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Babu M, Pavithran K. Therapeutic Drug Monitoring as a Tool for Therapy Optimization. Drug Metab Lett 2022; 15:DML-EPUB-122284. [PMID: 35382721 DOI: 10.2174/1872312815666220405122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
Abstract
The use of pharmacotherapy for improving healthcare in society is increasing. A vast majority of patients have either received subtherapeutic treatment (which could result from low pharmacokinetic) or experienced adverse effects due to the toxic levels of the drug. The medicines used to treat chronic conditions, such as epilepsy; cardiovascular diseases; and oncological, neurological, and psychiatric disorders, require routine monitoring. New targeted therapies suggest an individualized treatment that can slowly move practitioners away from the concept of a one-size-fits-all-fixed-dosing approach. Therapeutic drug use can be monitored based on pharmacokinetic, pharmacodynamic, and pharmacometric methods. Based on the experiences of therapeutic drug monitoring of various agents across the globe, we can look ahead to the possible developments of therapeutic drug monitoring in India.
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Affiliation(s)
- Merin Babu
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre Amrita Vishwa Vidyapeetham, Ponekkara P.O, Kochi, Kerala, India
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre Amrita Vishwa Vidyapeetham, Ponekkara P.O, Kochi, Kerala, India
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Rice FL, Albrecht PJ, Wymer JP, Black JA, Merkies IS, Faber CG, Waxman SG. Sodium channel Nav1.7 in vascular myocytes, endothelium, and innervating axons in human skin. Mol Pain 2015; 11:26. [PMID: 25957174 PMCID: PMC4447014 DOI: 10.1186/s12990-015-0024-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/24/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The skin is a morphologically complex organ that serves multiple complementary functions, including an important role in thermoregulation, which is mediated by a rich vasculature that is innervated by sympathetic and sensory endings. Two autosomal dominant disorders characterized by episodes of severe pain, inherited erythromelalgia (IEM) and paroxysmal extreme pain disorder (PEPD) have been directly linked to mutations that enhance the function of sodium channel Nav1.7. Pain attacks are accompanied by reddening of the skin in both disorders. Nav1.7 is known to be expressed at relatively high levels within both dorsal root ganglion (DRG) and sympathetic ganglion neurons, and mutations that enhance the activity of Nav1.7 have been shown to have profound effects on the excitability of both cell-types, suggesting that dysfunction of sympathetic and/or sensory fibers, which release vasoactive peptides at skin vasculature, may contribute to skin reddening in IEM and PEPD. RESULTS In the present study, we demonstrate that smooth muscle cells of cutaneous arterioles and arteriole-venule shunts (AVS) in the skin express sodium channel Nav1.7. Moreover, Nav1.7 is expressed by endothelial cells lining the arterioles and AVS and by sensory and sympathetic fibers innervating these vascular elements. CONCLUSIONS These observations suggest that the activity of mutant Nav1.7 channels in smooth muscle cells of skin vasculature and innervating sensory and sympathetic fibers contribute to the skin reddening and/or pain in IEM and PEPD.
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Affiliation(s)
- Frank L Rice
- Integrated Tissue Dynamics, LLC, Rensselaer, NY, 12144, USA.
| | - Phillip J Albrecht
- Integrated Tissue Dynamics, LLC, Rensselaer, NY, 12144, USA. .,Department of Neurology, Albany Medical College, Albany, NY, 12209, USA.
| | - James P Wymer
- Department of Neurology, Albany Medical College, Albany, NY, 12209, USA.
| | - Joel A Black
- Center for Neuroscience & Regeneration Research, Yale University School of Medicine, West Haven, CT, 06516, USA. .,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
| | - Ingemar Sj Merkies
- Department of Neurology, Spaarne Hospital, Hoofddorp, the Netherlands. .,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Stephen G Waxman
- Center for Neuroscience & Regeneration Research, Yale University School of Medicine, West Haven, CT, 06516, USA. .,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
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