Why is Therapeutic Drug Monitoring (TDM) often required for Voriconazole therapy?

Answer

Genetic differences in CYP2C19 cause vast metabolic variability.

Therapeutic Drug Monitoring (TDM) is clinically necessary for voriconazole because its plasma concentrations are highly unpredictable among different patients, largely due to genetic polymorphisms affecting the CYP2C19 enzyme responsible for its clearance. Unlike many other medications where standard dosing achieves therapeutic targets reliably, voriconazole can be either dangerously high or ineffectively low based on individual metabolic rates. TDM allows clinicians to measure the actual blood concentration, especially in critically ill or immunocompromised patients, guiding necessary dose escalations or reductions to ensure the drug stays within the optimal therapeutic window, balancing the need for cure against the risk of toxicity.

Why is Therapeutic Drug Monitoring (TDM) often required for Voriconazole therapy?

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