Dose adjustment

Phase I. This involves general testing for human pharmacology in healthy volunteers, ie, safe-dose adjustment deterrnination of absorption, metabohsm, and excretion patterns and monitoring for side effects. Usually fewer than 10 test subjects ate involved. 

Since the dose is given to produce an effect, it is obvious that pharmacokinetics is a required but not yet sufficient tool for drug dose adjustment Pharmacokinetics (PK) must be combined with pharmacodynamics (PD) to derive the individualized dose. 

Based on therapeutic drag monitoring ( TDM) and the individual parameter estimates, every drag can be made applicable to every patient by individual dose adjustment. 

Luzius Dettli was not only the first who described the linear function for the dependence of diug elimination on glomerular filtration rate. He was also the first who proposed the fundamental dose adjustment recommendation, the proportional dose reduction rule. Two alternatives are given to either reduce the single dose (D) or extend the interval (Tau). 

A second, completely different dose adjustment tule exists. Calvin Kunin proposed to start with the standard dose and to administer one half of the standard dose after one individual half-life. The halfdosage rule of Kunin should only be applied if the individual half-life is longer than the standard administration interval. 

The dose after dialysis (Dhd) must replace the maintenance dose adjusted to renal failure (Dfail) and the... 

Used to derive an intermediate inhalation Minimal Risk Level (MRL) of 5 x 10 ppm dose adjusted for intermittent exposure and divided by an uncertainty factor of 100 (10 for extrapolation from animal to humans, 10 for human variability). 

After a baseline angiogram confirms the presence and location of the vascular occlusion, a microcatheter is navigated over a microwire into the occluded vessel, traversing the thrombus. Once the microcatheter is positioned immediately distal to the clot, thrombolytic infusion begins the microcatheter is then pulled back through the clot while dmg is infused. Dose adjustments and total dose calculations are made depending on the clinical circumstances, pretreatment dose of rt-PA received, degree of recanalization, and relative size and function of the territory at risk. 

A historical cohort of 102 patients with CVT (43 of whom had an ICH) was also retrospectively examined in this study to estimate the safety of UFH. Twenty-seven patients with ICH received dose-adjusted intravenous heparin. Of these four died... 

The serum creatinine is measured to identify patients who may need dosing adjustments for some medications, as well as those who are at high risk of morbidity and mortality. 

Elevated plasma concentrations of QT interval-prolonging drugs due to drug interactions or absence of dose adjustment for organ dysfunction... 

Warfarin has been the primary oral anticoagulant used in the United States for the past 60 years. Warfarin is the anticoagulant of choice when long-term or extended anticoagulation is required. Warfarin is FDA-approved for the prevention and treatment of VTE, as well as the prevention of thromboembolic complications in patients with myocardial infarction, atrial fibrillation, and heart valve replacement. While very effective, warfarin has a narrow therapeutic index, requiring frequent dose adjustments and careful patient monitoring.15,29... 

Patients with an oxygen saturation less than 90% (less than 95% in children, pregnant women, and patients with co-existing heart disease) should receive oxygen with the dose adjusted to keep oxygen saturation above these levels.3,12,40 Hypoxemia usually results from a ventilation/perfusion mismatch, and low oxygen levels (less than 30% of the fraction of inspired air) administered by nasal cannula or facemask are sufficient to reverse hypoxemia in most patients. 

Time between dose adjustments 4-6 weeks 4-6 weeks 2 weeks 4 weeks 1 week... 

Monitor patient for response to therapy, need for dose adjustments, and presence of adverse drug reactions. 

Develop a plan to assess efficacy of pharmacologic therapy. Also consider if the patient s therapy requires any dose adjustments. 

Develop a formal plan to assess response and adverse effects of dopamine agonists. When appropriate, be sure to make dose adjustments. 

The Food and Drug Administration (FDA) approved dose of daclizumab is 1 mg/kg within 24 hours of transplant surgery and then 1 mg/kg administered every 2 weeks after surgery for a total of five doses.7,9,11 No dose adjustment is necessary in renal impairment, but no data are available for dose adjustments in hepatic dysfunction. Several trials have shown that a shorter dosing regimen of daclizumab, two doses given in a similar manner as basiliximab, may be as safe and effective as the full five-dose course.12,13... 

Consensus-based guidelines indicate that the management of allergic rhinitis in children follows the same principles as those in adults, with special considerations for dose adjustments and adverse effects. 

Trade Name Dosage Forms Prescribed Doses Dose Adjustments Restrictions Events Potential... 

Drug Name Generic/(Abbreviation)/ Trade Name Dosage Forms Commonly Prescribed Doses Dose Adjustments Food Restrictions Significant Adverse Events Drug Interaction Potential... 

Is the patient taking the appropriate dose of each medication Are the doses adjusted for renal or hepatic failure Are the doses adjusted for drug interactions with concomitant medications ... 

---