Long-term pharmacokinetics of clozapine

1998 ◽  
Vol 173 (4) ◽  
pp. 341-344 ◽  
Author(s):  
Martin Kurz ◽  
M. Hummer ◽  
G. Kemmler ◽  
I. Kurzthaler ◽  
A. Saria ◽  
...  
Keyword(s):  
Plasma Level ◽  
Coefficient Of Variation ◽  
Plasma Levels ◽  
Maintenance Treatment ◽  
Clinical Symptoms ◽  
Significant Degree ◽  
Individual Variability ◽  
Second Step

BackgroundPrevious studies of clozapine pharmacokinetics have shown a wide intra- and inter-individual variability of plasma levels in patients on stable clozapine doses. We investigated dose-plasma level relationships and intra-individual variability of plasma levels during maintenance treatment with clozapine.MethodForty-one patients on clozapine were followed for 26 weeks with repeated plasma level measurements and assessments of co-medication and clinical symptoms. In a second step, 15 patients on stable clozapine doses between treatment Weeks 12 and 52 were followed in the same way. Coefficient of variation was used as a parameter of plasma level deviation.ResultsDose-plasma level correlations stayed significant from Week 6 to Week 26 (n=41). The group of patients followed up to Week 52 showed a mean intra-individual coefficient of variation of 52.8% (s.d. =20.6), and remained stable psychopathologically.ConclusionsEven though clozapine plasma levels may show a significant degree of variation, this is not necessarily reflected in a change in psychopathology.

Biological and Analytic Components of Variation in Long-Term Studies of Serum Constituents in Normal Subjects

1970 ◽  
Vol 16 (12) ◽  
pp. 1028-1032 ◽  
Author(s):  
Ernest Cotlove ◽  
Eugene K Harris ◽  
George Z Williams
Keyword(s):  
Uric Acid ◽  
Individual Variation ◽  
Coefficient Of Variation ◽  
Total Protein ◽  
Normal Subjects ◽  
Individual Variability ◽  
Normal Range ◽  
Laboratory Procedures ◽  
Long Term Studies

Abstract Biological components of variation for each of 15 serum constituents have been estimated in 68 normal subjects by weekly measurements over several months, and concurrent measurements on invariant human serum pools. Intra-individual coefficient of variation was smallest, less than 2%, for Na, Cl, Ca, Mg; 3 to 4% for CO2, albumin, and total protein; 5 to 7% for K, glucose, cholesterol, and phosphate; and largest, 9 to 12%, for uric acid, urea nitrogen, SGOT, and LDH. Inter-individual variation was larger than intra-individual variation for all 15 tests except Cl, CO2, and K. Analytic deviation was as large as or larger than biological (intra- or inter-individual) variability for constituents, such as calcium, which are under precise homeostatic control, thus producing artifactual widening in the observed normal range and obscuring the borderline between normal and abnormal results. Limits of tolerable variability in laboratory procedures are proposed, based on composite intra- and inter-individual variation, that would permit medically significant deviations in results to be detected. Such limits were exceeded by current methodology in at least half the 15 tests.

Large Variations of Plasma Levels During Maintenance Treatment with Depot Neuroleptics

1996 ◽  
Vol 169 (5) ◽  
pp. 618-621 ◽  
Author(s):  
Eva Tuninger ◽  
Sten Levander
Keyword(s):  
Side Effects ◽  
Plasma Level ◽  
Plasma Levels ◽  
Clinical Effect ◽  
Clinical Symptoms ◽  
Repeated Measurements ◽  
Neuroleptic Treatment ◽  
Neuroleptic Medication ◽  
Depot Neuroleptics ◽  
Depot Neuroleptic

BackgroundStability of neuroleptic medication has been associated with optimal clinical effect and minimal side-effects. Depot administration is assumed to yield better stability.MethodThirty patients on depot neuroleptic treatment were followed during three years with repeated measurements of plasma level and concurrent ratings of clinical symptoms and side-effects.ResultsOf 120 blood samples 35 (29%) measurements were outside ± 2 s.d. measurement error (expected 5%). Perphenazine levels were more variable (46%) than haloperidol (25%) and flupenthixol (12.5%). No relationship was found between side-effect ratings and fluctuations of plasma levels.ConclusionDepot neuroleptic medication does not eliminate a clinically unwanted and sometimes marked variation in plasma level.

scholarly journals Advanced baseline immunosuppression is associated with elevated levels of plasma markers of fungal translocation and inflammation in long-term treated HIV-infected Tanzanians

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Godfrey Barabona ◽  
Macdonald Mahiti ◽  
Mako Toyoda ◽  
Doreen Kamori ◽  
Salim Masoud ◽  
...  
Keyword(s):  
Plasma Level ◽  
Plasma Levels ◽  
Inflammatory Marker ◽  
Hiv Treatment ◽  
Cd4 Count ◽  
Inflammatory Biomarkers ◽  
Latent Reservoir ◽  
Proviral Dna ◽  
Antibody Titers

Abstract Background For over a decade, antiretroviral therapy (ART) in resource-limited countries was only recommended for patients with advanced HIV disease. We investigated this group of patients in order to determine any relationship between degree of immunosuppression during treatment initiation and the subsequent levels of inflammatory biomarkers, reservoir size and plasma marker of fungal translocation after achieving long-term virological control. Methods We analyzed 115 virally suppressed (female 83.5%) and 40 untreated (female 70%) subjects from Dar es Salaam, Tanzania. The size of HIV latent reservoir (proviral DNA copy) was determined using quantitative PCR. Inflammatory biomarkers; IL-6, IL-10, and soluble CD14 (sCD14), were measured using multiplex cytometric beads array. Antibody titers for Cytomegalovirus (CMV) and Epstein Barr virus (EBV), plasma level of 1-3-beta-d-Glucan (BDG) was measured using ELISA. High-sensitivity C-reactive protein (hsCRP) was measured using nephelometric method. Results The median age was 36 (IQR 32-44) and 47 (IQR 43–54) years in untreated and virally suppressed patients respectively. Median duration of treatment for virally suppressed patients was 9 years (IQR 7–12) and median baseline CD4 count was 147 cells/mm3 (IQR 65–217). Virally suppressed patients were associated with significantly lower plasma levels of IL-10, sCD14 and BDG (P < 0.05) when compared to untreated patients. However, plasma level of IL-6 was similar between the groups. Baseline advanced level of immunosuppression (CD4 < 100cells/cm3) was associated with significantly higher plasma level of IL-6 (P = 0.02), hsCRP (P = 0.036) and BDG (P = 0.0107). This relationship was not seen in plasma levels of other tested markers. Degree of baseline immunosuppression was not associated with the subsequent proviral DNA copy. In addition, plasma levels of inflammatory marker were not associated with sex, CMV or EBV antibody titers, treatment duration or regimen. Conclusions Our data suggest that advanced immunosuppression at ART initiation is associated with severity of inflammation and elevated fungal translocation marker despite long term virological control. Further studies are needed to evaluate the potential increased burden of non-AIDS comorbidities that are linked to elevated inflammatory and fungal translocation markers as a result of the policy of HIV treatment at CD4 count < 200 cells/cm3 implemented for over a decade in Tanzania.

Idiopathic venous thrombosis

2006 ◽  
Vol 26 (01) ◽  
pp. 52-54 ◽  
Author(s):  
P. A. Kyrle
Keyword(s):  
Chronic Disease ◽  
Venous Thrombosis ◽  
Vitamin K ◽  
Clinical Benefit ◽  
Plasma Levels ◽  
Vitamin K Antagonists ◽  
Antithrombin Deficiency ◽  
Optimal Duration ◽  
Risk Of Treatment

SummaryVenous thrombosis is a chronic disease with a recurrence rate of approximately 30% within 5-8 years. The optimal duration of secondary thromboprophylaxis in these patients entails balancing the risk of recurrence against the risk of treatment-associated bleeding. There is agreement that patients with a first idiopathic venous thrombosis should receive vitamin K antagonists for at least 3-6 months. Convincing trials showing a clinical benefit in terms of morbidity or mortality with respect to expansion of anticoagulation beyond 6 months are lacking. Nevertheless, some subgroups of patients with venous thrombosis may benefit from indefinite anticoagulation. Thus, patients with antithrombin deficiency, combined or homozygous defects, more than one unprovoked episode of thrombosis, the lupus anticoagulant or high factor VIII plasma levels are good candidates for long-term prevention.

scholarly journals Association of Urinary and Plasma Levels of Trimethylamine N-Oxide (TMAO) with Foods

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1426
Author(s):  
Mauro Lombardo ◽  
Giovanni Aulisa ◽  
Daniele Marcon ◽  
Gianluca Rizzo ◽  
Maria Grazia Tarsisano ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Fish Consumption ◽  
Plasma Levels ◽  
Cooking Methods ◽  
Saltwater Fish ◽  
Increased Risk ◽  
Mediator Role ◽  
Fish And Shellfish ◽  
The Relationship

Introduction: Trimethylamine N-oxide (TMAO) may play a key mediator role in the relationship between the diet, gut microbiota and cardiovascular diseases, particularly in people with kidney failure. The aim of this review is to evaluate which foods have a greater influence on blood or urinary trimethylamine N-oxide (TMAO) levels. Methods: 391 language articles were screened, and 27 were analysed and summarized for this review, using the keywords “TMAO” AND “egg” OR “meat” OR “fish” OR “dairy” OR “vegetables” OR “fruit” OR “food” in December 2020. Results: A strong correlation between TMAO and fish consumption, mainly saltwater fish and shellfish, but not freshwater fish, has been demonstrated. Associations of the consumption of eggs, dairy and meat with TMAO are less clear and may depend on other factors such as microbiota or cooking methods. Plant-based foods do not seem to influence TMAO but have been less investigated. Discussion: Consumption of saltwater fish, dark meat fish and shellfish seems to be associated with an increase in urine or plasma TMAO values. Further studies are needed to understand the relationship between increased risk of cardiovascular disease and plasma levels of TMAO due to fish consumption. Interventions coupled with long-term dietary patterns targeting the gut microbiota seem promising.

Monitoring of tricyclic antidepressant plasma levels and clinical response: a review of the literature. Part II

1989 ◽  
Vol 4 (2) ◽  
pp. 81-90 ◽  
Author(s):  
I.R. De Oliveira ◽  
P.A.S. Do Prado-Lima ◽  
B. Samuel-Lajeunesse
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Elderly Patients ◽  
Plasma Levels ◽  
Tricyclic Antidepressant ◽  
Review Of The Literature ◽  
Central Nervous System Toxicity ◽  
Routine Measurement ◽  
System Toxicity

SummaryPart II of this paper contains some general considerations on tricyclic antidepressant (TCA) monitoring. Long-term assessment of TCA plasma levels is advised by the few existent studies, although each of these focusses on different aspects. Cardiovascular and central nervous system toxicity is reviewed as well as pharmacokinetics and the importance of protein binding. Some consideration is also given to their use in elderly patients. The authors conclude that although available data support its usefulness in many situations, routine measurement of TCA levels is not warranted.

scholarly journals Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Xiaorong Yan ◽  
Huiqing Wang ◽  
Cai Li ◽  
Yuanxiang Lin ◽  
Lin Lin ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Spinal Deformity ◽  
Tumor Recurrence ◽  
Clinical Symptoms ◽  
Short Term ◽  
Before And After ◽  
Intradural Extramedullary ◽  
Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

Maintenance treatment with subcutaneous immunoglobulins in the long-term management of anti-HMCGR myopathy.

2020 ◽  
Author(s):  
Angela Zuppa ◽  
Chiara Demichelis ◽  
Giuseppe Meo ◽  
Valeria Prada ◽  
Chiara Gemelli ◽  
...  
Keyword(s):  
Maintenance Treatment ◽  
Term Management

scholarly journals COVID-19 in an Asymptomatic Renal Transplant Recipient Employed in the Health Care Setting: A Case Report

2021 ◽  
Author(s):  
Harsha Adnani ◽  
Akshay Khatri ◽  
Nirav Agrawal ◽  
Ernesto Molmenti ◽  
Madhu Bhaskaran
Keyword(s):  
Health Care ◽  
Renal Transplant ◽  
Transplant Recipient ◽  
Renal Transplant Recipient ◽  
Clinical Symptoms ◽  
Severe Disease ◽  
Care Facility ◽  
Health Care Facility ◽  
Asymptomatic Patients

AbstractDuring the ongoing pandemic, there have been varying presentations of coronavirus disease 2019 (COVID-19) infection, with the concern that patients who are immunosuppressed (due to underlying medical conditions and/or therapies) are at higher risk of severe disease. We report the case of an elderly renal transplant recipient working in a long-term health care facility who was being monitored by weekly surveillance testing and tested positive for COVID-19 by polymerase chain reaction (PCR) testing, despite having no clinical symptoms. He recovered with supportive care, despite being on multiple long-term immunosuppressant drugs and having multiple comorbidities. Additionally, it was found that he did not mount an antibody response, when he tested negative by serologic testing. Through this case, we wish to highlight the unique clinical scenario of asymptomatic patients who may have an underwhelming immune response to COVID-19, but may nevertheless be an important source of dissemination. We further discuss the probable mechanism of such asymptomatic presentations in immunosuppressed patients, while reinforcing the importance of self-isolation of COVID-19 patients (particularly in asymptomatic health care workers).

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