Leading Article

Drug Safety

, Volume 29, Issue 9, pp 735-768

First online:

Therapeutic Drug Monitoring and Pharmacogenetic Tests as Tools in Pharmacovigilance

  • Eveline Jaquenoud SirotAffiliated withPsychiatrische Dienste Aargau AG, MediQ, Klinik Königsfelden Email author 
  • , Jan Willem van der VeldenAffiliated withGlobal Safety and Pharmacovigilance, PharmaNet AGPostgraduate Programme in Pharmaceutical Medicine, Université Libre de Bruxelles
  • , Katharina RentschAffiliated withInstitut für Klinische Chemie, Universitätsspital Zürich
  • , Chin B. EapAffiliated withUnité de Biochimie et Psychopharmacologie, Department of Psychiatry, Center for Psychiatric Neuroscience
  • , Pierre BaumannAffiliated withUnité de Biochimie et Psychopharmacologie, Department of Psychiatry, Center for Psychiatric Neuroscience

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Therapeutic drug monitoring (TDM) and pharmacogenetic tests play a major role in minimising adverse drug reactions and enhancing optimal therapeutic response. The response to medication varies greatly between individuals, according to genetic constitution, age, sex, co-morbidities, environmental factors including diet and lifestyle (e.g. smoking and alcohol intake), and drug-related factors such as pharmacokinetic or pharmacodynamic drug-drug interactions. Most adverse drug reactions are type A reactions, i.e. plasma-level dependent, and represent one of the major causes of hospitalisation, in some cases leading to death. However, they may be avoidable to some extent if pharmacokinetic and pharmacogenetic factors are taken into consideration.

This article provides a review of the literature and describes how to apply and interpret TDM and certain pharmacogenetic tests and is illustrated by case reports. An algorithm on the use of TDM and pharmacogenetic tests to help characterise adverse drug reactions is also presented. Although, in the scientific community, differences in drug response are increasingly recognised, there is an urgent need to translate this knowledge into clinical recommendations. Databases on drug-drug interactions and the impact of pharmacogenetic polymorphisms and adverse drug reaction information systems will be helpful to guide clinicians in individualised treatment choices.