Proceedings PaperTherapeutic Drug Monitoring of Antifungals: Pharmacokinetic and Pharmacodynamic ConsiderationsSmith, Jeannina MD*; Andes, David MD†Author Information From the *Department of Medicine, Section of Infectious Diseases, University of Michigan, Ann Arbor, Michigan; and †Department of Medicine, Section of Infectious Diseases and Medical Microbiology and Immunology, University of Wisconsin, Madison, Wisconsin. Received for publication October 24, 2007; accepted December 26, 2007. Correspondence: David Andes, 600 Highland Avenue, Room H4/572, Madison, WI 53792 (e-mail: [email protected]). Therapeutic Drug Monitoring: April 2008 - Volume 30 - Issue 2 - p 167-172 doi: 10.1097/FTD.0b013e318167d0e0 Buy Metrics Abstract Therapeutic drug monitoring of any pharmacologic agent should be considered when there is both significant pharmacokinetic variability and strong, clinically relevant, exposure-effect relationships. Many antifungal drugs exhibit marked variability in drug concentration as a result of inconsistent absorption, metabolism, elimination, or interaction with concomitant medications. For each of the available antifungal drugs, both preclinical and clinical trials have exhibited a relationship between serum concentrations and treatment efficacy. For a smaller subset of compounds, a similar relationship has been identified for the toxicity. The kinetic variability among patients falls outside the therapeutic window for a group of four antifungal compounds. This review summarizes the current literature on therapeutic drug monitoring for these antifungal agents. © 2008 Lippincott Williams & Wilkins, Inc.