East Bay Nephrology Medical Group
E&M Education
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Drug
Therapy Requiring Intensive Monitoring for Toxicity The Table of Risk lists drug therapy requiring
intensive monitoring for toxicity as a high risk management option. For
drugs with a well-defined clinical response and a high therapeutic index
(i.e., low toxicity), intensive therapeutic drug monitoring is not
necessary. For acute or short-term drug therapy there is no advantage to
monitoring drug levels. For treatment of chronic disorders, such as
antihypertensive therapy, if the desired response can be readily assessed
by a noninvasive technique, such as blood pressure monitoring, serial drug
level monitoring is not medically necessary. Administration
of cytotoxic chemotherapy is always considered high risk under
management options when monitoring of blood cell counts is used as a
surrogate for toxicity. Drugs
that have a narrow therapeutic window and a low therapeutic index may
exhibit toxicity at concentrations close to the upper limit of the
therapeutic range and may require intensive clinical monitoring. The table
below lists examples of drugs that may need to have drug levels monitored
for toxicity. This is not an all exclusive list. On medical review, to
consider therapy with one of these drugs as a high risk management option,
we would expect to see documentation in the medical record of drug levels
obtained at appropriate intervals.
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