Therapeutic Drug Monitoring LC/MS

Pharmacological treatments and their side effects can have an impact on the patients’ safety or life’s quality. Specifically, the so called ADME (absorption, distribution, metabolism, and excretion) of the drug can be highly influenced by the genetics, environment and administration of other drugs due to co-morbidities. Therefore, in some cases the treatment with a fixed drug dose can turn out risky for patients’ health. For this reason, the Monitoring of a drug therapy which is optimized for a specific case is necessary.
On one hand, this can be particularly needed for drugs that present a narrow therapeutic range, which can be easily exceeded causing many toxic effects and/or increasing drugdrug interactions (DDIs) (Tuzimski, et al. 2020_review). On the other hand, if the drug concentration is lower than the safety ranges the pharmacological activity might not occur.
In the light of this, Therapeutic Drug Monitoring (TDM) is a strategic way to “adjust” the treatment and the dose based on patient’s clinical case (Kuhlin_cMSpec_2018).

For a long time, immunoassays have been chosen as methods for TDM. However, the necessity to analyze specific metabolites and to avoid non-specific interference coming from other molecules or matrix led to switch to an alternative method which provides high selectivity and sensitivity, high-quality data and reproducibility. This has been found in liquid chromatography methods coupled with UV, fluorescence detectors (FLD) or MS detectors triple quad (Mass Spectrometry).Liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) techniques allows to analyze drugs with high selectivity and sensitivity.

IMMUNOSUPPRESSANTS   Immunosuppressants in whole blood by LC/MS – (100 tests) (Cyclosporin A, Everolimus, Sirolimus, Tacrolimus) Immunosuppressants in whole blood by LC/MS –  (500 tests) (Cyclosporin A, Everolimus, Sirolimus, Tacrolimus) Immunosuppressants DUAL KIT in whole blood/Plasma by LC/MS – (100 tests)  (Cyclosporin A, Everolimus, Mycophenolic Acid, Sirolimus, Tacrolimus) Immunosuppressants DUAL KIT in whole blood/Plasma by LC/MS –  (200 tests)  (Cyclosporin A, Everolimus, Mycophenolic Acid, Sirolimus, Tacrolimus) Immunosuppressants DUAL KIT in whole blood/Plasma by LC/MS –  (500 tests) (Cyclosporin A, Everolimus, Mycophenolic Acid, Sirolimus, Tacrolimus) Benzodiazepines in serum by LC/MS (100 tests) (Bromazepam, Lorazepam, Clonazepam, Flunitrazepam, Chlordemethyldiazepam, Nordiazepam, Clobazam, Diazepam, Midazolam, Nitrazepam, Oxazepam, Flurazepam, Triazolam)   Benzodiazepines in serum by LC/MS –  (100 tests) (Bromazepam, Lorazepam, Clonazepam, Flunitrazepam, Chlordemethyldiazepam, Nordiazepam, Clobazam, Diazepam, Midazolam, Nitrazepam, Norclobazam, Zopiclone, Trazodone, Demoxepam, Chlordiazepoxide)   Benzodiazepines and Barbiturates in urine by LC/MS (100 test) (Allobarbital, Alprazolam, Amobarbital, Barbital, Bromazepam, Butalbital, Cathinone, Clobazam, Clonazepam, Cocaethylene, Diazepam, Hexobarbital, Fentanyl, Flunitrazepam, Hydroxy-Alprazolam, Hydroxy-Bromazepam, Lorazepam, Lormetazepam, Lsd, Mescaline, Nordiazepam, Norketamine, Oxazepam, Pentobarbital, Secbutarbital, Secobarbital, Temazepam, Thiopental) ANTIARRHYTHMICS Antiarrhythmics in serum and in plasma by LC/MS (Amiodarone, Desethylamiodarone, Flecainide, Propafenone, Sotalol, Quinidine) ANTI-INFECTIVE DRUGS  Antibiotics in plasma by LC-MS/MS –  (100 tests) (Amikacin, Ceftazidime, Ciprofloxacin, Daptomycin, Gentamicin, Levofloxacin, Linezolid, Meropenem, Streptomycin, Teicoplanin, Vancomycin) Antibiotics in plasma by LC-MS/MS –  (500 tests) (Amikacin, Ceftazidime, Ciprofloxacin, Daptomycin, Gentamicin, Levofloxacin, Linezolid, Meropenem, Streptomycin, Teicoplanin, Vancomycin) Antimycotics in plasma by LC-MS/MS –(100 tests) ((5-Flucytosine, Anidulafungin, Caspofungin, Fluconazole, Hydroxy- Itraconazole, Isavuconazole, Itraconazole, Ketoconazole, Micafungin, Posaconazole, Voriconazole) Antituberculosis Drugs in plasma by LC/MS (100 tests)   ANTIEPILEPTICS   Antiepileptics in serum / in plasma by LC/MS – (100 tests) (Levetiracetam, Lamotrigine, Primidone, Oxcarbazepine, Carbamazepine Epoxide, 10,11-Dihydro-10-Hydroxy-Carbamazepine, Carbamazepine, Phelbamate, Desmethylsuximide, Rufinamide, Phenytoin, Methsuximide, Topiramate, Phenobarbital, Valproic Acid, Ethosuximide, Lacosamide, Zonisamide, Perampanel, Sulthiame, Pregabalin, Brivaracetam, Gabapentin, Stiripentol, Vigabatrin, Tiagabine) Antiepileptics in serum /plasma by LC/MS –  (500 tests) (Levetiracetam, Lamotrigine, Primidone, Oxcarbazepine, Carbamazepine Epoxide, 10,11-Dihydro-10-Hydroxy-Carbamazepine, Carbamazepine, Phelbamate, Desmethylsuximide, Rufinamide, Phenytoin, Methsuximide, Topiramate, Phenobarbital, Valproic Acid, Ethosuximide, Lacosamide, Zonisamide, Perampanel, Sulthiame, Pregabalin, Brivaracetam, Gabapentin, Stiripentol, Vigabatrin, Tiagabine)   Antiepileptics in plasma by LC/MS –  (100 tests) Levetiracetam, Lamotrigine, Primidone, Oxcarbazepine, Carbamazepine Epoxide, 10,11-Dihydro-10-Hydroxy-Carbamazepine, Carbamazepine, Phelbamate, Desmethylsuximide, Rufinamide, Phenytoin, Methsuximide, Topiramate, Phenobarbital, Valproic Acid, Ethosuximide, Lacosamide, Zonisamide, Perampanel)   Antiepileptics in plasma by LC/MS –  (500 tests) Levetiracetam, Lamotrigine, Primidone, Oxcarbazepine, Carbamazepine Epoxide, 10,11-Dihydro-10-Hydroxy-Carbamazepine, Carbamazepine, Phelbamate, Desmethylsuximide, Rufinamide, Phenytoin, Methsuximide, Topiramate, Phenobarbital, Valproic Acid, Ethosuximide, Lacosamide, Zonisamide, Perampanel)   CHEMOTHERAPY DRUGS Tamoxifen, Endoxifen in plasma by LC/MS – (100 tests) 5-Fluorouracil in PBMC by  LC-MS/MS (100 tests) Irinotecan in plasma by LC-MS/MS – (100 tests) Ponatinib in plasma by  LC-MS/MS (100 tests)      DRUGS FOR PANIC, ANXIETY OR MENTAL DISORDER Antidepressants in serum /plasma by LC/MS (Amitriptyline, Citalopram and Escitalopram, Clomipramine, Desipramine, Desvenlafaxine, Doxepine, Duloxetine, Fluoxetine, Fluvoxamine, Imipramine, Norclomipramine, Nordoxepine, Norfluoxetine, Nortriptyline, Paroxetine, Sertraline, Venlafaxine) Antipsychotics in plasma  by LC/MS – (Quetiapine, Aripiprazole, Olanzapine, Risperidone, Haloperidol, Clozapine, Norclozapine, Paliperidone, Fluphenazine, Ziprasidone)

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