TDM of psychoactive medication in the risk patient

Elderly patients with multiple drug treatments without severe organic impairment or with pre-existing cardiovascular, liver, kidney and cerebral diseases, pregnant and nursing women, drug dependant patients and children belong to risk groups regarding treatment with psychoactive medication. Psychoactive drugs are prescribed to 60% of elderly nursing home inhabitants mostly as long term medication. Besides about 5 different drugs prescribed over the counter medications (not devoid of drug drug interactions as e.g. St Johns’ word) are used. TDM is the main tool to reduce risk of toxicity due to drug drug interactions and an widely accessible means to monitor drug concentrations in high risk conditions like liver disease and renal impairment or in case of emergencies like cardiac infarction, arrhythmias or comatose states.