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New Drugs: Practical clinical pharmacology: monitoring drug concentrations and clinical trials

The idea of using a measured concentration to help decide the optimum dose of a drug and consequently derive the maximum therapeutic benefit with the minimum risk of side effects is a seductive concept. Unfortunately the ability of the biochemist to measure the concentration of a wide variety of pharmacological agents quickly and cheaply has outstripped the doctor's ability to apply these concentrations clinically. Only a few drugs are appropriate for routine monitoring, and these have a narrow therapeutic ratio and show a good relation between concentration and efficacy or toxicity. Despite the absence of much supportive data a "therapeutic range" has been enthusiastically espoused and adopted for many drugs. This terminology assumes unequivocal benefit and bestows