Pharmacodynamic principles and target concentration intervention

This tutorial reviews the principles of dose individualisation with an emphasis on target concentration intervention (TCI). Once a target effect is chosen then pharmacodynamics can predict the target concentration and pharmacokinetics can predict the target dose to achieve the required response. Dose individualisation can be considered at three levels: population, group and individual. Population dosing, also known as fixed dosing or “one size fits all” is often used but is poor clinical pharmacology; group dosing uses patient features such as weight, organ function and co-medication to adjust the dose for a typical patient; individual dosing uses observations of patient response to inform about pharmacokinetic and pharmacodynamics in the individual and use these individual differences to individualise dose.

Overviews and advances in studies of target concentration intervention / 中国药学杂志

OBJECTIVE: To review the target concentration intervention (TCI) theory and provide reliable evidences for the optimization of drug treatment in clinical practice. METHODS: Relevant literatures were extensively and comprehensively reviewed. RESULTS: Since 1960s, therapeutic drug monitoring (TDM) had been applied in clinical practice to realize individualized drug administration. Due to some potential limitations of TDM such as neglecting inter-individual variability and failure to take drug effects into account, more and more scholars proposed a new theory which is called TCI as an alternative of TDM. The TCI approach takes advantage of known patient variables, pharmacokinetics and pharmacodynamics to interpret drug effect and concentration observations. It not only overcomes the defects of TDM, but also provides a complete strategy for individual administration. CONCLUSION: TCI is an extension of TDM, which has clinical significance for individualized therapy.