Labs - DRUG Levels (Alphabetical order)

Acetaminophen :

Therapeutic Range:  5-20 mcg/mL Comments: Potentially toxic / Critical value: >150 mcg/mL - Measured 4 hours after the dose. The ceiling analgesic effect is obtained with a dose of 1 gram (adult). Rumack-Matthew nomogram for single acute acetaminophen poisoning: Recommended reading / References: Acetadote® (acetylcysteine) Injection. Package insert. Cumberland Pharmaceuticals Inc. Nashville, TN 37203. Feb 2006. Rumack BH, Matthew M. Acetaminophen poisoning and toxicity. Pediatrics 1975; 55:871–876 Rumack BH, Peterson RC, Koch GG, Amara IA. Acetaminophen overdose: 662 cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 1981;141:380-385.

Amikacin:

Therapeutic Range:   Peak: 20-30 mcg/ml.   Trough: 4-8 mcg/ml Comments: Half-life: (average 2-3 hours) Potentially toxic: peak: >30.0 mcg/mL, trough: >8.0 mcg/mL. Drawing levels: Draw peak 30 minutes after a 30 infusion or 60 minutes after an IM injection. Draw trough just prior to next dose or at least one half-life after the peak.

Amitriptyline

Therapeutic Range:   120 to 150 ng/ml Comments: Toxic level: >500 ng/ml Half-life: 17-40 hours Steady state: 3-8 days. Drawing levels: draw trough immediately prior to next dose

Carbamazepine

Therapeutic Range:   4 to 12 mcg/ml Comments: Toxic level: >12 mcg/ml Half-life: 10 - 26 hours in adults. Time to steady state: 2 to 10 days (Possibly 2-4 weeks due to autoinduction.)   Monitoring: draw trough immediately prior to next dose.

Desipramine

Therapeutic Range:   150 to 300 ng/ml Comments: Toxic level: >500 ng/ml Half-life: 12-54 hours Time to steady state: 6-11 days. Monitoring: obtain trough just prior to next dose.

Digoxin

Therapeutic Range:   0.8 to 2.0 ng/ml Comments: Steady state: 7- 10 days (possibly longer). Toxic level: >2.4 ng/ml Half-life: 33 - 51 hours. Obtaining levels: determine serum digoxin levels at least 4 hours after an IV dose or 6 hours after an oral dose in order to allow sufficient time for drug distribution.

Disopyramide

Therapeutic Range:   2 to 5 mcg/ml Comments: Toxic level: >5 mcg/ml Half-life: 5 - 10 hours.

Ethosuximide

Therapeutic Range:   40 to 100 mcg/mL Comments: Toxic level: >100 mcg/ml Half-life: 20 to 60 hours. TTime to steady state: 7-10 days. Obtaining levels: peak: 2-4 hours after the dose. Trough: immediately prior to next dose.

Gentamicin

Therapeutic Range:   Conventional dosing: Peak: 4-10 mcg/ml. Trough: 0.5 to 2 mcg/ml Comments: HHalf-life: (average 2-3 hours). Drawing levels: Draw peak 30 minutes after a 30 infusion or 60 minutes after an IM injection. Draw trough just prior to next dose or at least one half-life after the peak.

Imipramine

Therapeutic Range::   150 to 250 ng/ml Comments:: Toxic level: >500 ng/ml Half-life: 9-24 hours Steady state: 2-5 days.

Lidocaine

Therapeutic Range::    1.5 to 5.0 mcg/ml Comments:: Potentially Toxic level: >5 mcg/ml Half-life: 1.5 hours Time to steady state: 6-12 hours.

Lithium

Therapeutic Range::  0.5 to 1.3 mEq/L Comments: Potentially Toxic level: >1.5 mEq/L Half-life: 17-36 hours. Drawing levels: just prior to next dose or at least 6-12 hours after the last dose

Nortriptyline

Therapeutic Range:: 50 to 150 ng/ml Comments:: Toxic level: >500 ng/ml Half-life: 15-90 hours Steady state: 4-20 days. Drawing levels: just prior to next dose

Phenobarbital

Therapeutic Range::    15 to 40 mcg/ml Comments:: (Steady state: 15-25 days) Toxic level: >40 mcg/ml Half-life: 1.5 - 3 days Drawing levels: Peak: 4-12 hours after dose. Trough: immediately prior to next dose

Phenytoin

Therapeutic Range::   Total: 10 to 20 mcg/ml.   Free: 1-2 mcg/ml. Comments:: Toxic level: >20-30 mcg/ml Half-life: 7-42 hours (average: 24 hours) Time to steady state: 7-10 days. Drawing levels: IV: 2-4 hours after loading dose. Oral (peak): 3-9 hours after dose (not critical).        Trough: immediately prior to next dose.

Primidone

Therapeutic Range::   5 to 12 mcg/ml  Comments:: Toxic level: >12 mcg/ml Half-life: 6 - 12 hours. Converted into two active metabolites: phenobarbital and phenylethylmalonamide (PEMA).

Procainamide

Therapeutic Range:   4 to 10 mcg/ml.  NAPA: 6 - 20 mcg/ml. Comments: (Steady state: 12 to 18 hours) Toxic level: >16 mcg/ml Half-life: 2.5 - 4.5 hours

Quinidine

Therapeutic Range:   2 to 5 mcg/ml Comments: Potentially toxic level: >6 mcg/ml Half-life: 4-11 hours Draw trough level: immediately prior to next dose

Salicylate

Therapeutic Range:   50 to 250 mcg/ml (5-25 mg/dL) Comments: Potentially toxic level: >300 mcg/ml (> 30 mg/dL)

Theopylline

Therapeutic Range:   (adult): 10 to 20 mcg/ml. Comments: Toxic level: >20 mcg/ml Half-life: 3 -10 hours Time to steady state: 36 hours (average). Drawing levels: Draw trough immediately prior to next dose and 1-2 days after any dosage change (adults).

Tobramycin

Therapeutic Range:   Conventional dosing: Peak: 4-10 mcg/ml. Trough: 0.5 to 2 mcg/ml. Comments: Half-life: (average 2-3 hours). Drawing levels: Draw peak 30 minutes after a 30 infusion or 60 minutes after an IM injection. Draw trough just prior to next dose or at least one half-life after the peak.

Valproic Acid

Therapeutic Range:    40 to 100 mcg/ml Comments: (Steady state: 2-4 days) Toxic level: >100 mcg/ml Half-life: 9 - 18 hours in adults. 4 - 14 hours in children

Vancomycin

Therapeutic Range:    Peak: 20-40 mcg/ml.  Trough: 5-15 mcg/ml . Comments: Half-life: (average: 6 hours). Drawing levels: Draw peak at least 1 hour after a 60-minute infusion. Draw trough immediately prior to the next dose.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.