ABSTRACT
An important factor in the failure of pharmacotherapy is uncertainty in the relationship between doses and effect. This factor can be divided into the uncertainty in the relationship between doses and plasma concentration, and the uncertainty in the relationship between plasma concentration and the effect. The persistent neglect of chirality and its implications for drug action as a matter of fact has its roots in the fact that hardly any of the (highly recommended) clinically orientated textbooks on pharmacology, pharmacokinetics, or toxicology principles such as stereoselectivity, stereospecificity, stereochemistry, etc, emphasize or even mention chirality. Few scientists will deny that stereoselectivity in action is a common and important phenomenon. It concerns the relationship between dose and plasma level as well that between plasma level and effect, pharmacokinetics as well as pharmacodynamics, the latter for the desired as well as undesired actions. In both the study of pharmacokinetics in general and for therapeutic drug monitoring, selective methods are essential.
