Maintenance therapy

Other Infections. The slowly excreted sulfonamides (eg, sulfamethoxypyrida2ine, sulfadimethoxine) are used for treatment of minor infections such as sinusitis or otitis, or for prolonged maintenance therapy. Soluble sulfonamides are sometimes used for proto2oal infections in combination with other agents. Pyrimethamine, combined with sulfonamides, has been used for toxoplasmosis or leishmaniasis, and trimethoprim with sulfonamides has been used in some types of malaria. In nocardiosis, sulfonamides have been used with cycloserine [68-41-7] (17). 

A common strategy for treating chronic opiate addiction iavolves the substitution of methadone which can either be provided as maintenance therapy or tapered until abstinence is achieved. Naltrexone and buprenorphine [52485-79-7] have also been used ia this manner. The a2 adrenergic agonist clonidine [4205-90-7] provides some rehef from the symptoms of opiate withdrawal, probably the result of its mimicking the inhibitory effect of opiates on the activity of locus coerukus neurons. 

To be successful, antineoplastic therapy often has to be applied for considerable periods of time. The initial therapy period is being termed induction therapy which is then followed by a maintenance therapy and possibly a reinduction therapy. ... 

Maintenance therapy is designed to reduce the patient s desire to return to the drug that caused addiction, as well as to prevent withdrawal symptoms. The dosses used vary with the patient, die length of time die individual has been addicted, and the averse amount of drug used each day. Fhtients enrolled in an outpatient methadone program for detoxification or maintenance therapy on methadone must continue to receive methadone when hospitalized. 

TCAs Once-a-day dosing may be prescribed for maintenance therapy. When the nurse administers the total daily dosage at night, the sedative effects promote sleep, and the adverse reactions appear less troublesome Because protriptyline may produce a mild stimulation in some patients, it is usually not given as a single bedtime dose... 

LITHIUM The dosage of lithium is individualized according to serum levels and clinical response to the drug. The desirable serum lithium levels are 0.6 to 1.2 mEq/L Blood samples are drawn immediately before die next dose of lithium (8-12 hours after the last dose) when lithium levels are relatively stable During die acute phase die nurse monitors serum lithium levels twice weekly or until die patient s manic phase is under control. During maintenance therapy, the serum lidiium levels are monitored every 2 to 4 months. 

Serum levels (digoxin) may be ordered daily during the period of digitalization and periodically during maintenance therapy. Periodic electrocardiograms, serum electrolytes, hepatic and renal function tests, and other laboratory studies also may be ordered. 

Nuitjen MJC, Hardens M, Souetre E (1995). A Markov Process Analysis comparing the cost effectiveness of maintenance therapy with citalopram versus standard therapy in major depression. Pharmacoeconomics, 159-68. 

Restart the patient on maintenance therapy. Instruct the patient on what to do if asthma should worsen and to follow-up with his/her health care provider in 3 to 5 days. 

Ranitidine 1 50 mg If symptoms recur frequently, consider maintenance therapy with the lowest effective dose. 

Many patients with GERD relapse if medication is withdrawn, and long-term maintenance treatment is required in such patients.1 Candidates for maintenance therapy include patients whose symptoms return once therapy is discontinued or decreased, patients with complications such as Barrett s esophagus or strictures, and perhaps patients with atypical symptoms. 

The H2RAs may be effective maintenance therapy for patients with mild disease.5 The PPIs are first choice for maintenance treatment of moderate to severe GERD.22 Preliminary data suggest that on demand maintenance therapy may be effective for some patients.1 With on-demand therapy, patients takes their PPIs only when symptoms occur. However,... 

Record the frequency and severity of symptoms by interviewing the patient after 6 to 8 weeks of acid-suppressing therapy. Continued symptoms may indicate the need for long-term maintenance therapy. 

Low-dose maintenance therapy with a proton pump inhibitor or histamine2-receptor antagonist is only indicated for patients who fail HP eradication, have HP-negative ulcers, or develop severe complications related to their ulcer disease. 

Patients with CD are at high risk for disease relapse after induction of remission. Within 2 years, up to 80% of patients suffer a relapse therefore, most patients should be evaluated for indefinite maintenance therapy. Maintenance of remission of CD may be achieved with oral or topical aminosalicylate derivatives, immunosuppressants (such as azathioprine, 6-mercaptopurine, and methotrexate), or infliximab. 

Corticosteroids, while effective for rapidly inducing remission, are not effective for maintenance therapy and are associated with significant adverse effects with long-term use. Therefore, systemic or topical corticosteroids should not be used for maintaining remission in patients with IBD. Unfortunately up to 50% of patients treated acutely with corticosteroids become dependent on them to prevent symptoms.2... 

These tests should be monitored closely (every 2 to 4 weeks) at the start of therapy and then approximately every 3 months during maintenance therapy. 

Assess whether the patient will require maintenance therapy after remission induction. If so, identify the treatment... 

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