Therapeutic Drug Monitoring in Pediatric Practice: A Critical Appraisal

The criteria for drug monitoring in children are almost similar as applicable in adults, though certain factors need to be taken into consideration. The dramatic pace of change in other areas of clinical therapeutics has not reflected significantly in the specialty of pediatrics, accounting for the poor development of therapeutic drug monitoring in children. Major drug interactions in the pediatric population have been revealed. CYP3A4 hepatic microsomal enzyme plays a major role in these drug interactions.The continuing education and awareness of these interactions among healthcare practitioners is critical in optimizing effectiveness and minimizing toxicity. Therapeutic drug monitoring is primarily indicated for drugs with narrow therapeutic margin; though certain category of patients may still manifest evidence of toxicity, despite drug concentration being within the therapeutic range. The use of pharmacodynamic data in synergy with therapeutic drug monitoring represents the most viable approach to individualized therapy. Pediatrics is at the epicenter of the emerging discoveries in the field of genomic medicine. The relevance of therapeutic drug monitoring as a global therapeutic index encompassing pharmacokinetics, pharmacodynamics, pharmacogenomics and drug interactions can never be overemphasized. In conclusion, the prospects of clinical pharmacogenomics as therapeutic drug monitoring for the future in pediatric practice is quite promising.