BMJ  2007;334:312-315 (10 February), doi:10.1136/bmj.39090.709537.47

Practice

Cases in primary care laboratory medicine

Pitfalls of testing and summary of guidance on safety monitoring with amiodarone and digoxin

¹ Clinical Laboratory, General Hospital, Bishop Auckland DL14 6AD, ² Department of Clinical Pharmacology, Division of Medical Sciences, University of Birmingham, Birmingham B15 2TH

Patients on a range of drug therapies are often not monitored appropriately, even though this can improve patient safety. Knowledge of the effects of drugs on non-target body systems is essential to guide monitoring and interpretation of monitoring tests

The first 150 words of the full text of this article appear below.

Introduction

Considerable guidance is available on the safety monitoring required for many commonly used drugs. In some cases, where a clinical effect correlates with drug concentrations, this involves monitoring concentrations of the drug in blood (therapeutic drug monitoring). In other cases, such monitoring is of limited value, although knowing drug concentrations can help in diagnosing toxicity. Secondary effects of the drug on other body systems may also be monitored by using other tests or measurements.

Audits of compliance with drug safety monitoring recommendations in a range of prescribing situations have shown that monitoring of compliance remains an important area for improvement as a contributor to patient safety.^{1 2 3 4 5}

This article considers two scenarios involving the cardiovascular drugs digoxin and amiodarone and the monitoring required to detect their therapeutic and adverse effects. It also reviews the evidence based and consensus guidance that is available.

Summary points Drug safety monitoring in routine practice is often suboptimal . . . [Full text of this article]

Case 1

Case 2

Discussion

Case 1
Box 1: What safety monitoring is required in a patient receiving digoxin in primary care?
Case 2
Box 2: What safety monitoring is required in a patient receiving amiodarone in primary care?

Evidence note

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