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As a pharmacist for 36 years, I am rarely surprised about most things that happen in my professional life. However, I continue to be amazed by the depth and breadth of both the practice and research efforts in the area of therapeutic drug monitoring. As I write this, it is baseball season, so perhaps that eternal philosopher says it best:

"In theory, there is no difference between theory and practice. In practice, there is."—Yogi Berra

Antibiotics usually take front-and-center attention in clinical pharmacokinetics. While the aminoglycosides continue to develop quietly, vancomycin is demanding more attention as pharmacokinetic/pharmacodynamic (PK/PD) relationships are uncovered and pathogen MICs push upward (short version: the bacteria are winning).

Immunosuppressants continue to be the number one category of monitored drugs in our health care system, and sirolimus makes its debut in this edition of the book. Of course, being a large transplant center contributes to this trend, but it is a rare clinician that doesn't encounter transplant patients and their medications on a routine basis.

While being a static area for quite some time, the next generation anticonvulsants are finally coming into their own. Updated treatment guidelines put these agents squarely in the spotlight, and the increase in serum concentration monitoring for these medications has been impressive. The challenge with these newer drugs is the role that therapeutic drug monitoring will play in their therapy because the concentration-response relationships are not as well defined for them compared to the older agents. Lamotrigine, levetiracetam, oxcarbazepine, and eslicarbazepine are included in this edition.

As for me, preparation for the fourth edition begins today.

Larry A. Bauer, PharmD
May 17, 2014

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