Revisited: Therapeutic and toxic blood concentrations of more than 1100 drugs and other xenobiotics

• Published in: Critical care (London, England) England), 2020-05, Vol.24 (1), p.195-4, Article 195
• Main Authors: Schulz, Martin, Schmoldt, Achim, Andresen-Streichert, Hilke, Iwersen-Bergmann, Stefanie
• Format: Article
• Language: English
• Subjects: Analgesics; Anesthesia; Annual reports; Critical care; Drug Dosage Calculations; Drug dosages; Drug monitoring; Drug Monitoring - methods; Drug Monitoring - trends; Drug overdose; Drug testing; Drug traffic; Drug-related side effects and adverse reactions; Health aspects; Humans; Information services; Intensive care; Intoxication; Narcotics; Overdose; Plasma; Poisoning; Psychotropic drugs; Review; Severity of Illness Index; Therapeutic drug monitoring; Xenobiotics; Xenobiotics - analysis; Xenobiotics - blood
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-020-02915-5

In order to assess the significance of drug/substance levels measured in intensive care medicine and clinical and forensic toxicology as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available. We revisited and expanded our 2012 compilation of therapeutic and toxic plasma concentration ranges as well as half-lives of now more than 1100 drugs and other xenobiotics.Data have been abstracted from original papers, text books, and previous compilations and have been completed with data collected in our own forensic and clinical toxicology laboratories. We compiled the data presented in the table and the corresponding annotations over the past 30+ years. A previous compilation was completely double-checked, revised, and updated, if necessary. In addition, more than 200 substances, especially drugs who have been introduced since 2012 to the market as well as illegal drugs and other xenobiotics which became known to cause intoxications were added. We carefully referenced all data. Moreover, the annotations providing details were updated and revised, when necessary.For more than 1100 drugs and other xenobiotics, therapeutic ("normal") and, if data was available, toxic, and comatose-fatal plasma/blood concentrations as well as elimination half-lives were compiled in a table.In case of intoxications, the blood concentration of the substance and/or metabolite better predicts the clinical severity of the case when compared to the assumed amount and time of ingestion. Comparing and contrasting the clinical case against the data provided, including the half-life, may support the decision for or against further intensive care. In addition, the data provided are useful for the therapeutic monitoring of pharmacotherapies, to facilitate the diagnostic assessment and monitoring of acute and chronic intoxications as well as to support forensic and clinical expert opinions.