Patient compliance once-daily dosing

Initial daily doses of 10-40 and 100-600 mg are recommended in clinical practice for MMI and PTU, respectively [1, 2]. Several studies have shown that treatment of hyperthyroidism with single daily doses of 10-40 mg of MMI is effective in the induction of euthyroidism in 80-90% of patients within 6 weeks [2]. The aim of the further antithyroid therapy is to maintain euthyroidism with the lowest necessary diug dose. Intrathyroidal diug accumulation is one cause for the efficiency of a single daily dose regimen. Moreover, a once daily dose yields better patients compliance. Single daily doses of PTU have been shown to be less effective in achieving euthyroidism than administration of three divided doses a day. If a once daily... 

Monotherapy with a PPI is not only more effective in patients not responding to an H2RA or prokinetic agent alone, but it also improves compliance with once-daily dosing and is ultimately more cost-effective. 

Azithromycin. Azithromycin is another recently developed macrolide antibiotic. After oral administration on an empty stomach, azithromycin is rapidly absorbed and widely distributed throughout the body. Because azithromycin has an extended half-life, once-daily dosing is effective and encourages patient compliance. 

Parenteral administration is not perceived as a problem in the context of drugs which are administered infrequently, or as a once-off dose to a patient. However, in the case of products administered frequently/daily (e.g. insulin to diabetics), non-parenteral delivery routes would be preferred. Such routes would be more convenient, less invasive, less painful and generally would achieve better patient compliance. Alternative potential delivery routes include oral, nasal, transmucosal, transdermal or pulmonary routes. Although such routes have proven possible in the context of many drugs, routine administration of biopharmaceuticals by such means has proven to be technically challenging. Obstacles encountered include their high molecular mass, their susceptibility to enzymatic inactivation and their potential to aggregate. 

It is now becoming apparent that a single daily dose (rather than 2-3 doses per day) significantly enhances patient compliance and, therefore, effectiveness of treatment. For this reason, the long-acting diuretics which can be administered once a day offer an important advantage chlorthalidone, metolazone, trichlor-methiazide can be administered once a day with a 24 hour natriuretic effect. 

Single daily dosage - In adults, if seizure control is established with divided doses of three 100 mg extended phenytoin sodium capsules daily, once/day dosage with 300 mg may be considered patient compliance is essential on a once/day regimen. Only extended phenytoin sodium capsules are recommended once/day. 

A Methimazole has a longer TV2 than PTU and can be dosed once daily PTU requires three to four daily doses, which may affect compliance. PTU does not cause pretibial myxedema rather Graves hyperthyroidism leads to pretibial myxedema. Methimazole does not interact with amiodarone however, amiodarone can affect thyroid function, leading to both hypo- and hyperthyroidism. PTU therapy may result in spontaneous remission, but patients typically require therapy for many years (1 to 15 years). 

Divalproex sodium extended-release (Depakote ER) is a once daily (QD) formulation for VPA that was developed to improve patient compliance and reduce side effects compared to the standard twice-daily (BID) delayed release (DR) formulation (Depakote tablets). However, there are concerns of potential subthera-peutic concentrations following delayed or missed doses or toxic concentrations with replacement doses for the ER and DR formulations. 

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