A cross sectional knowledge attitude practice study on therapeutic drug monitoring among health care professionals in a tertiary care hospital

Poovizhi Bharathi Rajaduraivelpandian, Padmaja Udaykumar


Background: Therapeutic drug monitoring (TDM) is used to optimize drug’s therapeutic effect. Aim of this study is to assess the knowledge, attitude and practice of TDM in health care professionals.

Methods: This was a questionnaire-based cross-sectional study. Questionnaires were distributed to 610 nursing staff and 20 lab technicians. Questionnaires had queries on demography, knowledge, attitude and practice. Descriptive statistics and Pearson correlation were used to analyse the data.

Results: Among nurses, 7% had good, 60.9% had   fair and 32.2% had poor knowledge of TDM. Among lab technicians 18.2% had good and 81.8% had fair knowledge on TDM. 79.3% of nurses and all lab technicians had favourable attitude towards TDM. Weak positive correlation is seen between knowledge and attitude among nurses. 15.9% of nurses have sent request for TDM on phenytoin, sodium valproate, carbamazepine, methotrexate, lithium, clozapine, risperidone, tigecycline, vancomycin, gentamicin, digoxin and amiodarone. 100% lab technicians have estimated levels of methotrexate and lithium drug sample during the last one year.

Conclusions: Though knowledge on indication and pharmacological basis of TDM is lacking among participants, their knowledge on sample collection and sample type is good. They have a positive attitude towards TDM. Nurses have requested TDM for only 12 drugs. TDM of only two drugs was done by lab technicians. Future training should focus on pharmacological basis, selection of appropriate drug candidate and indication for TDM service. TDM service should be made available in all tertiary care institutions.


Adverse drug reaction, Cost benefit ratio, Lab technicians, Nurses, Therapeutic index

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Jang SH, Yan Z, Lazor JA. Therapeutic drug monitoring: A patient management tool for precision medicine. Clin Pharmacol Ther. 2016;99:148-50.

Hiemke C, Bergemann N, Clement HW, Conca A, Deckert J, Domschke K, et al. Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017. Pharmacopsychiatry. 2018;51(1-2):9-62.

Lee JJ, Beumer JH, Chu E. Therapeutic drug monitoring of 5-fluorouracil. Cancer Chemother Pharmacol. 2016;78(3):447-64.

Verheijen RB, Yu H, Schellens JHM, Beijnen JH, Steeghs N, Huitema ADR. practical Recommendations for Therapeutic Drug Monitoring of Kinase Inhibitors in Oncology. Clin Pharmacol Ther. 2017;102(5):765-76.

Moeung S, Chevreau C, Broutin S, Guitton J, Lelièvre B, Ciccolini J, et al. Therapeutic Drug Monitoring of Carboplatin in High-Dose Protocol (TI-CE) for Advanced Germ Cell Tumors: Pharmacokinetic Results of a Phase II Multicenter Study. Clin Cancer Res. 2017;23(23):7171-9.

Allegra S, Fatiguso G, Francia DS, Favata F, Pirro E, Carcieri C, et al. Therapeutic drug monitoring of voriconazole for treatment and prophylaxis of invasive fungal infection in children. Br J Clin Pharmacol. 2018;84(1):197-203.

Falzon D, Jaramillo E, Gilpin C, Weyer K. Therapeutic drug monitoring to prevent acquired drug resistance of fluoroquinolones in the treatment of tuberculosis. Eur Respir J. 2017;49(4).

Mitrev N, Casteele VN, Seow CH, Andrews JM, Connor SJ, Moore GT, et al. consensus statements on therapeutic drug monitoring of anti-tumour necrosis factor therapy in inflammatory bowel diseases. Aliment Pharmacol Ther. 2017;46(11-12):1037-53.

Doki K. Use of Pharmacogenetic Information for Therapeutic Drug Monitoring of an Antiarrhythmic Drug. Yakugaku Zasshi. 2018;138(9):1145-50.

Aonuma K, Shiga T, Atarashi H, Doki K, Echizen H, Hagiwara N, et al. Guidelines for Therapeutic Drug Monitoring of Cardiovascular Drugs Clinical Use of Blood Drug Concentration Monitoring (JCS 2015) - Digest Version. Circ J. 2017;81(4):581-612.

Serragui S, Zalagh F, Tanani DS, Ouammi L, Moussa LA, Badrane N, et al. Therapeutic drug monitoring of three antiepileptic drugs - back on twenty years of experience. Pan Afr Med J. 2016;25:10.

Jacob S, Nair AB. An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs. Drugs R D. 2016;16(4):303-16.

Urban AE, Cubala WJ. Therapeutic drug monitoring of atypical antipsychotics. Psychiatr Pol. 2017;51(6):1059-77.

Grundmann M, Kacirova I, Urinovska R. Therapeutic monitoring of psychoactive drugs - antidepressants: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(1):35-43.

Aghahowa SE, Ekeocha LE, Uhumwangho MU. Therapeutic drug monitoring: Perception among health - care workers in a developing tertiary institution. Nig Hosp Prac. 2015;16:1-3.

Destache CJ. Use of therapeutic drug monitoring in pharmacoeconomics. Ther Drug Monit. 1993;15(6):608-10.

Ndosi ME, Newell R. Nurses knowledge of pharmacology behind drugs they commonly administer. J Clin Nurs. 2009;18(4):570-80.

Law S, Haddad PM, Chaudhry IB, Hussain N, Drake RJ, Flanagan RJ, et al. Antipsychotic therapeutic drug monitoring: Psychiatrists attitude and factors predicting likely future use. Ther Adv Psychopharmacol. 2015;5(4):214-23.

Gogtay NJ, Kshirsagar NA, Dalvi SS. Therapeutic drug monitoring in a developing country: an overview. Br J Clin Pharmacol. 2001;52(1):103-8.

Schoenenberger JA, Aragones AM, Cano SM, Puig T, Castello A, Arbones GX, et al. The advantages of therapeutic drug monitoring in patients receiving antiretroviral treatment and experiencing medication-related problems. Ther Drug Monit. 2013;35(1):71-7.

Sireen ARS. The current status and future prospects of therapeutic drug monitoring of chemotherapy in Jordan. JJPS. 2012;5:51-62.