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Updated: Jun 8 2021

Therapeutic Index

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  • Overview
    • Therapeutic index (TI)
      • measurement of drug safety
      • refers to the relationship between toxic and therapeutic dosing
      • TI = TD50/ED50
        • therapeutic index of a drug is the ratio of the dose that produces toxicity to the dose that produces a clinically desired or effective response
        • TD50 = the dose of drug that causes a toxic response in 50% of the population
        • ED50 = the dose of drug that is therapeutically effective in 50% of the population
      • a safer drug has a higher therapeutic index
        • very large lethal dose, very small effective dose
      • a more dangerous drug has a lower therapeutic index
        • may require regular monitoring of drug levels
        • examples include:
          • warfarin
          • lithium
          • digoxin
          • phenytoin
          • gentamicin
          • amphotericin
          • 5-fluoro-urocil
          • zidovudine
    • Therapeutic drug monitoring
      • therapeutic window (TW) is the range of drug concentrations in which a drug is effective
      • TW concept is reflected in TI calculation
        • TW = MTC/MEC
          • Minimum effective concentration (MEC) is the minimum concentration that is required for drug effect
          • Minimum toxic concentration (MTC) is the minimum concentration in which toxicity usually occurs
          • If you have a low dose for the drug to start working (MEC) and a high dose at which the drug is toxic (MTC) you have a wide window in which the drug can safely be used (TW)
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