Therapeutic Drug Monitoring最新文献

{"title":"\"Goofballing\": An Emerging Threat With Clinical Challenges-A Short Communication.","authors":"Guillaume Drevin, Marie Briet, Séverine Ferec, Chadi Abbara","doi":"10.1097/FTD.0000000000001354","DOIUrl":"https://doi.org/10.1097/FTD.0000000000001354","url":null,"abstract":"<p><strong>Background: </strong>The coinjection of methamphetamine and opioids, known as \"goofballing,\" is an emerging practice among people who inject drugs. This combination poses significant clinical challenges due to the opposing pharmacological effects of stimulants and depressants. The increasing prevalence of this practice, particularly in North America, raises significant concerns regarding its impact on public health and patient management.</p><p><strong>Material and methods: </strong>The authors report the case of a 48-year-old man admitted to the intensive care unit with suspected sepsis after intravenous heroin use. During methadone substitution therapy, the patient developed hyperthermia, diffuse myalgia, and mild somnolence. Physical investigation revealed no evidence of infection. Toxicological analyses were conducted on blood and urine samples using targeted and nontargeted screening methods.</p><p><strong>Results: </strong>Toxicological analyses revealed the presence of methamphetamine, amphetamine (a metabolite of methamphetamine), morphine, codeine, methadone, and EDDP in both blood and urine. The presence of 6-acetylmorphine in the urine confirmed recent heroin exposure. No other substances were detected in any sample. The patient was later treated for coinjection of heroin and methamphetamine, which supported the diagnosis of goofballing-induced hyperthermia rather than sepsis.</p><p><strong>Conclusions: </strong>This case highlights the diagnostic challenges associated with the \"goofball\" phenomenon. The coadministration of methamphetamine and heroin can lead to severe atypical toxicological symptoms. Health care providers should be aware of this emerging practice to ensure rapid diagnosis and appropriate management. Public health initiatives should focus on harm reduction strategies to mitigate associated risks.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of Teicoplanin Dosing Regimen in Adult Patients Using an Externally Evaluated Population Pharmacokinetic Model.","authors":"Xiaojing Li, Qiang Sun, Genzhu Wang, Xiaoying Wang, Baiqian Xing, Zhikun Xun, Zhongdong Li","doi":"10.1097/FTD.0000000000001349","DOIUrl":"https://doi.org/10.1097/FTD.0000000000001349","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify population pharmacokinetic models suitable for optimizing individualized teicoplanin dosing regimens in adult Chinese patients.</p><p><strong>Methods: </strong>PubMed and Web of Science were searched for teicoplanin population pharmacokinetic models developed for the general adult population. Patient data used for the external evaluation, including demographics, teicoplanin-related information (administration and blood concentration), and laboratory test values, were collected from the Beijing Electric Power Hospital. External evaluation was performed using the Nonlinear Mixed-Effects Modeling software. Models with excellent predictive abilities were identified, and Monte Carlo simulations were conducted.</p><p><strong>Results: </strong>A total of 66 teicoplanin concentrations used for external evaluation were obtained from 62 patients. The model built by Ogami et al performed excellently, with a bias of -7.56% and inaccuracy of 26.28%. The model consisted of the following parameters: clearance (L/h) = (0.379 + 0.211 × creatinine clearance/100) × (total body weight/70)0.75; volume (V) 1 (L) = 38.2 × (fat-free mass/70); Q (L/h) = 2.42 × (total body weight/70)0.75; V2 (L) = 106 × (fat-free mass/70). The model was subsequently used in Monte Carlo simulations (n = 1000). For general infections (minimum plasma concentration [Cmin] = 10-15 mg/L), the loading dose (LD) and maintenance dose (MD) of teicoplanin should be at least 400 mg to achieve the target concentration. For endocarditis or severe infections, where a target concentration (Cmin = 15-30 mg/L) is required, LD should be at least 800 mg. Alternatively, the LD and MD of teicoplanin should be at least 600 mg to achieve desired therapeutic levels.</p><p><strong>Conclusions: </strong>By combining external evaluations using Nonlinear Mixed-Effects Modeling with Monte Carlo simulations, the model developed by Ogami et al was identified as the most suitable for guiding clinical dosing under different pathophysiological conditions.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rational Basis for Personalized Treatment Using Concentration-Guided Dosing.","authors":"Nick Holford, Zvonimir Petric","doi":"10.1097/FTD.0000000000001350","DOIUrl":"https://doi.org/10.1097/FTD.0000000000001350","url":null,"abstract":"<p><strong>Background: </strong>The purpose of the review is to explain and encourage the use of terminology that distinguishes between the steps of measurement and reporting of concentrations, interpretation of the measurements, and subsequent prediction of individualized doses. The principles of concentration-guided dosing (CGD) provide a rational basis for personalized dosing. Existing terminology such as therapeutic drug monitoring (TDM) or model-informed precision dosing (MIPD) may have multiple meanings or be imprecisely defined. A brief history of CGD reveals the evolution of more accurate terminology focused on using concentration observations to provide individual drug dose guidance to clinicians.</p><p><strong>Methods: </strong>Relevant literature was identified using keyword searches such as \"TDM,\" \"therapeutic range,\" \"individualized dosing,\" \"target concentration intervention,\" \"precision dosing,\" \"MIPD,\" and \"personalized dosing.\" Studies were included if they addressed the theoretical basis, clinical implementation, and/or effectiveness of CGD approaches. The findings were synthesized to underscore the relevance of a CGD approach in the context of clinical pharmacology.</p><p><strong>Results: </strong>CGD is commonly implemented using either the therapeutic window approach (TWA) or the target concentration approach (TCA). The dosing approach is often not specified for TDM and MIPD. Clinicians, clinical pharmacologists, and pharmacists have typically been trained to view TWA as the gold standard for personalized dosing.</p><p><strong>Conclusions: </strong>Although many clinicians are well-versed in dosing using TWA, understanding and awareness of the benefits of TCA are still lacking. TCA offers accurate, personalized treatment by guiding the clinical team to use an optimally effective and safe dose for each patient.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Modeling for Predicting Infliximab Pharmacokinetics in Pediatric and Young Adult Patients With Crohn Disease: Leveraging Ensemble Modeling With Synthetic and Real-World Data.","authors":"Kei Irie, Phillip Minar, Jack Reifenberg, Brendan M Boyle, Joshua D Noe, Jeffrey S Hyams, Tomoyuki Mizuno","doi":"10.1097/FTD.0000000000001348","DOIUrl":"https://doi.org/10.1097/FTD.0000000000001348","url":null,"abstract":"<p><strong>Background: </strong>Predicting infliximab pharmacokinetics (PK) is essential for optimizing individualized dosing in pediatric patients with Crohn disease (CD). Machine learning (ML) has emerged as a tool for predicting drug exposure; however, its development typically requires large datasets. This study aimed to develop an ML model for infliximab PK prediction by leveraging population PK model-based synthetic and real-world data.</p><p><strong>Methods: </strong>An initial ML model was trained using the XGBoost algorithm with synthetic infliximab concentration data (n = 560,000) generated from an established pediatric PK model. The prediction errors were assessed using real-world data, including 292 plasma concentrations from 93 pediatric and young adult patients with CD. A second XGBoost model, incorporating clinical features, was used to correct these errors. The performance of the model was evaluated using the root mean square error (RMSE) and mean prediction error (MPE).</p><p><strong>Results: </strong>The first ML model yielded RMSE and MPE values of 6.44 and 1.84 mcg/mL, respectively. The features of the second XGBoost model included the predicted infliximab concentrations, cumulative dose, and dosing interval duration. A 5-fold cross-validation demonstrated improved performance of the ensemble model (RMSE = 4.30 ± 1.09 mcg/mL, MPE = 0.21 ± 0.39 mcg/mL) compared with the initial model and was comparable with the Bayesian approach (RMSE = 4.81 mcg/mL, MPE = -0.67 mcg/mL).</p><p><strong>Conclusions: </strong>This study demonstrated the feasibility of combining synthetic and real-world data to develop an ML-based approach for infliximab PK prediction, potentially enhancing precision dosing in pediatric CD.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Lenvatinib Concentration Monitoring in a Patient With Thyroid Cancer Exhibiting Hand-Foot Syndrome.","authors":"Yusuke Watanabe, Kosuke Doki, Ikuo Sekine, Hisato Hara, Masato Homma","doi":"10.1097/FTD.0000000000001312","DOIUrl":"10.1097/FTD.0000000000001312","url":null,"abstract":"<p><strong>Background: </strong>Hand-foot syndrome (HFS) is a common adverse event associated with lenvatinib treatment. Lenvatinib dose adjustment using therapeutic drug monitoring may be beneficial in the management of HFS, as symptoms improve with dose reduction or treatment interruption. The serum lenvatinib levels were monitored in a patient with lenvatinib-induced HFS.</p><p><strong>Case presentation: </strong>A 74-year-old woman was administered lenvatinib (24 mg/d) for papillary thyroid cancer. Although lenvatinib was withheld several times owing to the occurrence of HFS, the severity of the HFS was controlled to within grade 1 by reducing the dose to 4 mg/d. The lenvatinib dose was subsequently increased to 8 mg/d owing to the progression of lung metastases, resulting in increased HFS severity. The association between serum lenvatinib levels and the severity of HFS was examined in this case: serum lenvatinib levels were higher in grade 2 HFS than in grade 1 HFS (median 42.1 vs. 22.5 ng/mL; P < 0.05).</p><p><strong>Conclusions: </strong>This case's findings suggest that serum lenvatinib concentrations are associated with the severity of lenvatinib-induced HFS and that there may be an overlap between drug concentrations, metastatic suppression, and the grade of HFS.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":"323-325"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nifedipine May Be an Inhibitor of Clozapine Metabolism as Seen in 5 Patients: 2 From a US Double-Blind Study and 3 From a German Therapeutic Drug Monitoring Study.","authors":"Georgios Schoretsanitis, Ekkehard Haen, Hélène Verdoux, Michael Paulzen, Jose de Leon","doi":"10.1097/FTD.0000000000001277","DOIUrl":"10.1097/FTD.0000000000001277","url":null,"abstract":"<p><strong>Background: </strong>Clozapine is the only licensed antipsychotic for treatment-refractory schizophrenia. Therapeutic drug monitoring (TDM) refers to the measurement of clozapine concentration. Clozapine TDM can be used to optimize treatment, particularly by identifying pharmacokinetic interactions between clozapine and comedications.</p><p><strong>Methods: </strong>We identified 5 cases of patients with available clozapine concentrations who were concomitantly receiving nifedipine and clozapine. These cases were drawn from 2 independent datasets: 2 from a double-blind, randomized clinical trial in the United States and 3 from a German TDM naturalistic database. As an index of clozapine clearance, we used the trough-level concentration-to-dose (C/D) ratios to estimate the minimum therapeutic doses. To estimate dose-correction factors for nifedipine treatment, we included only clozapine concentrations at steady state. We divided the clozapine minimum therapeutic doses (MTD) from the on-condition by the off-nifedipine condition.</p><p><strong>Results: </strong>In 4 patients, the ratio of on/off nifedipine for MTD ranged between 0.58 and 0.82. Another patient had no data and had to be compared with published control data (female smoker of African ancestry), providing a correction factor of 0.52 after eliminating 5 concentrations contaminated by the development of obesity.</p><p><strong>Conclusions: </strong>In the absence of access to TDM, when prescribing nifedipine to clozapine-treated patients, we recommend reducing the daily dose of clozapine by one-third because of the weak inhibition of clozapine metabolism. With access to TDM, TDM should guide dosing as unusual patients may need larger dose reductions, as it is possible that in some patients, nifedipine may be a moderate inhibitor requiring halving clozapine dose. Further prospective studies are warranted.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":"47 3","pages":"438-441"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanism-Based Pharmacokinetic/Pharmacodynamic Model of Voriconazole for Predicting the Clinical Outcomes of Adult Patients With Invasive Aspergillosis.","authors":"Monchai Duangpraphat, Richard C Wilson, Timothy M Rawson, Wichai Santimaleeworagun, Worapong Nasomsong, Alison H Holmes, Vasin Vasikasin","doi":"10.1097/FTD.0000000000001268","DOIUrl":"10.1097/FTD.0000000000001268","url":null,"abstract":"<p><strong>Background: </strong>Voriconazole is the first-line therapy for invasive aspergillosis (IA). To determine the minimum inhibitory concentration of Aspergillus, a voriconazole pharmacokinetic-pharmacodynamic (PK-PD) model linked to galactomannan response was developed and evaluated, and its clinical correlation for IA treatment was elucidated.</p><p><strong>Methods: </strong>Adult patients with probable or definite IA and at least one serum voriconazole measurement were included. A two-compartment voriconazole PK model was linked to a previously described PD model of galactomannan response. PK and PD parameters were estimated using a nonparametric adaptive grid technique. The relationship between the ratio of voriconazole exposure that induced half-maximum galactomannan response (EC50) and the observed terminal galactomannan concentration was evaluated. The factors associated with the PK-PD parameters and mortality were also determined.</p><p><strong>Results: </strong>Between January 2013 and December 2022, 41 patients were prescribed voriconazole for IA. The 30-day mortality rate was 17%. A high correlation was found for the observed-predicted Bayesian posterior estimates of voriconazole and galactomannan levels. Moreover, a nonlinear relationship was identified between AUC:EC50 and terminal galactomannan. The factors associated with higher AUC:EC50 were intravenous administration and intubation. In the survival analysis, higher EC50 tended to be associated with mortality, higher AUC was significantly associated with increased mortality, and higher AUC:EC50 tended to be associated with higher mortality. After adjusting for the intravenous route, higher AUC and AUC:EC50 were not associated with mortality.</p><p><strong>Conclusions: </strong>Individual EC50 estimation can provide insights into in vivo host and organism responses. Elevated EC50 showed comparable and unfavorable trends to higher minimum inhibitory concentration. Thus, determining EC50 might help guide individualized target serum voriconazole levels.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":"378-384"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analytical Documentation of a Purple Urine Bag Syndrome Case.","authors":"Alexandr Gish, Apolline Saint Omer, Juliette Faillie, Arnaud Lionet, Aghiles Hamroun, Olivier Gaillot, Marie Lenski, Jean-Michel Gaulier","doi":"10.1097/FTD.0000000000001313","DOIUrl":"10.1097/FTD.0000000000001313","url":null,"abstract":"","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":"442-443"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose Optimization of Amikacin in the Emergency Department: A Population Pharmacokinetics Simulation Study.","authors":"Nada Dia, Sabrina De Winter, Matthias Gijsen, Stefanie Desmet, Peter Vanbrabant, Willy Peetermans, Isabel Spriet, Erwin Dreesen","doi":"10.1097/FTD.0000000000001279","DOIUrl":"10.1097/FTD.0000000000001279","url":null,"abstract":"<p><strong>Background: </strong>In adult patients with sepsis or septic shock admitted to the emergency department, a single intravenous 15 mg/kg amikacin dose provides inadequate pharmacokinetic-pharmacodynamic target attainment at the locally reported minimum inhibitory concentration (MIC) of 2 mg/L and the European Committee on Antimicrobial Susceptibility Testing clinical breakpoint for Enterobacterales of 8 mg/L.</p><p><strong>Objectives: </strong>To provide an amikacin dosing strategy with a clinically acceptable probability of target attainment (PTA) for all patients.</p><p><strong>Methods: </strong>Stochastic simulations were performed using a two-compartment population pharmacokinetics model of amikacin (NONMEM 7.5). PTA was evaluated for various dosing strategies across a range of virtual patients' body weight, body mass index, serum total protein, serum sodium, fluid balance, and estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (eGFR CKD-EPI ), at the locally reported MIC of 2 mg/L and the clinical breakpoint of 8 mg/L. The pharmacokinetic-pharmacodynamic targets were a 24-hour area under the concentration-time curve (AUC 24h )/MIC of ≥80 and a 24-hour postdose concentration (C 24h ) of < 3 mg/L for efficacy and safety, respectively.</p><p><strong>Results: </strong>The PTA for the clinical breakpoint of 8 mg/L was <90% with standard 15 mg/kg dosing, across all patient characteristics. A flat 1500-mg dose achieved ≥90% PTA for the entire population at a MIC of 2 mg/L. However, at the clinical breakpoint of 8 mg/L, a flat 3500-mg dose provided ≥90% PTA only when the eGFR CKD-EPI was <96 mL/min/1.73 m 2 . The C 24h was similar for 1500 mg and 15 mg/kg dosing, whereas 3500 mg resulted in a higher C 24h .</p><p><strong>Conclusions: </strong>A flat dose is recommended over weight-based dosing. However, selecting a 1500-mg or 3500-mg dose may compromise either efficacy (MIC 2 mg/L) or safety (clinical breakpoint 8 mg/L), posing a dilemma. Clinical validation is warranted.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":"47 3","pages":"353-362"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lamotrigine Use in Lactating Women: Passage Into Breast Milk and Infant Exposure.","authors":"Daphne den Besten-Bertholee, Ilse Wegner, Daan J Touw, Peter G J Horst, Paola Mian","doi":"10.1097/FTD.0000000000001299","DOIUrl":"10.1097/FTD.0000000000001299","url":null,"abstract":"<p><strong>Background: </strong>Lamotrigine, an antiseizure medication used for epilepsy and bipolar disorders, is often prescribed to women of childbearing age due to relatively low teratogenic risk. It is known that lamotrigine use in lactation leads to detectable concentrations in breast milk, although concentrations vary significantly among individuals.</p><p><strong>Case presentation: </strong>A 35-year-old pregnant woman with epilepsy presented to our outpatient clinic. She was seizure-free and was taking lamotrigine 200 mg once daily. She is highly motivated to breastfeed her baby after birth but is concerned about the infant's exposure to lamotrigine through lactation. Lamotrigine concentrations were measured in both the breast milk and plasma of the suckling infants.</p><p><strong>Conclusions: </strong>Although lamotrigine is excreted into breast milk, and detectable in infants, the benefits of breastfeeding should not be overlooked. Higher plasma concentrations generally lead to higher breast milk concentrations, so aiming for the lowest possible maternal plasma levels is beneficial. These findings underscore the importance of TDM in this population.</p>","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":" ","pages":"317-319"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}