Drug monitoring: factors to consider during Covid-19

David Erskine, Director, London Medicines Information Services, Specialist Pharmacy ServicePublished

This page gives background information and factors to consider for drug monitoring during Covid-19.

You can find our main guidance and advice on individual medicines here

General factors to consider when making a monitoring decision include

Drug related factors

  • Ensure the drug is still clinically appropriate for the patient. This may be a good time to review need.
  • Consider alternative medicines and what testing might be involved in starting such medicines which would negate any advantage in switching
  • Is it essential to monitor? Is monitoring happening to avoid harm or to inform a critical change to medication?
  • Do the results influence clinical care? If they don’t, why monitor?
  • Is this a drug with a narrow therapeutic index?
  • Would extending the monitoring period potentially cause harm?
  • Is monitoring required at set time intervals e.g. clozapine (safety), lithium (safety)
  • What is the recommended frequency of testing? More frequent testing suggests increased importance of testing; annual tests could suggest less important with respect to clinical management or safety

Patient related factors

  • Is the patient stabilised on the current drug and dose?
  • Has the dose changed recently?
  • Has the patient’s clinical condition changed recently?
  • When was the most recent test done?
  • What has been the trend in results over time?
  • Can you identify and prioritise your high risk patients – they may be high risk due to the meds they take or high risk due to the lability of their condition which requires close monitoring
  • Does the patient have any recent blood results, e.g. renal function? If not, is there any patient information or reason that would indicate a change?

Practical factors

  • Target drug monitoring to those on the highest risk drugs
  • Determine the number of patients involved.  For example lots of patients in a practice have annual blood monitoring for hypertension, very few patients have monthly lithium monitoring.
  • Where does the monitoring take place now? Where might it take place if the usual clinic is not available?  Local arrangements for sharing testing facilities might be preferable to patients accessing all surgeries / clinics.