A cross-sectional study of the current situation with therapeutic drug monitoring in Thailand: Requirements, challenges and the role of educational institutions


  • Sorawit Chatjaroenpat Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
  • Chawanagon Chuenmueang Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
  • Siriluk Jaisue Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand




Clinical pharmacokinetic, Pharmacy education, Pharmacy practice, Therapeutic drug monitoring (TDM)


Background: Therapeutic drug monitoring (TDM) is a drug dose determination tool for individualised therapy.

Objective: This study examined the TDM services provided by hospitals and topics taught in pharmacy schools in Thailand.

Methods: TDM service and curriculum questionnaires were sent to 179 hospitals and all 19 pharmacy schools in Thailand. Correlations were tested using Fisher’s exact test.

Results: Completed questionnaires were returned by 116 hospitals (64.8%). Forty-three hospitals (37.1%) conducted TDM and most were large hospitals (>500 beds, n=27, 62.8%). Higher numbers of beds and pharmacists positively correlated with conducting TDM (p < 0.001 and p = 0.003, respectively). Phenytoin was the most frequently monitored drug (n=39, 90.7%). All pharmacy schools taught TDM for phenytoin, valproic acid, vancomycin, carbamazepine, and digoxin. The most frequently cited benefit of TDM was to prevent adverse drug reactions (n = 108, 93.1%). The primary reason cited for not conducting TDM was a lack of in-house laboratories (n=78, 67.2%).

Conclusion: Despite a positive attitude among respondents and that TDM subjects were being taught in all pharmacy schools in Thailand, less than half of the surveyed hospitals reported conducting TDM. Providing smaller hospitals with access to the TDM laboratories and expertise at large hospitals could increase this proportion.


Agustí, A., Celli, B. R., Criner, G. J., Halpin, D., Anzueto, A., Barnes, P., Bourbeau, J., Han, M. K., Martinez, F. J., Montes de Oca, M., Mortimer, K., Papi, A., Pavord, I., Roche, N., Salvi, S., Sin, D. D., Singh, D., Stockley, R., López Varela, M. V., Wedzicha, J. A., & Vogelmeier, C. F. (2023). Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary. Archivos de bronconeumologia, 59(4), 232–248. https://doi.org/10.1016/j.arbres.2023.02.009

Albassam, A., Alghanem, S. S., Alawadhi, F., & Alsulaimani, Z. (2022). Knowledge, confidence, and perception toward therapeutic drug monitoring among physicians and pharmacists in Kuwait. Therapeutic drug monitoring, 44(4), 511–519. https://doi.org/10.1097/FTD.0000000000000966

Al Mutarid, M., Alhossan, A., Khan, T., Alyami, M. G., Almutared, K. M., Alshiban, M., Alyami, A. H. D., Alyami, M. M. M., AlKulayb, J. A. H., Alyami, D. S., & Almutarid, Q. D. (2022). Knowledge and attitude of healthcare practitioners toward therapeutic drug monitoring practices in the Najran Region, Kingdom of Saudi Arabia. Cureus, 14(12), e32214. https://doi.org/10.7759/cureus.32214

Al-Shaer, M. H., Rubido, E., Cherabuddi, K., Venugopalan, V., Klinker, K., & Peloquin, C. (2020). Early therapeutic monitoring of β-lactams and associated therapy outcomes in critically ill patients. The Journal of Antimicrobial Chemotherapy, 75(12), 3644–3651. https://doi.org/10.1093/jac/dkaa359

Antunes, M. V., Linden, R., & Schaiquevich, P. (2021). Therapeutic drug monitoring in developing nations: Assessing the current state of affairs in South America. Expert opinion on drug metabolism & toxicology, 17(3), 251–254. https://doi.org/10.1080/17425255.2021.1859478

Chaiyakunapruk, N., Jones, S.M., Dhippayom, T., & Sumpradit, N. (2016). Pharmacy practice in Thailand. Pharmacy practice in developing countries, 3-22. https://doi.org/10.1016/B978-0-12-801714-2.00001-0

De Oliveira, D. M. P., Forde, B. M., Kidd, T. J., Harris, P. N. A., Schembri, M. A., Beatson, S. A., Paterson, D. L., & Walker, M. J. (2020). Antimicrobial resistance in ESKAPE pathogens. Clinical microbiology reviews, 33(3), e00181–19. https://doi.org/10.1128/CMR.00181-19

Ferrari, F., Santander, I. R. M. F., & Stein, R. (2020). Digoxin in atrial fibrillation: An old topic revisited. Current cardiology reviews, 16(2), 141–146. https://doi.org/10.2174/1573403X15666190618110941

Firman, P., Tan, K. S., Clavarino, A., Taing, M. W., & Whitfield, K. (2022). Pharmacist-managed therapeutic drug monitoring programs within Australian hospital and health services-A national survey of current practice. Pharmacy, 10(5), 135. https://doi.org/10.3390/pharmacy10050135

Green, T. J., Walker, L. E., & Turner, R. M. (2022). A European cross-sectional survey to investigate how involved doctors training in clinical pharmacology are in drug concentration monitoring. European journal of clinical pharmacology, 78(7), 1105–1113. https://doi.org/10.1007/s00228-022-03316-z

Healthcare Accreditation Institute (HAI), (2022). Hospital and health care standards. Thailand. https://www.ha.or.th/EN/Contents/ ce6cf1c2-fba5-4164-a651-f7d4c5e1ed3e.pdf

Kang, J. S., & Lee, M. H. (2009). Overview of therapeutic drug monitoring. The Korean Journal of Internal Medicine, 24(1), 110. https://doi.org/10.3904/kjim.2009.24.1.1

Leung, D., Ensom, M. H. H., & Carr, R. (2019). Survey of therapeutic drug monitoring practices in Pediatric Health Care Programs across Canada. The Canadian journal of hospital pharmacy, 72(2), 126–132. https://pubmed.ncbi.nlm.nih.gov/31036973/

O'Hara, K., Wright, I. M., Schneider, J. J., Jones, A. L., & Martin, J. H. (2015). Pharmacokinetics in neonatal prescribing: evidence base, paradigms and the future. British journal of clinical pharmacology, 80(6), 1281–1288. https://doi.org/10.1111/bcp.12741

Pedersen, C. A., Schneider, P. J., & Scheckelhoff, D. J. (2016). ASHP National Survey of Pharmacy Practice in hospital settings: Monitoring and patient education-2015. American Journal of health-system pharmacy, 73(17), 1307–1330. https://doi.org/10.2146/ajhp160081

Ploylearmsang, C., Kanjanasilp, J., Kessomboon, N., Suttajit, S., Suwannaprom, P., Sripa, S., Sittichotiwong, R., Srimarueang, T., Sonsri, S., & Kittiboonyakun, P. (2019). Hospital pharmacy practice and the way forward for pharmacy education in Thailand. The Canadian journal of hospital pharmacy, 72(1), 34–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391247

Saikaew, S., Thongprachum, A., Pongsararuk, R., Thanraka, A., Kunyanone, N., Chaiyasirinroje, B., Luangsook, P., Butr-Indr, B., Phunpae, P., Wattananandkul, U. (2022) Genotypic distribution and the epidemiology of Multidrug-Resistant Tuberculosis in upper Northern Thailand. Antibiotics, 11(12), 1733. https://doi.org/10.3390/antibiotics11121733

Salamone, S. J., Courtney, J. B., & Clarke, W. A. (2023). New immunoassays in therapeutic drug monitoring: Where is the journey heading?. Therapeutic drug monitoring, 45(1), 11–13. https://doi.org/10.1097/FTD.0000000000001048

Scalese, M. J., & Salvatore, D. J. (2017). Role of digoxin in atrial fibrillation. Journal of Pharmacy Practice, 30(4), 434–440. https://doi.org/10.1177/0897190016642361

Shawahna, R., Shraim, N., & Aqel, R. (2022). Views, knowledge, and practices of hospital pharmacists about using clinical pharmacokinetics to optimize pharmaceutical care services: a cross-sectional study. BMC health services research, 22(1), 411. https://doi.org/10.1186/s12913-022-07819-4

Vamos, M., Erath, J. W., & Hohnloser, S. H. (2015). Digoxin-associated mortality: a systematic review and meta-analysis of the literature. European Heart Journal, 36(28), 1831–1838. https://doi.org/10.1093/eurheartj/ehv143

Yin, T., Liang, H., Huang, Q., Zhou, B., Tang, M., Lou, J., & Xiang, D. (2023). A survey of therapeutic drug monitoring status in China. Therapeutic drug monitoring, 45(2), 151–158. https://doi.org/10.1097/FTD.0000000000001060

Zhang, C., Lei, J., Liu, Y., Wang, Y., Huang, L., & Feng, Y. (2021). Therapeutic drug monitoring and pharmacogenetic testing in Northern China. Frontiers in pharmacology, 12, 754380. https://doi.org/10.3389/fphar.2021.754380




How to Cite

Chatjaroenpat , S., Chuenmueang, C., & Jaisue, S. (2024). A cross-sectional study of the current situation with therapeutic drug monitoring in Thailand: Requirements, challenges and the role of educational institutions. Pharmacy Education, 24(1), p. 154–163. https://doi.org/10.46542/pe.2024.241.154163



Research Article