TDM case report as example for clinical pharmacological commenting by means of the internet platform Konbest

TDM becomes a valuable therapeutic tool in clinical practise if the determined drug concentration is supplied with a clinical pharmacological comment in the TDM report. Konbest is an internet based platform developed and programmed for clinical pharmacological commenting of TDM data even across large distances. We present a case report where drug concentrations were measured in the clinical pharmacological laboratory of the psychiatric university hospital of Regensburg/Germany and the clinical pharmacological commenting was performed in Bolzano/Italy by means of Konbest. This case report describes a female patient aged 47 with a lamotrigine plasma level of 10344 ng/ml on oral monotherapy of 200 mg/d lamotrigine. Konbest holds two more lamotrigine concentrations: 3823 ng/ml two weeks earlier on the same dose and 9372 ng/ml a year ago on 175 mg/d lamotrigine in combination with 1000 mg/d valproate. The second lamotrigine concentration was within the dose-related reference range, the two others were some twofold above the concentration expected for the prescribed dose. UGT inhibition of the lamotrigine metabolism by valproate was identified as cause for both the first and third high lamotrigine concentration with the comedication forgotten to report with the first specimen. A slow metabolizer was ruled out since the patient had once shown a lamotrigine concentration in agreement with the dose prescribed. With our tools these conclusions where much easier to draw.