETAM; FELBAMATE; GABAPENTIN; LAMOTRIGINE; LORAZEPAM; MIDAZOLAM; OXCARBAZEPINE; PENTOBARBITAL; PHENOBARBITAL; PHENYTOIN; PREGABALIN; PROPOFOL; SEDATIVE AGENT; THIOPENTAL; TOPIRAMATE; VALPROIC ACID; VIGABATRIN;

BRAIN DEATH; CARDIOPULMONARY INSUFFICIENCY; COMA; CONTINUOUS INFUSION; DISTRIBUTION VOLUME; DRUG ANTAGONISM; DRUG BLOOD LEVEL; DRUG ELIMINATION; DRUG EXCRETION; DRUG HALF LIFE; DRUG METABOLISM; DRUG MONITORING; DRUG POTENTIATION; DRUG PROTEIN BINDING; DRUG WITHDRAWAL; EPILEPTIC STATE; FOCAL EPILEPSY; HUMAN; INTENSIVE CARE; KIDNEY DYSFUNCTION; LIVER DYSFUNCTION; MAXIMUM PLASMA CONCENTRATION; NEUROMONITORING; PATIENT CARE; PROPOFOL INFUSION SYNDROME; REVIEW; SEDATION; SEIZURE; SIDE EFFECT; TONIC CLONIC SEIZURE; TRAUMATIC BRAIN INJURY; UNSPECIFIED SIDE EFFECT;

ANTICONVULSANTS; BRAIN INJURIES; CONSCIOUS SEDATION; CRITICAL CARE; DRUG MONITORING; HUMANS; INTENSIVE CARE UNITS; PROGNOSIS; SEIZURES; STATUS EPILEPTICUS;

EID: 77952259424     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e3283374e3c     Document Type: Review

References (33)

1. Ensom MHH, Davis GA, Cropp CD, et al. Clinical pharmacokinetics in the 21st century. Does the evidence support definitive outcomes? Clin Pharmacokinet 1998;34:265-279.
2. Anderson GD. Pharmacokinetic, pharmacodynamic, and pharmacogenetic targeted therapy of antiepileptic drugs. Ther Drug Monit 2008;30:173-180.
3. Bring P, Ensom MH. Does oxcarbazepine warrant therapeutic drug monitoring? A critical review. Clin Pharmacokinet 2008;47:767-778. This comprehensive review article used a previously validated decision algorithm to determine that routine TDM of oxcarbazepine is not warranted except in special situations.
4. Huynh F, Mabasa VH, Ensom MH. A critical review: does thiopental continuous infusion warrant therapeutic drug monitoring in the critical care population? Ther Drug Monit 2009;31:153-169. This review critically evaluated the utility of routine TDM of thiopental infusion for various indications in the critical care setting using a decision algorithm. Although the focus was on TBI, the review included pharmacokinetic studies that incorporated thiopental levels for other indications seen in neurocritical care.
5. Patsalos PN, Berry DJ, Bourgeois BF, et al. Antiepileptic drugs: best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008;49:1239-1276. These guidelines concisely summarize known pharmacokinetic characteristics of major AEDs and also outline situations in which TDM of AEDs is warranted.
6. Spina SP, Ensom MH. Clinical pharmacokinetic monitoring of midazolam in critically ill patients. Pharmacotherapy 2007;27:389-398. This review uses a decision algorithm to determine the utility of midazolam TDM in the critically ill population. (Pubitemid 46327906)
7. Abbott Diagnostics. Tests on the TDx System. Therapeutic drug monitoring. http://www.abbottdiagnostics.com/Products/Instruments-by-Platform/sys tests.cfm?sys-id=27 [Accessed 31 October 2009].
8. Beckmann Coulter Therapeutic Drug Monitoring. Bulletin 9282 tdm 1 http://www.beckmancoulter.com/literature/ClinDiag/9282%20tdm1%201002pdf [Accessed 31 October 2009].
9. UKHealthClinical Pharmacokinetics Service and Anticoagulation Guidelines http://www.hosp. uky.edu/pharmacy/cps/PKmanual-disclaimer.html [Accessed 31 October 2009].
10. Wong WH, Lim TA, Lim KY. Interaction between propofol and thiopental: isobolographic analysis using dose, central compartment and effect compartment concentrations. Internet J Anesthesiol 2008; 17. [ISSN 1092-406X].
11. de Wit M, Best AM, Epstein SK, et al. Lorazepam concentrations, pharmacokinetics and pharmacodynamics in a cohort of mechanically ventilated ICU patients. J Intensive Care Med 2008;23:184-194.
12. Meinitzer A, Kalcher K, Gartner G, et al. Drugs and brain death diagnostics: determination of drugs capable of inducing EEG zero line. Clin Chem Lab Med 2008;46:1732-1738.
13. Peters FT, Jung J, Kraemer T, et al. Fast, simple, and validated gas chromatographic-mass spectrometric assay for qunatification of drugs relevant to brain death in human blood plasma samples. Ther Drug Monit 2005;27:334-344. (Pubitemid 40770991)
14. von Winckelmann SL, Spriet I, Willems L Therapeutic drug monitoring of phenytoin in critically ill patients. Pharmacotherapy 2008;28:1391-1400. This excellent review outlines phenytoin pharmacokinetics in the context of the critically ill, including the issues of protein binding and key drug-drug cytochrome P450-mediated interactions, and provides reasons supporting routine free phenytoin monitoring in this patient population.
15. Iwamoto T, Kagawa Y, Naito Y, et al. Clinical evaluation of plasma free phenytoin measurement and factors influencing its protein binding. Biopharm Drug Dispos 2006;27:77-84.
16. Hermida J, Tutor JC. A theoretical method for normalizing total serum valproic acid concentration in hypoalbuminemic patients. J Pharmacol Sci 2005;97:489-493. This study develops an equation to correct valproic acid levels for albumin in patients with hypoalbuminemia since free valproic acid monitoring is not widely available in the clinical setting. (Pubitemid 40628525)
17. Dutta S, Faught E, Limdi NA. Valproate protein binding following rapid intravenous administration of high doses of valproic acid in patients with epilepsy. J Clin Pharm Ther 2007;32:365-371. (Pubitemid 47063160)
18. Chan K, Beran RG. Value of therapeutic drug level monitoring and unbound (free) levels. Seizure 2008;17:572-575. This case report provides an example when access to free level phenytoin and valproic acid monitoring would be useful, particularly when a patient is taking several concomitant AEDs.
19. Chong E, Dupuis LL Therapeutic drug monitoring of lamotrigine. Ann Pharmacother 2002;36:917-920. (Pubitemid 34517424)
20. Paul F, Veauthier C, Fritz G, et al. Perioperative fluctuations of lamotrigine serum levels in patients undergoing epilepsy surgery. Seizure 2007;16:479-484. (Pubitemid 47209237)
21. Uges JW, van Huizen MD, Engelsman J, et al. Safety and pharmacokinetics of intravenous levetiracetam infusion as add-on in status epilepticus. Epilepsia 2009;50:415-421.
22. Szaflarski JP, Meckler JM, Szaflarski M, et al. Levetiracetam use in critically ill patients. Neurocrit Care 2007;7:140-147. (Pubitemid 350242663)
23. Lancelin F, Franchon E, Kraoul L, et al. Therapeutic drug monitoring of levetiracetam by high-performance liquid chromatography with photodiode array ultraviolet detection: preliminary observations on correlation between plasma concentration and clinical response in patients with refractory epilepsy. Ther Drug Monit 2007;29:576-583. (Pubitemid 47494055)
24. May TW, Rambeck B, Neb R, et al. Serum concentrations of pregabalin in patients with epilepsy: the influence of dose, age, and comedication. Ther Drug Monit 2007;29:789-794. (Pubitemid 350190856)
25. Zanotta N, Raggi ME, Radice L, et al. Clinical experience with topiramate dosing and serum levels in patients with epilepsy. Seizure 2006;15:86-92. (Pubitemid 43192417)
26. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. Management and prognosis of severe traumatic brain injury. J Neurotrauma 2007; 24: S1-S106.
27. Milligan TA, Hurwitz S, Bromfield EB. Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery. Neurology 2008;26:665-669. This is an interesting study that challenges the use of phenytoin as the traditional agent of choice for seizure prophylaxis in high-risk neurosurgical patients.
28. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119-141. (Pubitemid 34112188)
29. Yahwak JA, Riker RR, Fraser GL. Determination of a lorazepam dose threshold for using the osmol gap to monitor for propylene glycol toxicity. Pharmacotherapy 2008;28:984-991.
30. Nelsen JL, Haas CE, Habtemariam B, et al. A prospective evaluation of propylene glycol clearance and accumulation during continuous-infusion lorazepam in critically ill patients. Ann Pharmacother 2005;39:1732-1736. (Pubitemid 351667152)
31. Carson SS, Kress JP, Rodgers JE, et al. A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients. Crit Care Med 2006;28:250-258.
32. Ho KM, Ng JY. The use of propofol for medium and long-term sedation in critically ill adult patients: a meta-analysis. Intensive Care Med 2008;34:1969-1979.
33. Corbett SM, Montova ID, Moore FA. Propofol-related infusion syndrome in intensive care patients. Pharmacotherapy 2008;28:250-258. (Pubitemid 351206970)