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Precision Dosing and Therapeutic Drug Monitoring for Busulfan and Vancomycin

Megan N. Freeland, PharmD
December 22, 2020

Clinicians are intimately familiar with therapeutic drug monitoring, especially those who work in a hospital or other institutional setting. Therapeutic drug monitoring for busulfan, vancomycin, digoxin, lithium, and several other drugs is common practice. 

But as precision dosing carves out its place in clinical practice, it may leave you wondering: how does therapeutic drug monitoring fit in? The answer: Therapeutic drug monitoring and precision dosing are closely intertwined. Let’s discuss exactly how.

Is therapeutic drug monitoring still relevant?

You use therapeutic drug monitoring to determine how much of a certain medication is in a patient’s blood. At InsightRX, we’re especially interested in therapeutic drug monitoring related to busulfan and vancomycin, two drugs for which we offer precision dosing support.

Therapeutic drug monitoring for busulfan

Busulfan is primarily used as a preparative agent prior to hematopoietic stem cell transplant (HCT). Of the many drugs that can be used in a preparative regimen, busulfan is the only one that requires therapeutic drug monitoring.

Monitoring busulfan exposure using therapeutic drug monitoring is an effective way to mitigate the risk of busulfan toxicity, given its status as a DNA alkylating chemotherapy agent and the known risk of pulmonary toxicity.

Therapeutic drug monitoring for vancomycin

Similarly, in the case of vancomycin, therapeutic drug monitoring is similarly intended to reduce patients’ risk of toxicity—specifically, nephrotoxicity. You may be used to drawing two levels—peak and trough—to monitor vancomycin levels at your institution. But in many cases, only one level is needed when using our precision dosing software, InsightRX Nova.

How does precision dosing affect the practice of therapeutic drug monitoring?

Therapeutic drug monitoring and precision dosing work hand in hand. Here’s another way to think about it: in part, precision dosing is powered by therapeutic drug monitoring. 

Dosing software combines a variety of inputs—including patient-specific characteristics and data, as well as population PK models—to produce an optimal dosing regimen for a particular patient. Through therapeutic drug monitoring, you’re able to supply the dosing software with the information it needs about how a patient’s body is processing a particular medication at that time. 

This becomes especially helpful when providing care for populations whose PK profiles are highly variable for a variety of reasons. They may be obese or critically ill, for example, and the traditional dosing approach may not be sufficient to provide the maximum efficacy with the lowest possible risk of toxicity. 

Rather, using the combined strategies of therapeutic drug monitoring and precision dosing, you’re able to ensure their medication regimen is optimal for their particular condition at a narrow range in time.

Understanding this process better should help underscore the fact that precision dosing and TDM are indeed complementary.

Start your free trial of the leading precision dosing platform, InsightRX Nova.

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