VigiLanz patient monitoring software helps physicians and pharmacists identify and prevent adverse drug events

DPV Example Rules

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We have chosen a set of DPV Production rules created by VigiLanz and our Clients. All  rules are available to any client free of charge and new rules created by a client become part of  the rule library open to all.  Here we are showing only some of the rule description, not all the details of each rule.  The VigiLanz Rule Builder allows the user with the correct privileges to build rules easily and quickly using drop down menus that show all the formulary drugs and all the Hospital’s labs.  The user makes drug/lab selections and fills in other required fields such as whether the lab is a high or low lab and the lab values they desire for the rule to fire.  The other value that is chosen by the user is the what we call the Good Medical Practice Interval.  This is a time period either fixed or variable that the VigiLanz system uses to reduce the number of alerts.  If a rule is satisfied by a correct drug action within this period that activation of that rule will not become an alert.  Thus if a physician in the normal course of rounds makes a change in the drug regime within the time period the pharmacist will not have to intervene. 

Past lab values can be made part of the rule so that not only does the current lab have to be greater or less than the cutoff value but also the previous lab values have to bare a user chosen relation to the current lab.  (For example the Maximum or Minimum or Average or Median or the immediately previous lab of all the patient’s previous labs has to be less/more than X% (or some distinct value you choose)  of the current lab for the rule to fire.)

Filters can be chosen that restrict the scope of the rule for age, gender, weight, Unit of the Hospital or prescribing Physician.  Associated drugs and/or labs can also be chosen that qualify the rule even further so that the rule will only activate if that set of additional drugs/labs are present as well as all the other parameters that are set in the rule.

Each rule directs a correct drug action chosen by the user that will satisfy the rule.  This can be raise or lower the dose, discontinue the drug, change the dosing schedule etc. all through choices available through drop down menus that display the available options. If a rule is satisfied within the Good Medical Practice Interval it will not become an alert and will disappear in the warning phase from the action screens.  If not satisfied in time or the drug action is incorrect it will become an alert. 

The rule can be given accelerators such that very abnormal or trending labs call for faster  or slower action. 

Rules can be created, edited, put into production, taken out of production and assigned to clinical rule groups as the user wishes. Rules can also be cloned so that a rule for one drug/lab/weight range/age etc. can easily be made for a another in an instant.
  
The following are Rule Descriptions only.  All the details that make up each rule are easily seen in the Rule Builder and can be viewed as a group within the Vigilanz Report System. Here we show only the rule description that the user created.  It should give a general sense of why the rule was created. For a closer look at our rules think of calling or writing for an online demo.

Rule Description
Rule that alerts to elevated potassium level in elderly females on potassium replacement who are also on amlopidine, or triamterenne/HCTZ, or digoxin, and whose labs show an elevated dig level, decreased calcium or renal insufficiency; with acceleration.
Alerts to the toxic serum level of carbamazepine.
Alerts to toxic levels of lithium.
Alerts to toxic levels of phenobarbital
Alerts to toxic levels of procainamide.
Alerts to the sub therapeutic serum level of carbamazepine.
Alerts to toxic levels of theophylline.
Alerts to sub therapeutic PTT while on heparin.
Alerts to sub therapeutic levels of primidone.
Alerts to toxic levels of primidone.
Alerts to the elevation of glucose for patients on acarbose and a phenothiazine.
Rule designed to monitor patients receiving insulin for the development of hypoglycemia
Rule designed to monitor for hyperkalemia in patients receiving potassium supplementation.
Rule designed to monitor for hyperkalemia in patients receiving potassium supplementation and lisinopril.
Rule designed to monitor for thrombocytopenia in patients receiving heparin.
Rule designed to monitor for hyperkalemia in patients receiving lisinopril.
Rule designed to monitor elevations in liver function tests (ALT) in patients receiving amiodarone.
Rule designed to monitor for low trough levels of vancomycin.
Thrombocytopenia in patients receiving enoxaparin whose platelets have dropped at least 30% AND are <200
Rule designed to monitor aPTT and Heparin
Alerts to hypoglycemia with metformin.
Alerts to the possibility of hepatic failure due to valproic acid induced hepatitis, requiring discontinuation of the drug.
Alerts to the possibility of hepatic failure due to valproic acid induced hepatitis, requiring discontinuation of the drug.
Rule designed to monitor the development of hypoglycemia in patients receiving tolbutamide.
Alerts to the need to evaluate phenytoin as the potential cause of neutropenia and/or thrombocytopenia
Rule designed to monitor the development of hypoglycemia in patients receiving tolazamide.
Rule designed to monitor the development of hypoglycemia in patients receiving acetohexamide.
Rule designed to monitor the development of hyperglycemia in patients receiving acetohexamide.
Rule designed to monitor increased susceptibility to hypoglyemia in elderly patients receiving chlorpropamide.
Rule designed to monitor increased susceptibility to hypoglyemia in elderly patients receiving glyburide.
Rule designed to monitor the development of hypoglycemia in patients receiving glipizide.
Rule designed to monitor the development of hypoglycemia in patients receiving glimepiride.
Rule designed to monitor for hyperkalemia in patients receiving lisinopril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving benazepril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving captopril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving enalapril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving fosinopril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving moexipril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving quinapril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving ramipril and a potassium sparing diuretic
Rule designed to monitor for hyperkalemia in patients receiving trandolapril and a potassium sparing diuretic
Rule designed to monitor for increased Potassium in patients receiving benazepril.
Rule designed to monitor for increased Potassium in patients receiving captopril.
Rule designed to monitor for increased Potassium in patients receiving enalapril.
Rule designed to monitor for increased Potassium in patients receiving fosinopril.
Rule designed to monitor for increased Potassium in patients receiving moexipril.
Rule designed to monitor for decreases in renal function (BUN) in patients receiving quinapril.
Rule designed to monitor for increased Potassium in patients receiving ramipril.
Rule designed to monitor for increased Potassium in patients receiving trandolapril.
Rule designed to monitor the development of  thrombocytopenia in patients on methotrexate and probenecid
Rule designed to monitor the development of  thrombocytopenia in patients on methotrexate
Rule designed to monitor for hyperkalemia in patients on triamterine and potassium
Rule designed to monitor for increased Potassium in patients receiving lorsartan.
Rule designed to monitor for increased Potassium in patients receiving valsartan.
Rule designed to monitor for increased Potassium in patients receiving irbesartan.
Rule designed to monitor for increased Potassium in patients receiving candesartan.
Rule designed to monitor for increased Potassium in patients receiving eprosartan.
Rule designed to adjust meperidine dosages in patients with decreased renal function.
Rule designed to monitor for hyperkalemia in patients receiving captopril and a potassium sparing diuretic
Tracks digoxin levels for patients on digoxin watching for toxic levels and low serum potassium.
Rule designed to monitor for decreased serum potassium levels while receiving digoxin.
Rule designed to monitor for hyperkalemia in patients receiving captopril and a potassium sparing diuretic
Alerts to patients receiving cimetidine and checking for low platelet levels
Ranitidine and PLATELETS has FALLEN 50 percent of previous value  & Any of last 1 PLATELETS (PLT) results within last 3 days are < 100 
Alerts to patients receiving nizatidine and low platelet count  PLATELETS (PLT) has FALLEN 50 percent of previous value  & Any of last 1 PLATELETS (PLT) results within last 3 days are < 100  (Check previous PLT levels)
Rule designed to monitor elevations in liver function tests (ALT) with lovastatin.
Rule designed to monitor elevations in liver function tests with atorvastatin.  ALT (SGPT) or AST (SGOT) > 450 & having the minimum ALT/AST results during the last 7 days rising at least 20% from that minimum
Rule designed to monitor elevations in liver function tests (ALT) with pravastatin.
Alerts to toxic levels of desipramine.
Patients who are receiving protamine as antidote for anticoagulation
Patients receiving phytonadione while receiving warfarin
Patient receiving Flumazenil as antidote to benzodiazepine toxicity
Patient receiving naloxone as antidote to opiate toxicity
Rule designed to monitor elevations in liver function tests (ALT) with rosuvastatin.
Rule designed to monitor elevations in liver function tests (ALT) with fluvastatin.  SGOT (AST/GOT) > 450 & the minimum SGOT (AST/GOT) results during the last 7 days has risen 20% from that minimum
Patients receiving amphoteracin with declining renal function
Elevation in creatinine while receiving acyclovir
Patient is on AMIODARONE and DIGOXIN
If any of the last 1 PLATELETS (PLT) results during the last 1 days is <50 & patient is on ASPIRIN, CLOPIDOGREL, TICLODIPINE, or NSAIDs.
If any of the last 1 PLATELETS (PLT) results during the last 1 days is <50 & patient is on NSAIDs.
High quinidine levels
Rule designed to monitor elevations in liver function tests with fluvastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with lovastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Rosuvastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with phenytion.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with cyclosporine.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Methotrexate.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Warfarin.  ALT (SGPT) or AST (SGOT) > 300 & check any of the last ALT/AST results during the last 7 days is <300 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Isoniazid.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Heparin induced thrombocytopenia identification
Elevation in Creatinine while receiving Lisinopril > 1.5  & CREATININE has RISEN 1.0 since previous result.
Elevation in Creatinine while receiving enalapril > 1.5  & CREATININE has RISEN 1.0 since previous result. 
Checking for renal dysfunction in patients receiving repeat administrations of Amikacin Creatinine Value of >1.5  AND check if CREATININE has check if RISEN .5 since previous result.
Elevation in Creatinine while receiving Aspirin> 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving celecoxib > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving Diclofenac > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving ibuprofen > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving INDOMETHACIN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving KETOROLAC > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving NABUMETONE > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving NAPROXEN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving PIROXICAM > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving SALSALATE > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving SULINDAC > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving TOLMETIN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving ACYCLOVIR> 1.5  & CREATININE has RISEN 0.5 since previous result.  Can mark a SrCr to be alerted for % rise
Elevation in Creatinine while receiving AMPHOTERICIN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving FLUCONAZOLE> 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving ITRACONAZOLE > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving CYCLOSPORINE > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving CARBOPLATIN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving CISPLATIN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving IFOSFAMIDE > 1.5  & CREATININE has RISEN 0.5 since previous result.  Can mark a SrCr to be alerted for % rise
Elevation in Creatinine while receiving METFORMIN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving meperidine > 1.5 
Elevation in Creatinine while receiving CIPROFLOXACIN > 1.5  & CREATININE has RISEN 0.5 since previous result.
Elevation in Creatinine while receiving RANITIDINE > 2
If OSMOLARITY has risen 20% of the previous value and patient is on ATIVAN (LORAZEPAM) (prn orders excluded) (route=IV)
Patient with a Mg lab result over 3.5  & creatinine over 3.0 --  Check if on any Magnesium
COLCHICINE and serum creatinine in last 1 day is greater than or equal to 2.0
Patient is ordered for Heparin and fondaparinux
Patient is ordered for COLCHICINE and CYCLOSPORINE
Patient is ordered for COLCHICINE and TACROLIMUS
Patient has order for concurrent use of AZATHIOPRINE and ALLOPURINOL
Patient ordered for voriconazole and SIROLIMUS
Rule designed to monitor elevations in liver function tests with atorvastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with lovastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Simvastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Simvastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Rosuvastatin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Isoniazid.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with phenytion.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with cyclosporine.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Methotrexate.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Rule designed to monitor elevations in liver function tests with Warfarin.  ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value
Warning with CK 5X ULN, Rhabdo definitive at 10X.  Check if patient has a history of being on a Statin.  Check if CK elevation is of non-cardiac origin (CK-MB is >5 and the CK Index is <3.5)
Monitors for rising creatinine in a male adult on rosuvastatin
Monitors for rising creatinine in a female adult on rosuvastatin
Monitors for bile duct release of gamma glutamyl transpeptidase in an adult on rosuvastatin.
Monitors and alerts to when a hypothyroid patient is on rosuvastatin, indicating a higher predilection for rhabdomyolysis.
Monitors for candesartan induced hypokalemia
Monitors for rising creatinine for a person on candesartan
Monitors for elevated serum transaminase for person on candesartan
Monitors for elevated serum transaminase for person on candesartan
Monitors for possible rhabdomyolysis in a person on candesartan.
Alerts to the need to change the levofloxacin dose to a max of 250 mg/day or 750 mg q48h for a CrCl=20-49 ml/min 
Alerts to the need to lower the levofloxacin dose: max 250 mg/day or 500 mg q48h for CrCl <20 ml/min
Alerts to the need to increase levofloxacin dose with CrCl >50 ml/min to 500-750 mg/day
Alerts to the need to increase prophylaxis dose of enoxaparin if CrCl>30 ml/min and age<65 and wt>50kg to 40 mg q24h
Alerts to the need to lower enoxaparin prophylaxis dose to 30 mg q24h if AGE>65 and WT<50 kg even though CrCl is >30 ml/min
Alerts to the need to increase enoxaparin prophylaxis dose in obesity with CrCl >30 and wt >150kg to 40 mg q12h
Alerts to the need to reduce enoxaparin to 1mg/kg q24h with a CrCl <30 ml/min if pt on >1 mg/kg/day
Alerts to the need to reduce famotidine dose to max of 20 mg/day with CrCl <50 ml/min
Alerts to the possible need to decrease digoxin dose (check for DIG levels, if any)
Alerts to the possible need to decrease digoxin dose in a patient <50 kg (check for DIG levels)
Alerts for the need to decrease colchicine dose: max of 0.6 mg/day with CrCl 10-50 ml/min
Alert for need to discontinue colchicine in a patient with CrCl <10 ml/min
Alerts to the need to reduce the enoxaparin dose to 30 mg q24h for a CrCl <30 ml/min (if prophylaxis)
Alerts to the need to reduce the daily allopurinol dose in a patient with CrCl <10 ml/min to 100 mg/day
Alerts to the need to change vancomycin dosing to approx 15 mg/kg q48h if CrCl 10-30 ml/min
Alerts to the need to increase famotidine dosing to 40 mg/day if CrCl > 50 ml/min
Alerts to the possible need to reduce digoxin dosing in patients >65 yo. Screening tool
Alerts to the need to adjust vancomycin dosing to approx 15 mg/kg/day with CrCl= 30-60 ml/min
Alerts to the need to reduce the dose of allopurinol to a max of 200 mg/day if CrCl 10-20 ml/min
Alerts to the need INCREASE enoxaparin dose to  1 mg/kg q12h dosing in ACS if CrCl >30 ml/min
Alerts to the need to increase enoxaparin dose: 
consider 1.5 mg/kg/day for non-ACS use if CrCl=30-45 ml/min, for CrCl >45 either 1 mg/kg q12h or 1.5 mg/kg/day is OK for DVT/PE
Alerts to possible need to DC ACEI/ARB if K>5.0
Alerts to toxic levels of total phenytoin (corrected)in patients receiving amiodarone, allopurinol, or warfarin.
Alert to the need to use metformin with caution for CrCl=30-60, and DC if CrCl<30
Alerts to possible linezolid induced thrombocytopenia
Alerts to possible drop in RBC due to linezolid induced myelosupression
Alerts to possible linezolid induced leucopenia or neutropenia secondary to myelosuppression
Alerts to the possibility of HIT with a positive heparin associated platelet antibody result.
Check for heparin/enoxaparin use and need for DTI
Fluconazole and CrCl <50 ml/min
Alerts to the need to reduce dose by 50% if CrCl <50 ml/min. (Normal dose can be up to 800 mg/day for serious fungal infections)
Naloxone taken from Pyxis. Evaluate for possible ADR
Flumazenil taken from Pyxis.
Evaluate for possible ADR.
Glucagon taken from Pyxis.
Evaluate for possible ADR-hypoglycemia or beta blocker toxicity
Digoxin level >2.0, evaluate for possible ADR
or dose adjustment
Elevated theophylline >20, evaluate for possible ADR or dose adjustment
Elevated carbamazepine level >12, evaluate for possible ADR, or dose adjustment
Elevated lithium level >1.2, evaluate for possible ADR, or dose adjustment
D50/W IV, or glucose tablet or glucose gel given.
Evaluate for possible hypoglycemia ADR
Gentamicin trough level >2 alert.
Tobramycin trough level >2 alert,
Gentamicin dose assessment using adjusted BW.
ODA protocol is 6 mg/kg/day.
(r/o gram + synergy dosing)
Gentamicin dose assessment using adjusted body weight.
(r/o adjusted gram + synergy dosing)
Gentamicin dose assessment using adjusted body weight.
(r/o gram + synergy dosing)
Gentamicin dose assessment using adjusted body weight (ABW).
(r/o gram + synergy dosing)
Gentamicin dose assessment using adjusted BW.
Should not exceed 2 mg/kg/day if CrCl <30 ml/min
(r/o gram + synergy dosing)
Tobramycin dosing assessment using adjusted body weight (ABW).
Digoxin dose assessment using Ideal Body Weight.
Check for dig levels and stable renal function.
Alerts to the possible need to DC Aranesp or reduce the dose for a rising Hgb >12 which is
associated with adverse outcomes.
Alerts to the possible need to dose adjust gabapentin for creatinine clearance = 30-59.
If stable dose, query patient for side effects.
Alerts to the possible need to dose adjust gabapentin for creatinine clearance = 15-30
If stable dose, query patient for side effects.
Alerts to the possible need to dose adjust gabapentin for creatinine clearance=7.5-15.
If stable dose, query patient for side effects.
Alerts to the possible need to dose adjust gabapentin for creatinine clearance <7.5 ml/min.
If stable dose, query patient for side effects.
Alerts to a possible dose adjustment for amikacin to 15 mg/kg/day for a CrCl >80 ml/min using Adjusted Body Weight (ABW)
Alerts to a possible dose adjustment for amikacin to 12 mg/kg/day for a CrCl = 60-80 ml/min using Adjusted Body Weight (ABW)
Alerts to a possible dose adjustment for amikacin to 7.5 mg/kg/day for a CrCl = 40-60 ml/min using Adjusted Body Weight (ABW)
Alerts to a possible dose adjustment for amikacin to 4 mg/kg/day for a CrCl = 30-40 ml/min using Adjusted Body Weight (ABW)
Alerts to a possible dose adjustment for amikacin to 7.5 mg/kg q48h for a CrCl =20-30 ml/min using Adjusted Body Weight (ABW)
Alerts to a possible dose adjustment for amikacin to 4 mg/kg q48h for a CrCl = 10-20 ml/min using Adjusted Body Weight (ABW)
Alerts to the need for a possible dose adjustment for amikacin to 3 mg/kg q72h for a CrCl <10 ml/min using Adjusted Body Weight (ABW)
Consider q12h dosing interval with cefazolin and CrCl=10-50
Consider q24h frequency with cefazolin and CrCl <10 ml/min
Alerts to elevated lactic acid levels in diabetics on metformin.
Alerts to the possibility of pancreatis with acidosis due to valproic acid, requiring rapid discontinuation of the drug.
Alerts to the possibility of pancreatis with acidosis due to valproic acid, requiring rapid discontinuation of the drug.
Alerts to toxic levels of total phenytoin.
Alerts to toxic levels of total phenytoin in patients receiving amiodarone, allopurinol, or warfarin.
Alerts to toxic levels of valproic acid.
Phenytoin level greater than 18 and Albumin less than 3.3
Alerts to the possible need to discontinue enoxaparin in a patient with INR >2
Elevated valproic acid level >100, evaluate for possible ADR. Normal range=50-100, some seizure patients may need 80-150 for seizure control.
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