Management Options: Drug Therapy Requiring Intensive Monitoring for Toxicity

Palmetto GBA has created a Table of Risk that lists drug therapy requiring intensive monitoring for toxicity as a high risk management option. For drugs with a well-defined clinical response and a high therapeutic index (i.e., low toxicity), intensive therapeutic drug monitoring is not necessary. For acute or short-term drug therapy there is no advantage to monitoring drug levels. For treatment of chronic disorders, such as antihypertensive therapy, if the desired response can be readily assessed by a noninvasive technique, such as blood pressure monitoring, serial drug level monitoring is not medically necessary. Administration of cytotoxic chemotherapy is always considered high risk under management options when monitoring of blood cell counts is used as a surrogate for toxicity. Drugs that have a narrow therapeutic window and a low therapeutic index may exhibit toxicity at concentrations close to the upper limit of the therapeutic range and may require intensive clinical monitoring.

MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia; and MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.