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Biochemical monitoring

Drug Monitoring
This guide is intended only as a quick reference, and is not exhaustive. It is based on common recommendations. The frequency of testing may need to be individualised to the patient, their condition and treatment. For more details see latest edition o shared care documents and the individual Within 2 weeks of initiation or significant dose change, then 12 monthly. Monitor more frequently in high risk patients.
3 months after starting then 6 monthly, and for 6 months after stopping.
6 monthly. Chest Xray if pulmonary toxicity suspected. 12 monthly.
Routine drug levels not necessary, but consider if toxicity suspected – At least 6 hrs post dose. Ideally 8 – 12 hours.
1 month after initiation, then after alteration in dose or condition. Yearly as routine. High dose thiazides may induce diabetes, perform urinalysis yearly.
Gemfibrozil also needs FBC 3 monthly for first year 1o prevention - repeat only if indicated/appropriate to improve compliance/concordance. 2o prevention - 2 – 3 months after changing dose, thereafter 12 monthly Repeat after 3 months and 12 months. Do not measure again unless clinically indicated.
At least every 12 weeks once stable in individual therapeutic range.
3 monthly for first year, then 6 monthly for 4 years, then 12 monthly.
6 –12 monthly once maintenance dose reached. Range 10-20mg/l . Needs trough measurement prior to dose.
3 months after the start of treatment (and within 1 month if See TEWV Transfer of Prescribing Document
See TEWV Hyperprolactinaemia Guidance
Every 3 months for the first year then 12 monthly Consider for high risk patients 6 monthly Manufacturer recommends blood counts and
Weight should be monitored in patients who gain weight hepatic and renal function tests but evidence of
practical value unsatisfactory
Drug Monitoring
Manufacturer recommends blood counts but
evidence of practical value unsatisfactory
May be useful in some situations. It takes 7 to 10 days to reach steady state. Range 40-80 micromol/litre.
2 monthly for 6 months, then every 12 monthly.
Routine measurement of valproate blood levels is not recommended unless there is evidence of ineffectiveness, poor adherence or toxicity. Weight should be monitored in patients who gain weight rapidly.
1 week after starting and 1 week after every dose change and until the levels are stable. 3 monthly once stabilised. Measure drug level 12 hrs post dose. Range 0.4 – 0.8 See TEWV Shared Care Document
See TEWV Transfer of Prescribing Document
2 monthly for first year, then 12 monthly.
Monitor 12 monthly for signs and symptoms of heart failure 3 monthly for first year, then 12 monthly.
2 to 6 monthly until person stable on treatment then 6 monthly (or according to individual need). Discontinue if HbA1C has not reduced by at least 0.5% (5.5 mmol/mol) within 6 months of starting treatment.
3 monthly. Discontinue if HbA1C has not reduced by at least 1% (11 mmol/mol) in 6 months and if a weight loss of at least 5% has not been achieved at 1 year.
Measure at least 6 – 8 weeks following a dose change then 12 monthly once stable Drug Monitoring
Monthly once shared care initiated and if remains stable reduce monitoring to 3 monthly. People heterozygote for TPMT monitor at monthly intervals.
3 monthly once shared care initiated.
See shared care protocol specific to NHS
2 monthly once shared care initiated.
Foundation Trust patient is under. Please note
If co-prescribed with another immunosuppressant or monitoring suggested is a guide only and shared
potentially hepatoxic agent monthly monitoring should be care guidance may differ across different trusts.
6 monthly in 2nd year if results have been stable.
Thereafter, monitoring may be discarded. Drug Monitoring
Abbreviations:
U&Es
Urea and Electrolytes incl. creatinine and eGFR Reviewed and Updated March 2010 byIan Davidson Associate Director of Primary Care and Clinical Quality CDPCT

Source: http://cddmedicinesmanagement.nhs.uk/documents/Prescribing/Guidelines/Drug_Monitoring/Drug_monitoring_guide.pdf

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