TABLE A-3
TOXICOLOGY AND THERAPEUTIC DRUG MONITORING
|
|
THERAPEUTIC RANGE |
|
TOXIC LEVEL |
|
|
DRUG |
SI UNITS |
CONVENTIONAL UNITS |
SI UNITS |
CONVENTIONAL UNITS |
|
Acetaminophen |
66-199 μmol/L |
10-30 μg/mL |
>1320 μmol/L |
>200 μg/mL |
|
Amikacin |
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|
Peak |
34-51 μmol/L |
20-30 μg/mL |
>60 μmol/L |
>35 μg/mL |
|
Trough |
0-17 μmol/L |
0-10 μg/mL |
>17 μmol/L |
>10 μg/mL |
|
Amitriptyline/nortriptyline |
430-900 nmol/L |
120-250 ng/mL |
>1800 nmol/L |
>500 ng/mL |
|
(total drug) |
||||
|
Amphetamine |
150-220 nmol/L |
20-30 ng/mL |
>1500 nmol/L |
>200 ng/mL |
|
Bromide |
1.3-6.3 mmol/L |
Sedation: 10-50 |
6.4-18.8 mmol/L |
51-150 mg/dL: mild |
|
9.4-18.8 mmol/L |
mg/dL |
>18.8 mmol/L |
toxicity |
|
|
Epilepsy: 75-150 mg/dL |
>37.5 mmol/L |
>150 mg/dL: severe toxicity >300 mg/dL: lethal |
||
|
Carbamazepine |
17-42 μmol/L |
4-10 μg/mL |
85 μmol/L |
>20 Mg/mL |
|
Chloramphenicol |
||||
|
Peak |
31-62 Mmol/L |
10-20 Mg/mL |
>77 Mmol/L |
>25 Mg/mL |
|
Trough |
15-31 Mmol/L |
5-10 Mg/mL |
>46 Mmol/L |
>15 Mg/mL |
|
Chlordiazepoxide |
1.7-10 μmol/L |
0.5-3.0 μg/mL |
>17 μmol/L |
>5.0 μg/mL |
|
Clonazepam |
32-240 nmol/L |
10-75 ng/mL |
>320 nmol/L |
>100 ng/mL |
|
Clozapine |
0.6-2.1 ^moi/L |
200-700 ng/mL |
>3.7 μmol/L |
>1200 ng/mL |
|
Cocaine |
>3.3 Mmol/L |
>1.0 Mg/mL |
||
|
Codeine |
43-110 nmol/mL |
13-33 ng/mL |
>3700 nmol/mL |
>1100 ng/mL (lethal) |
|
Cyclosporine |
||||
|
Renal transplant |
||||
|
0-6 months |
208-312 nmol/L |
250-375 ng/mL |
>312 nmol/L |
>375 ng/mL |
|
6-12 months after |
166-250 nmol/L |
200-300 ng/mL |
>250 nmol/L |
>300 ng/mL |
|
transplant |
||||
|
>12 months |
83-125 nmol/L |
100-150 ng/mL |
>125 nmol/L |
>150 ng/mL |
|
Cardiac transplant |
||||
|
0-6 months |
208-291 nmol/L |
250-350 ng/mL |
>291 nmol/L |
>350 ng/mL |
|
6-12 months after |
125-208 nmol/L |
150-250 ng/mL |
>208 nmol/L |
>250 ng/mL |
|
transplant |
||||
|
>12 months |
83-125 nmol/L |
100-150 ng/mL |
>125 nmol/L |
150 ng/mL |
|
Lung transplant |
||||
|
0-6 months |
250-374 nmol/L |
300-450 ng/mL |
>374 nmol/L |
>450 ng/mL |
|
Liver transplant |
||||
|
0-7 days |
249-333 nmol/L |
300-400 ng/mL |
>333 nmol/L |
>400 ng/mL |
|
2-4 weeks |
208-291 nmol/L |
250-350 ng/mL |
>291 nmol/L |
>350 ng/mL |
|
5-8 weeks |
166-249 nmol/L |
200-300 ng/mL |
>249 nmol/L |
>300 ng/mL |
|
9-52 weeks |
125-208 nmol/L |
150-250 ng/mL |
>208 nmol/L |
>250 ng/mL |
|
>1 year |
83-166 nmol/L |
100-200 ng/mL |
>166 nmol/L |
>200 ng/mL |
|
Desipramine |
375-1130 nmol/L |
100-300 ng/mL |
>1880 nmol/L |
>500 ng/mL |
|
Diazepam |
||||
|
(and metabolite) |
||||
|
Diazepam |
0.7-3.5 μmol/L |
0.2-1.0 μg/mL |
>7.0 μmol/L |
>2.0 μg/mL |
|
Nordazepam |
0.4-6.6 μmol/L |
0.1-1.8 μg/mL |
>9.2 μmol/L |
>2.5 μg/mL |
|
Digoxin |
0.64-2.6 nmol/L |
0.5-2.0 ng/mL |
>3.1 nmol/L |
>2.4 ng/mL |
|
Disopyramide |
>7.4 μmol/L |
2.5 μg/mL |
20.6 μmol/L |
>7 μg/mL |
|
Doxepin and nordoxepin |
||||
|
Doxepin |
0.36-0.98 μmol/L |
101-274 ng/mL |
>1.8 μmol/L |
>503 ng/mL |
|
Nordoxepin |
0.38-1.04 μmol/L |
106-291 ng/mL |
>1.9 μmol/L |
>531 ng/mL |
|
Ethanol |
||||
|
Behavioral changes |
>4.3 mmol/L |
>20 mg/dL |
||
|
Legal limit |
>17 mmol/L |
>80 mg/dL |
||
|
Critical with acute |
>54 mmol/L |
>250 mg/dL |
||
|
exposure |
||||
TABLE A-3 I
TOXICOLOGY AND THERAPEUTIC DRUG MONITORING
|
|
THERAPEUTIC RANGE |
TOXIC LEVEL |
||
|
DRUG |
SI UNITS |
CONVENTIONAL UNITS |
SI UNITS |
CONVENTIONAL UNITS |
|
Ethylene glycol |
||||
|
Toxic |
>2 mmol/L |
>12 mg/dL |
||
|
Lethal |
>20 mmol/L |
>120 mg/dL |
||
|
Ethosuxamide |
280-700 μmol/L |
40-100 μg/mL |
>700 μmol/L |
>100 μg/mL |
|
Flecainide |
0.5-2.4 μmol/L |
0.2-1.0 μg/mL |
>3.6 μmol/L |
>1.5 μg/mL |
|
Gentamicin |
||||
|
Peak |
10-21 μmol/mL |
5-10 μg/mL |
> 25 μmol/mL |
>12 μg/mL |
|
Trough |
0-4.2 μmol/mL |
0-2 μg/mL |
> 4.2 μmol/mL |
>2 μg/mL |
|
Heroin (diacetyl |
>700 μmol/L |
>200 ng/mL |
||
|
morphine) |
(as morphine) |
|||
|
Ibuprofen |
49-243 μmol/L |
10-50 μg/mL |
>97 μmol/L |
>200 μg/mL |
|
Imipramine |
||||
|
(and metabolite) |
||||
|
Desimipramine |
375-1130 nmol/L |
100-300 ng/mL |
>1880 nmol/L |
>500 ng/mL |
|
Total imipramine + |
563-1130 nmol/L |
150-300 ng/mL |
>1880 nmol/L |
>500 ng/mL |
|
desimipramine |
||||
|
Lidocaine |
5.1-21.3 μmol/L |
1.2-5.0 μg/mL |
>38.4 μmol/L |
>9.0 μg/mL |
|
Lithium |
0.5-1.3 meq/L |
0.5-1.3 meq/L |
>2 mmol/L |
>2 meq/L |
|
Methadone |
1.3-3.2 μmol/L |
0.4-1.0 μg/mL |
>6.5 μmol/L |
>2 μg/mL |
|
Methamphetamine |
20-30 ng/mL |
0.1-1.0 μg/mL |
||
|
Methanol |
>6 mmol/L >16 mmol/L >28 mmol/L |
>20 mg/dL >50 mg/dL, severe toxicity >89 mg/dL, lethal |
||
|
Methotrexate |
||||
|
Low-dose |
0.01-0.1 μmol/L |
0.01-0.1 μmol/L |
>0.1 mmol/L |
>0.1 mmol/L |
|
High-dose (24h) |
<5.0 μmol/L |
<5.0 μmol/L |
>5.0 μmol/L |
>5.0 μmol/L |
|
High-dose (48h) |
<0.50 μmol/L |
<0.50 μmol/L |
>0.5 μmol/L |
>0.5 μmol/L |
|
High-dose (72h) |
<0.10 μmol/L |
<0.10 μmol/L |
>0.1 μmol/L |
>0.1 μmol/L |
|
Morphine |
35-250 μmol/L |
10-70 ng/mL |
180-14000 μmol/L |
50-4000 ng/mL |
|
Nitroprusside |
103-499 μmol/L |
6-29 μg/mL |
860 μmol/L |
>50 μg/mL |
|
(as thiocyanate) |
||||
|
Nortriptyline |
190-569 nmol/L |
50-150 ng/mL |
>1900 nmol/L |
>500 ng/mL |
|
Phenobarbital |
65-172 μmol/L |
15-40 μg/mL |
>215 μmol/L |
>50 μg/mL |
|
Phenytoin |
40-79 μmol/L |
10-20 μg/mL |
>118 μmol/L |
>30 μg/mL |
|
Phenytoin, free |
4.0-7.9 μg/mL |
1-2 μg/mL |
>13.9 μg/mL |
>3.5 μg/mL |
|
% Free |
0.08-0.14 |
8-14% |
||
|
Primidone and |
||||
|
metabolite |
||||
|
Primidone |
23-55 μmol/L |
5-12 μg/mL |
>69 μmol/L |
>15 μg/mL |
|
Phenobarbital |
65-172 μmol/L |
15-40 μg/mL |
>215 μmol/L |
>50 μg/mL |
|
Procainamide |
||||
|
Procainamide |
17-42 μmol/L |
4-10 μg/mL |
>51 μmol/L |
>12 μg/mL |
|
NAPA (W-acetylpro- |
22-72 μmol/L |
6-20 μg/mL |
>126 μmol/L |
>35 μg/mL |
|
cainamide) |
||||
|
Quinidine |
>6.2-5.4 μmol/L |
2.0-5.0 μg/mL |
>31 μmol/L |
>10 Mg/mL |
|
Salicylates |
145-2100 μmol/L |
2-29 mg/dL |
>2172 μmol/L |
>30 mg/dL |
|
Sirolimus (trough level) |
||||
|
Kidney transplant |
4.4-13.1 nmol/L |
4-12 ng/mL |
>16 nmol/L |
>15 ng/mL |
TABLE A-3
TOXICOLOGY AND THERAPEUTIC DRUG MONITORING
|
|
THERAPEUTIC RANGE |
|
TOXIC LEVEL |
|
|
DRUG |
SI UNITS |
CONVENTIONAL UNITS |
SI UNITS |
CONVENTIONAL UNITS |
|
Tacrolimus (FK506) (trough) Kidney and liver 0-2 months post |
12-19 nmol/L |
10-15 ng/mL |
>25 nmol/L |
>20 ng/mL |
|
transplant >2 months post transplant |
6-12 nmol/L |
5-10 ng/mL |
||
|
Heart |
||||
|
0-2 months post |
19-25 nmol/L |
15-20 ng/mL |
>25 nmol/L |
>20 ng/mL |
|
transplant 3-6 months post transplant |
12-19 nmol/L |
10-15 ng/mL |
||
|
>6 months post transplant |
10-12 nmol/L |
8-10 ng/mL |
||
|
Theophylline |
56-111 μg/mL |
10-20 μg/mL |
>140 μg/mL |
>25 μg/mL |
|
Thiocyanate After nitroprusside |
103-499 μmol/L |
6-29 μg/mL |
860 μmol/L |
>50 Mg/mL |
|
infusion Nonsmoker |
17-69 μmol/L |
1-4 μg/mL |
||
|
Smoker |
52-206 μmol/L |
3-12 μg/mL |
||
|
Tobramycin Peak |
11-22 μg/L |
5-10 μg/mL |
>26 μg/L |
>12 μg/mL |
|
Trough |
0-4.3 μg/L |
0-2 μg/mL |
>4.3 μg/L |
>2 μg/mL |
|
Valproic acid |
350-700 μmol/L |
50-100 μg/mL |
>1000 μmol/L |
>150 Mg/mL |
|
Vancomycin Peak |
14-28 μmol/L |
20-40 μg/mL |
>55 μmol/L |
>80 μg/mL |
|
Trough |
3.5-10.4 μmol/L |
5-15 μg/mL |
>14 μmol/L |
>20 μg/mL |
