Therapeutic Drug Monitoring

Safe and effective use of the TCA drugs requires monitoring of serum levels. The importance of this monitoring is based on the relatively narrow range between therapeutic and toxic doses (therapeutic index of 3) of each agent. While annoying side effects (sedation, dry mouth, constipation) begin to occur at subtherapeutic serum concentrations, life-threatening cardiac and CNS effects develop in a dose dependent fashion above serum levels of 500 ng/mL. The metabolism and elimination rates vary 10- to 30-fold among individuals taking TCA drugs. For this reason, it is estimated that only 50% of the patients receiving a standard dose of a TCA drug would achieve an optimal therapeutic serum concentration. Of additional concern, 3 to 5% of patients will be deficient in hepatic enzymes that metabolize the TCA drugs and may develop life-threatening serum levels on standard doses. Therefore, steady-state serum levels of TCA drugs (drawn 10 to 12 hours after the last dose) are monitored to avoid toxicity, monitor compliance, and optimize the therapeutic response.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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