Therapeutic Drug Monitoring Tool
Clinical Edition

What is this tool?

Interactive pharmacokinetic simulator for Therapeutic Drug Monitoring (TDM)

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Visualize drug concentrations over time and assess therapeutic ranges

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Optimize dosing regimens for high-risk medications

How to use

1 Select drug & enter patient parameters
2 Review drug-specific information
3 Check safety guidelines & run simulation
4 Analyse results & clinical recommendations

Educational Tool Notice

This simulator is for educational and training purposes. Always consult current clinical guidelines, drug references, and institutional protocols for patient care decisions. Real TDM should always include clinical correlation and expert interpretation.

Step 1: Drug Selection & Simulation Parameters

For Vd calculation
Affects clearance
For renal adjustments
See interaction effects on graph

Step 2: Selected Drug Information

Select a drug to view specific information

Safety & Quality Assurance

CRITICAL VALUES - Immediate Actions Required
Gentamicin >12: Hold + check kidneys
Digoxin >2.5: Hold + electrolytes
Phenytoin >30: Hold + monitor toxicity
Vancomycin >80: Hold + increase monitoring
Lithium >1.5: Hold + check hydration
High-Risk TDM Drugs
Aminoglycosides: Nephro/ototoxicity
Digoxin: Narrow window, many interactions
Warfarin: Bleeding risk, diet interactions
Lithium: Toxicity, dehydration sensitive
Phenytoin: Non-linear kinetics

Clinical Guidelines

NURSING - Guidelines
Verify patient ID & allergies
Check renal/hepatic function
Monitor vital signs during IV
Document exact dose timing
Use infusion pumps for precision
PHARMACOLOGY - Focus
Consider CYP enzyme interactions
Monitor protein binding changes
Special population considerations
Genetic polymorphism effects
Organ function dose adjustments
LAB - Protocols
Follow strict timing requirements
Use correct collection tubes
Document collection timing
Maintain sample stability
Run QC with each batch
Report critical values STAT

Laboratory Standards

Sample Collection Guidelines
  • Peak samples: Collect 1-2 hours post-dose (or as specified)
  • Trough samples: Collect immediately before next dose
  • Steady-state: Wait 4-5 half-lives before monitoring
  • Emergency levels: Can be drawn anytime for suspected toxicity
Quality Assurance
  • Analytical precision: CV <10% for most TDM assays
  • Accuracy: ±15% of target concentration
  • Reference standards: NIST-traceable when available
  • Proficiency testing: Participate in external QA programs
  • Method validation: Follow CLSI guidelines

Drug Interactions

Major TDM Drug Interactions
  • CYP3A4 Inhibitors: Increase levels of cyclosporine, tacrolimus
  • CYP3A4 Inducers: Decrease levels of cyclosporine, tacrolimus
  • Nephrotoxic combinations: Aminoglycosides + vancomycin + ACE inhibitors
  • Ototoxic combinations: Aminoglycosides + furosemide + vancomycin
  • Digoxin interactions: Amiodarone, quinidine, verapamil (↑ levels)
  • Phenytoin interactions: Valproic acid, warfarin, many others
Interaction Management
  • Check all medications for potential interactions before dosing
  • Adjust monitoring frequency when starting/stopping interacting drugs
  • Consider prophylactic dose adjustments for known interactions
  • Monitor for additive toxicity with same-class drugs
  • Document all drug changes affecting TDM drugs

Select a drug to view potential interactions

Concentration vs Time Profile

Simulation Results & Clinical Recommendations

Click "Simulate & Analyse" to see pharmacokinetic analysis and clinical recommendations…