Maintenance dose

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

Indications for treatment with streptokinase include acute occlusion of arteries, deep vein thrombosis, and pulmonary embolism. Streptokinase therapy in coronary thrombosis, which is the usual cause of myocardial infarction (54,71,72), has proved to be valuable. In this frequently fatal condition, the enzyme is adrninistered intravenously at a dose of 1.5 million units over 60 min, or given by intracoronary infusion at a 20,000- to 50,000-unit bolus dose followed by 2000 to 4000 units/min for 60 min therapy must be instituted as soon as practicable after the diagnosis of heart attack is made. For deep vein thrombosis, pulmonary embolism, or arterial occlusion, streptokinase is infused at a loading dose of 250,000 units given over 30 min, followed by a maintenance dose of 100,000 units over a 60-min period. 

Maintenance doses widely vary among patients (e.g., from 1 to 20 mg/day for warfarin), and are influenced by diet (variable vitamin K intake) and medications that affect coumarin metabolism (decreased drug clearance e.g., cotrimoxazole, amiodarone, erythromycin increased clearance e.g., barbiturates, carbamaze-pine, rifampin). Thus, regular monitoring is needed... 

If an immediate effect is needed, a loading dose (Dload) must be given to administer the therapeutic amount (Dload = Ao). To maintain the drug effect, the maintenance dose (D) must be administered repetitively with the administration interval (Tau). 

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

When a dierapeutic response occurs, die dosage may be reduced to a maintenance dose. 

Digitalis toxicity can occur even when normal doses are being administered or when the patient has been receiving a maintenance dose Many symptoms of toxicity are similar to tiie symptoms of the heart conditions for which tiie patient is receiving the cardiotonic. This makes careful assessment of the patient by the nurse a critical aspect of care... 

Gradual digitalization (giving a maintenance dose allowing the body to gradually accumulate therapeutic blood levels). 

Initial dose 5-20 mg PO maintenance dose 10-40 mg BID, TID sustained release ... 

Diet should be modified only in cases where foods have been proven to elicit symptoms. Patients with mastocytosis and Hymenoptera venom exposure are at risk for severe anaphylaxis. Thus, specific immunotherapy should be considered in patients with Hymenoptera venom allergy and then administered under close supervision [31]. The majority of patients with mastocytosis reportedly tolerate immunotherapy without significant side effects and appear protected following this approach [33,40]. However, there does appear to be some increased risk for adverse reactions during initiation of immunotherapy, as well as for therapy failures [31, 33]. An increased maintenance dose of insect venom has been reported to carry better success rates by sting provocation [41]. Also, in the light of 2 fatal cases of anaphylaxis after discontinuation of SIT in patients with mastocytosis [30], lifelong immunotherapy should be considered [26]. 

Alternative—methimazole 30 mg enterally every 6-8 h. Reduce dose once signs/symptoms are controlled. Usual maintenance dose is 15-60 mg daily in three equally divided doses... 

Begin phenytoin maintenance dose 12 h after the loading dose if indicated... 

Although an initial dose of 160 to 325 mg is required to achieve rapid platelet inhibition, long-term therapy with doses of 75 to 150 mg daily are as effective as higher doses. In addition, doses of less than 325 mg daily are associated with a lower rate of bleeding.29,30 The major bleeding rate associated with chronic aspirin administration in doses less than 100 mg per day is 1.6%, whereas the rate with doses more than 100 mg per day is 2.3%.30 Therefore, a daily maintenance dose of 75 to 160 mg is recommended.2... 

Lipid-Lowering Drug Dosage Forms Usual Adult Maintenance Dose Range Adverse Effects... 

Disease x 7 days, or Infliximab 5 mg/kg IV at weeks 0, 2, and 6 If no response to IV corticosteroids or infliximab Cyclosporine 4 mg/kg per day IV possible Restart oral mesalamine or sulfasalazine May continue infliximab at maintenance doses of 5 mg/kg every 8 weeks... 

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