Tuberculosis remains one of the world's most persistent infectious diseases, and despite decades of available treatments, achieving cure remains a long and winding road. The challenge isn't just the disease itself – there is also a notable difference in how patients respond to TB drugs. Where pharmacokinetic variability can range 20-50 fold and the complex multidrug regimens, therapeutic drug monitoring represents a crucial but underutilised tool. From the early bactericidal activity in the first two weeks to managing drug-resistant strains, TDM offers a path to optimising treatment while minimising toxicity. Yet significant barriers remain, particularly in the low- and middle-income countries where TB burden is highest.

In this episode, we'll hear about:

• The role of TDM in first-line TB therapy: why pharmacokinetic variability matters and when to perform monitoring for optimal outcomes

• Practical approaches to TB drug monitoring, from limited sampling strategies to population pharmacokinetic models, and how to interpret results in clinical context

• The heightened importance of TDM for second-line drugs in multidrug-resistant TB, where narrower therapeutic ranges make the difference between cure and toxicity

• Innovative solutions for resource-limited settings, including saliva-based point-of-care testing and alternative matrices that could democratise access to TDM in high-burden countries

• The challenge of implementation: bridging the gap between sophisticated laboratory methods and community-level care where they're needed most

About our guests:

Thi Nguyen is a PhD candidate at Sydney University School of Pharmacy. Originally from Vietnam, a high-TB-burden country, she focuses on developing saliva-based therapeutic drug monitoring to make personalised TB treatment accessible in resource-limited settings.

Marieke Sturkenboom is the recently appointed Laboratory Head at the Clinical Pharmacy and Pharmacology department at the University of Groningen Medical Centre in the Netherlands, with special expertise in TDM and model-informed precision dosing of anti-TB drugs.

We are also joined by Jorie Versmissen, Erasmus Medical Centre, Rotterdam, as co-host.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

The human microbiome, a complex community of bacteria, fungi, protozoa, and viruses, doesn't just passively coexist with the drugs we take; it actively participates in a bidirectional relationship that can impact drug efficacy and toxicity. From immunosuppressants in transplant patients to medicines in other fields of medicine, it is becoming apparent that the microbiome has been a missing piece in our understanding of drug variability, and that it can uniquely impact drug interactions. As this field rapidly evolves, it promises new strategies for personalising medicine through microbiome biomarkers and targeted manipulation of our microbial communities.

In this episode, we'll hear about:

• The bidirectional nature of drug-microbiome interactions: how drugs alter microbial composition and how microbes chemically modify drugs or influence their disposition

• Mycophenolate and tacrolimus as case studies that demonstrate how the microbiota influences drug disposition in transplant patients

• The clinical consequences of microbiome-drug interactions, from gastrointestinal toxicity to unexpected variability in dose requirements

• The challenges and limitations researchers face, and why regulatory frameworks need to evolve to incorporate microbiome considerations in drug development.

About our guests:

Laure Elens is a Professor of Pharmacokinetics at UCLouvain's Faculty of Pharmacy and Biomedical Sciences, and leads the PMGK research lab.

Roland Lawson is an Associate Professor of Pharmacology at the University of Limoges and leads the microbiome group of the INSERM research unit, Pharmacology & Transplantation.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

We gather the two chairs of the upcoming IATDMCT annual meeting in Singapore, Sophie Stocker and Jana Stojanova, plus Cindy Lau, who contribute to the organization of the young scientists' part of the event to discuss the content, urbi et orbi, of our annual meeting.

In this episode we'll hear about:

• The journey from an inspiration to the building of a real conference dedicated to creating innovative solutions in therapeutic drug monitoring and clinical toxicology.
• The keynote lectures, main topics and hosts selected highlights of a scientific program going from biosensors applications in TDM and CT to pharmacogenomics integrated approaches and the strong choices made by the local organizing committee.
• The networking initiatives conceived by the local organizing committee to foster collaboration within IATDMCT members and build a solid sense of belonging to the TDM and CT community.
• Not to mention, the social activities, culinary art and secret events and places cooked by the team to help you discover Singapore and have fun during the meeting.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit: https://iatdmct.org/join-us/

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Sophie is an associate professor of Pharmacology at the Sydney Pharmacy School in Sydney, Australia, the actual Chair of the IATDMCT Anti-infective scientific committee and the co-Chair of the 2025 annual IATDMCT meeting in Singapore.

Jana is a senior scientist at St Vincent's Hospital in Sydney, Australia, the founder and main host of the IATDMCT podcast "Eight Drugs A Week" and the co-Chair of the 2025 annual IATDMCT meeting in Singapore.

Cindy is an antimicrobial stewardship pharmacist at St Vincent's Hospital in Sydney, Australia and a member of the local organizing committee of the 2025 annual IATDMCT meeting for which she contributes, among other things, to the young scientists' activities.

We gather the two chairs of the upcoming IATDMCT annual meeting in Singapore, Sophie Stocker and Jana Stojanova, plus Cindy Lau, who contribute to the organization of the young scientists' part of the event to discuss the content, urbi et orbi, of our annual meeting.

In this episode we'll hear about:

• The journey from an inspiration to the building of a real conference dedicated to creating innovative solutions in therapeutic drug monitoring and clinical toxicology.
• The keynote lectures, main topics and hosts selected highlights of a scientific program going from biosensors applications in TDM and CT to pharmacogenomics integrated approaches and the strong choices made by the local organizing committee.
• The networking initiatives conceived by the local organizing committee to foster collaboration within IATDMCT members and build a solid sense of belonging to the TDM and CT community.
• Not to mention, the social activities, culinary art and secret events and places cooked by the team to help you discover Singapore and have fun during the meeting.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit: https://iatdmct.org/join-us/

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Sophie is an associate professor of Pharmacology at the Sydney Pharmacy School in Sydney, Australia, the actual Chair of the IATDMCT Anti-infective scientific committee and the co-Chair of the 2025 annual IATDMCT meeting in Singapore.

Jana is a senior scientist at St Vincent's Hospital in Sydney, Australia, the founder and main host of the IATDMCT podcast "Eight Drugs A Week" and the co-Chair of the 2025 annual IATDMCT meeting in Singapore.

Cindy is an antimicrobial stewardship pharmacist at St Vincent's Hospital in Sydney, Australia and a member of the local organizing committee of the 2025 annual IATDMCT meeting for which she contributes, among other things, to the young scientists' activities.

Pharmacogenetics now surrounds us and is an efficient tool to prevent disease or to guide drug therapy. By studying polymorphisms in the genes coding for metabolism enzymes and drug transporters, we can have clues to help choose the right drug or adjust drug dosage. Not to mention that pharmacogenetics is the ideal companion for therapeutic drug monitoring for a comprehensive treatment optimization. Treatment failure and adverse drug reactions may, at least partly, be explained with pharmacogenetics and we have never been so close to large-scale implementation of this strategy.

In this episode, the Chair and Vice-Chair of the IATDMCT pharmacogenetic scientific committee will give us an overview of everything you need to know on pharmacogenetics.

In this episode, we'll hear about: • How pharmacogenetics can be used to secure drug use in the field of oncology • Some other applications where gene polymorphisms are of particular interest: for example, to manage the antiplatelet effect of clopidogrel or to ensure an appropriate use of voriconazole • The interest of pharmacogenetic panels for primary care and the key study raising the level of evidence for the approach • The gap that still needs to be closed from a multiplexed approach with a few studied genes to the thousands required to fully explain drug variability • The win-win combination of pharmacogenetics with TDM (like a good Len-Mac song) for patient care

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit: https://iatdmct.org/join-us/ Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests: Erika is director of the Experimental and Clinical Pharmacology Unit of the Aviano Oncology Referral Centre, and contract professor at the School of Clinical Pharmacology and Toxicology, University of Trieste, Italy.

Jesse is a professor of Clinical Pharmacy and Pharmacogenetics, and Chair of the Laboratory of the Department of Clinical Pharmacy and Toxicology, at the Leiden University Medical Center, in the Netherlands.

Given we traditionally only monitored particular antibiotics to spare toxicity, and that beta lactams were widely considered such safe drugs, it was once difficult to imagine this drug class would become important TDM candidates. A bit more than a decade ago we started to see the first reports about augmented renal clearance in critically ill patients, often in situations in which antibiotic treatment was crucial, such as sepsis. TDM of beta lactams in the critical care is now recognised as a valuable tool to ensure adequate drug exposure and optimise therapeutic outcomes for these vulnerable patients. But the space is full of nuances and unanswered questions remain.

We are joined today by two big names in this space, Professors Birgit Koch and Jason Roberts, who we are fortunate to have help us navigate this complex therapeutic domain.

In this episode we'll hear about:

• TDM for beta-lactams in intensive care is growing, but are we doing it well?

• The long (and winding) road to practice change.

• Exposure targets: our experts' approach and some helpful advice.

• How much of a barrier do compatibility issues pose for continuous infusions?

• Jason's Venn diagram to consider patient outcomes

• Augmented renal clearance - not just in ICU patients: other settings where it ought to be considered.

• Spot the difference: our experts describe their services.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit: https://iatdmct.org/join-us/

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Birgit is a Hospital Pharmacist and Clinical Pharmacologist at Erasmus University Medical Centre, in Rotterdam, Netherlands, where she leads the Clinical Pharmacometrics group. She is director of the education program for Clinical Pharmacology residents and director of Research & Teaching in Pharmacy.

Jason is Director of the University of Queensland Centre for Clinical Research and an Australian National Health and Medical Research Council Leadership Fellow at The University of Queensland. He is a Clinical Pharmacist at Royal Brisbane and Women's Hospital, where he leads the Centre of Research Excellence RESPOND.

This time, it's the right time - not a second time, but a unique time - to take the road to Banff, Canada, for the 22nd edition of the IATDMCT annual congress.

This time, following a very successful virtual edition in 2020, we are very glad to be meeting in person. And what a place to meet! - surrounded by Banff's mountainous splendour. We are so grateful the congress organizing committee accepted the mission to make the show happen again, and we acknowledge the incredible work they've put behind two wonderful congresses.

We hope attendees will be inspired by the location, and we are certain it will be a very special IATDMCT meeting this year.

Joining us for the episode are organising committee heroes, congress chairs David Kinniburgh and Penny Colbourne, and Pamela Lyons, who apart from being an event organising extraordinaire, is also IATDMCT member manager, and runs our head office!

In this episode we'll hear ab-oo-t (pun intended!):

• How the congress theme ties in with Banff's history of exploration and beautiful mountain scenery.

• How the scientific program balances traditional topics with new frontiers in TDM and CT: wastewater testing for drug use, pioneering genetic testing and AI applications, developments in keeping abreast of novel psychoactive substances.

• The pre-congress workshop on emerging topics in clinical toxicology, including novel drug checking services and lessons learned following marijuana legalization.

• The social program that ensures guests will be fully immersed in the Canadian Rockies experience, including hiking opportunities, a western-themed dinner, and wildlife spotting

• Why inspiration, creative insight and joyful collaboration are essentially guaranteed at this meeting!

About our guests:

Dave is the Director of the Alberta Centre for Toxicology, an Adjunct Associate Professor at the Cumming School of Medicine of the University of Calgary, and a Clinical Professor at the University of Alberta, located in Edmonton, Alberta.

Penny is a Clinical Toxicologist at the University of Alberta Hospital and Clinical Professor at the University of Alberta.

Pam started at IATDMCT in 1995, with our Congress in Vienna. She's attended every Congress since! She takes care of our members and provides support to our senior leadership teams. Pam and the IATDMCT team are based at our head office in Kingston, Ontario.

There was a time when we performed laborious pharmacokinetic hand calculations to tailor drug dosages and regimens – a practice that can still be useful for those brave enough to perform logarithmic calculator manipulations. These days, we are fortunate to have an increasing number of software tools to help us with the task, however many rely on population pharmacokinetic models typically built with relatively small data sets, and often necessarily representing subpopulations with niche requirements. Tomorrow, our work will no doubt be helped by artificial intelligence and machine learning approaches, and we have already started to see such approaches applied in the research arena.

Today, we are lucky to be joined by two experts from the field of pharmacokinetic and pharmacodynamic modelling, Prof Michael Neely and Prof Jean-Baptiste Woillard.

In this episode we'll hear about:

• the differences between traditional population pharmacokinetics and machine learning approaches in predicting drug exposure and optimizing dosing regimens

• some advantages of ML approaches, including in handling nonlinear patterns

• the challenge of interpretability of results and dose recommendations from machine learning methods compared to traditional pharmacokinetic methods

• which clinical contexts we will soon see machine learning derived models applied to clinical care

• the future of modelling and machine learning in pharmacology, including ethical considerations and the concept of augmented intelligence

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit: https://iatdmct.org/join-us/

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Jean-Baptiste is a Professor of Clinical Pharmacology in the Department of Pharmacology, Toxicology and Pharmacovigilance in the Limoges University Hospital, France where he leads the Pharmacometrics and Artificial Intelligence hospital functional unit. He is also Deputy Director of the Inserm Unit 1248 at the University of Limoges, France.

Michael Neely is a Professor of Pediatrics at the Keck School of Medicine of the University of Southern California, Chief of the Division of Infectious Diseases and Director of the Laboratory of Applied Pharmacokinetics and Bioinformatics, both at the Children's Hospital Los Angeles.

This episode we're excited to introduce you to the young guns, the bright minds of the Young Scientist Committee of the IATDMCT, who are making waves in this ever-evolving field.

Our guests are Lea Wagmann, Hualin Cai, and Sumith Mathew, each bringing their unique perspectives and experiences from Germany, China, and India, respectively. From their early inspirations to their current endeavours, we'll uncover what drives them and the impact they're making on the future of pharmacology and toxicology. We'll delve into their expectations for the years ahead, exploring the forefront of the scene and the innovative ideas brewing within the young scientist community.

In this episode we'll hear about:

• Very interesting science each one is working on including quantification to support evaluation of compliance, a suite of modelling tools being applied in the resource limited setting, and the impact of the microbiome on psychopharmacology

• First congress experiences: meeting professional heroes and memorable moments

• How membership has enabled mentoring opportunities with some of the greats in the field

• Facing challenges such as lack of evidence for many drugs and wider need for education and training - and what YS are doing to address these

• YS involvement in initiatives such as the recently launched Regional Asian Pacific Section of the Association, and opportunities for support and mentorship in the region

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Lea Wagmann is a Clinical Toxicologist and postdoctoral researcher at the Department of Experimental and Clinical Toxicology of the Saarland University in Homburg, Germany.

Hualin Cai is an Associate Professor of Neuropsychopharmacology and Clinical Toxicology, the Department of Pharmacy and Institute of Clinical Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, China

Sumith Mathew is an Associate Professor of Pharmacology and Clinical Pharmacology at Christian Medical College, Vellore, India.

This episode is about a fairly recent development in TDM and clinical toxicology that has huge potential, which has actually been used for many decades. It was recently the 50th anniversary of the Guthrie method, where dried blood spots are used to screen inborn errors of metabolism in neonatal infants. Thanks to instrumental developments, dried blood spots, and more generally microsampling approaches, have been increasingly applied to quantify a wide range of drug entities. Although these approaches offer plenty of novel opportunities in our field, they are not without challenges and pitfalls.

Our guests today are two of the biggest names in microsampling – and also absolute IATDMCT VIPs and legends. We are joined by our current president, Jan-Willem Alffenaar, and president-elect, Christophe Stove, for deep dive on the topic.

In this episode we hear about:

• Which Beatle might be the most interesting test subject for microsampling evaluation

• How low can you go? When does it become a macrosample?

• Diverse microsampling approaches: dry, wet, different matrices

• Go robust – or go home

• Obvious, and not-so-obvious challenges; typical and very novel solutions

• Clinical, toxicological and research applications: what the innovators are doing, and potential for even greater global impact

• How many times would you prick your finger in a day? The sweet spot in being informative, but not terrible for patients

• From the Beatles to ABBA: money, money, money and the place of microsapmpling in health systems

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Jan-Willem is Professor of Clinical Pharmacology at The University of Sydney, and Chair of Clinical Pharmacy at Westmead Hospital, in Sydney Australia.

Christophe Stove is Professor, and director of the toxicology laboratory, at the Department of Bioanalysis, at Gent University in Belgium.