Analytical strategies for therapeutic monitoring of drugs and metabolites in biological fluids. Plenary lecture.

Therapeutic drug monitoring can involve quantitation in either microgram, nanogram or picogram concentrations present in a complex biological matrix (whole blood, urine or tissue). The chemical structure of a compound influences not only the analytical method best suited to its quantitation, but also its acid/base character (pKa) and its extractability. The dose administered, the bioavailability of the dosage form, and the pharmacokinetic profile of the drug govern the circulating concentrations of either the parent drug and/or its metabolites present in vivo, and dictate the ultimate sensitivity nd specificity required of the analytical method. The degree of sample preparation required is dependent on the analytical method used (gas--liquid chromatography, thin-layer chromatography, high-performance liquid chromatography) and on the tolerance of the specific type of detection system to contamination. Factors leading to compound losses during sample preparation (adsorption, stability) are critical at low concentrations and can adversely affect the reliability of an assay, therefore maximizing the overall recovery of the assay is essential not only for high sensitivity but also for good precision and accuracy. Therefore, the criteria to be used in sample preparation should aim to optimize all of the above factors in the overall development of a reliable and validated method for the compound suitable for use in clinical therapeutic monitoring.