4 We defined the following drugs to be NTI-drugs: aminoglycosides, ciclosporin, carbamazepine, digoxin, digitoxin, flecainide, lithium, phenytoin, phenobarbital, rifampicin, theophylline and warfarin.
Why some drugs have narrow therapeutic index?
Some drugs have a narrow therapeutic index, which means that there is only a small difference between the minimum effective concentrations and the minimum toxic concentrations in the blood. With such drugs, small increases in dose or in blood/serum concentrations could lead to toxic effects.
What is narrow therapeutic index?
Name Narrow Therapeutic Index Drugs Accession Number DBCAT003972 Description. Narrow therapeutic index (NTI) drugs are defined as those drugs where small differences in dose or blood concentration may lead to dose and blood concentration dependent, serious therapeutic failures or adverse drug reactions.
Which antibiotic has the narrowest therapeutic index?
Most antibiotics, such as the β-lactams, macrolides and quinolones have a wide therapeutic index and therefore do not require therapeutic drug monitoring. Some, such as the aminoglycosides and vancomycin, have a narrow therapeutic index, and toxicity may be severe and irreversible.Which drug is typically considered a narrow therapeutic index NTI drug?
Example NTI drugs include warfarin, levothyroxine, carbamazepine, digoxin, lithium carbonate, phenytoin, and theophylline. – Small within subject variability.
Does lithium have a narrow therapeutic range?
Lithium has a narrow therapeutic index; a large proportion of patients on chronic lithium therapy experience at least one episode of toxicity during treatment [8]. The highest intracellular lithium levels are found in the brain and the kidneys.
Is warfarin a narrow therapeutic index?
Not only does warfarin exhibit a narrow therapeutic index, but there can be 10 to 20-fold differences in the warfarin dose required to achieve target INR.
Does paracetamol have a narrow therapeutic index?
Other examples of drugs with a narrow therapeutic range, which may require drug monitoring both to achieve therapeutic levels and to minimize toxicity, include: paracetamol (acetaminophen), dimercaprol, theophylline, warfarin and lithium carbonate.Is theophylline a narrow therapeutic index drug?
Theophylline has an extremely narrow therapeutic window. Therefore, Theophylline toxicity occurs when serum theophylline levels surpass the levels in the therapeutic range.
Does penicillin have a narrow therapeutic index?For most patients (except those who are hypersensitive), penicillin has a very high therapeutic ratio and it is safe to use in much higher doses than those required to treat the patient, with no requirement to check the concentration attained.
Article first time published onIs Methotrexate a narrow therapeutic index?
Additionally, because methotrexate is not an emergency medication, and is not a narrow therapeutic index product, lack of, or partial, administration would not be expected to result in clinically significant concerns.
Why does warfarin have a narrow therapeutic range?
Warfarin is a narrow therapeutic index drug where individual daily dose requirements vary by at least 40-fold. Inability to maintain an INR between 2 and 3 can predispose to either thrombosis (INR<2) or haemorrhage (INR>3). Warfarin is metabolised by various P450 enzymes, the most important being CYP2C9.
Does aspirin have a narrow therapeutic index?
Clearly, most clinicians do not consider aspirin a Narrow Therapeutic Index drug. However, in its use as an antirheumatic drug, the dose required to achieve the therapeutic effects is close to the dose that results in undesirable toxicity.
Is Heparin a narrow therapeutic range?
Because UFH has a narrow therapeutic window and may cause bleeding complications, aggressive monitoring is necessary to ensure efficacy and patient safety. For these reasons, the Institute for Safe Medication Practices (ISMP) placed heparin on a list of high-alert medications.
Does gentamicin have a narrow therapeutic index?
Like other aminoglycosides, gentamicin has a narrow therapeutic index and therapeutic drug monitoring has proven to be beneficial, particularly in vulnerable populations such as the elderly.
Is tacrolimus a narrow therapeutic index?
Tacrolimus has a narrow therapeutic index (NTI), giving rise to questions about the potential for clinically relevant altered drug exposure.
Is levothyroxine a narrow therapeutic index drugs?
The reasons for this tendency are not fully clear, but levothyroxine is a medicine with a narrow therapeutic index, meaning that relatively small deviations from the proper dose can cause a clinically meaningful shift in pharmacological effects when administered to a patient.
What are the drugs with high therapeutic index?
- warfarin.
- lithium.
- digoxin.
- phenytoin.
- gentamicin.
- amphotericin.
- 5-fluoro-urocil.
- zidovudine.
What is the therapeutic index of paracetamol?
There have been no reports of acute toxicity in healthy adults ingesting a single dose of paracetamol below 125 mg/kg; historical data suggest that toxicity gen- erally occurs only above 150 mg/kg (176) (the therapeutic paracetamol dose is 10–15 mg/kg, therefore the therapeutic index is ~10).
What is the therapeutic range for theophylline?
Therapeutic serum levels of theophylline are between 10 to 20 mcg/ml. Most adults achieve these concentrations with daily slow-release oral theophylline preparations, 200-400 mg (approximately 10 mg/Kg) twice a day.
What is the therapeutic range for digoxin?
Therapeutic levels of digoxin are 0.8-2.0 ng/mL. The toxic level is >2.4 ng/mL.
How does lithium affect sodium levels?
While taking lithium, do not make sudden changes to your salt intake. A sudden decrease in sodium intake (a component of salt) may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall.
Does carbamazepine have a narrow therapeutic index?
Background and objectives: Carbamazepine is among those drugs that have been considered to have a narrow therapeutic plasma concentration range, that is, a narrow therapeutic index.
Does clindamycin have a narrow therapeutic index?
There are many drugs that have a narrow therapeutic index; in fact, too many to provide a complete list here. However, some of the most well-known include Lithium, Phenobarbitol, Phenytoin, Fentanyl, and Clindamycin.
Does rivaroxaban have a narrow therapeutic index?
Bioequivalence Study of 2 Formulations of Rivaroxaban, a Narrow-Therapeutic-Index Drug, in Healthy Chinese Subjects Under Fasting and Fed Conditions. Clin Pharmacol Drug Dev.
Do oral anticoagulants have a narrow therapeutic range?
In this context, warfarin is the most widely prescribed oral anticoagulant agent for preventing and treating these events. This medication has a narrow therapeutic range and, consequently, patients usually have difficulty in achieving and maintaining stable target therapeutics.
Which therapeutic index is the safest?
The larger the therapeutic index (TI), the safer the drug is. If the TI is small (the difference between the two concentrations is very small), the drug must be dosed carefully and the person receiving the drug should be monitored closely for any signs of drug toxicity.
Is heparin only IV?
Heparin comes as a solution (liquid) to be injected intravenously (into a vein) or deeply under the skin and as a dilute (less concentrated) solution to be injected into intravenous catheters. Heparin should not be injected into a muscle.
