Worldwide, only the levels of tricyclic antidepressants can be determined with classical therapeutic measurement methods. However, this class of drugs is the oldest of the antidepressants and is administered only in 10% of patients with depression. For antidepressant drugs, mainly given for depression, levels of selective serotonin reuptake inhibitors (SSRIs) can only be determined using protocols on an LC-MS/MS device. Accordingly, for antipsychotic drugs with the classical methods of therapeutic measurement there is no possibility of determining their therapeutic levels. There is great interest among psychiatrists in determining therapeutic levels of antipsychotic drugs, mainly for purposes of monitoring patient compliance with treatment.

New anticoagulants tend to replace the administration of acenocoumarol in patients with cardiac arrhythmia (atrial fibrillation) and exceed $16 billion in worldwide sales. For these drugs there is no biochemical test to determine their anticoagulant effect, so it is not possible to predict if or when a patient has an increased risk of bleeding, a particularly important and very often fatal side effect. Globally, the medical community recognizes this major issue, and efforts are directed toward developing measuring the concentration of new anticoagulants to establish the therapeutic concentration range of these drugs, which, currently, can only be achieved using LC-MS/MS equipment.

Monitoring of treatment with new antiepileptics is particularly important and inextricably linked to the titration and adjustment of the dosage for these drugs.  In addition to therapeutic measurement of serum and plasma antiepileptics levels, saliva and dried blood spots have emerged as examples of utility and importance for concentration monitoring. Measuring the concentration of new antiepileptic drugs using LC-MS/MS equipment will help in the proper use of these drugs in neonates, pregnant women, geriatric patients, and other specific populations.

Unlike other therapeutic fields, therapeutic monitoring of anti-HIV drugs is not widespread. In the last decade, concerted efforts have been made to determine the therapeutic range of the concentration of antiretroviral drugs and to be able to integrate the therapeutic monitoring of these drugs into the clinical routine. By using the LC-MS/MS equipment, the Unit will be able to be among the pioneers of this international initiative and effort.

Antibiotics are among the drugs most frequently administered to critically ill patients in the Intensive Care Unit. This is a group of patients that shows great pharmacokinetic diversity when taking antibiotics. Our knowledge of the relationship between antibiotic dosage, degree of exposure, and clinical action in this group of patients has increased over the past decade. Therapeutic monitoring of serum antibiotic concentrations is the most practical way of determining drug concentration but is not widely used. In the last two years, therapeutic measurement of antibiotics has become more widespread, especially for β-lactams, a class of antibiotics that until recently were believed to have a wide therapeutic window. IMPReS offers the possibility to ICU units of the PGNA and the other hospitals of the region to implement protocols of personalized administration for strong antibiotics.

Preeclampsia, a hypertensive syndrome that develops during pregnancy, is an important cause of morbidity and mortality both for the mother and the fetus. Aspirin is given to high-risk pregnant women to prevent the syndrome. However, all women receive the same dose regardless of the large heterogeneity of the specific population and the actual levels of aspirin that are achieved. At the same time, while there is a significant increase in the total exposure to aspirin, the effects-side effects of administration to the fetus are limited only to perinatal events. There is therefore particularly great interest in (a) the study of the levels and biological activity of aspirin during pregnancy at the individual level, (b) the identification of the constitutive factors that influence the pharmacokinetics, metabolism, and action of aspirin, with particular emphasis on pharmacogenetics and (c) neurodevelopmental study of the offspring and its correlation with levels of aspirin exposure during pregnancy. These questions can be investigated using the LC-MS/MS equipment in combination with the equipment of the other Units of the IMPReS Center.