Daily Maintenance Dose of a Long-acting Theophylline from a Single Theophylline Serum Level

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

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The coherence between daily maintenance dose and 12h-control concentrations of some psychotropic drugs in plasma

Nordisk Psykiatrisk Tidsskrift ◽

10.3109/08039488709097049 ◽

1987 ◽

Vol 41 (6) ◽

pp. 509-516

Author(s):

A. Amdisen ◽

F. Nielsen-Kudsk

Keyword(s):

Psychotropic Drugs ◽

Maintenance Dose ◽

Daily Maintenance Dose

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Paliperidone palmitate: Experience in a community mental health unit

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1556 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s804-s805

Author(s):

L. Carrión Expósito ◽

G.M. Chauca Chauca ◽

E.L. Guadalupe

Keyword(s):

Mental Health ◽

Retrospective Study ◽

Maintenance Dose ◽

Lower Number ◽

Paliperidone Palmitate ◽

Health Unit ◽

Dose Number ◽

Competing Interest ◽

Long Acting ◽

Mental Health Unit

IntroductionThere are many jobs that offer advantages of treatment with long-acting injectable in psychosis.ObjectiveTo know the changes in the different variables after the start of paliperidone palmitate (PP).Material and methodWe performed a descriptive and retrospective study. Were evaluated patients who received maintenance therapy with PP during 48 months.ResultsThe sample was composed of 29 patients: 72.4% men and 27.6% women. Average age of 46.21 years. In Figures 1, 2 and 3 show data obtained in relation to compliance with treatment, relapse, maintenance dose, number of admissions and visits to emergency departments respectively.ConclusionsThe administration of PP is associated with a higher level of compliance with treatment. The patients presented a lower number of relapses, hospitalizations and visits to the emergency room. The maintenance dose more used is 150 mg.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Effect of CYP2C9, CYP4F2 and VKORC1 genetic polymorphisms on pharmacokinetics and pharmacodynamics of mean daily maintenance dose of warfarin in Chinese patients

Blood Coagulation & Fibrinolysis ◽

10.1097/mbc.0000000000000213 ◽

2015 ◽

Vol 26 (2) ◽

pp. 167-174 ◽

Cited By ~ 4

Author(s):

Wenfang Zhuang ◽

Wei Wen ◽

Binbin Xuan ◽

Yanhong Chen ◽

Yanan Cao ◽

...

Keyword(s):

Genetic Polymorphisms ◽

Maintenance Dose ◽

Chinese Patients ◽

Pharmacokinetics And Pharmacodynamics ◽

Daily Maintenance Dose

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A simple technic for predicting daily maintenance dose of warfarin

The American Journal of Surgery ◽

10.1016/0002-9610(79)90133-8 ◽

1979 ◽

Vol 137 (4) ◽

pp. 572-576 ◽

Cited By ~ 11

Author(s):

Donald B. Williams ◽

Richard C. Karl

Keyword(s):

Maintenance Dose ◽

Daily Maintenance Dose

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Effect of CYP2C9 and VKORC1 genetic polymorphisms on mean daily maintenance dose of acenocoumarol in South Indian patients

Thrombosis Research ◽

10.1016/j.thromres.2013.02.006 ◽

2013 ◽

Vol 131 (4) ◽

pp. 363-367 ◽

Cited By ~ 12

Author(s):

Dhakchinamoorthi Krishna Kumar ◽

Sivalingam Madhan ◽

Jayaramen Balachander ◽

B.V. Sai Chandran ◽

Bascarne Thamijarassy ◽

...

Keyword(s):

Genetic Polymorphisms ◽

Maintenance Dose ◽

Indian Patients ◽

South Indian ◽

Daily Maintenance Dose

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EFFECTS OF SMALL DOSES OF L-THYROXINE AND TRIIODO-L-THYRONINE ON PITUITARY LH CONTENT OF THYROIDECTOMIZED RATS

Acta Endocrinologica ◽

10.1530/acta.0.0830726 ◽

1976 ◽

Vol 83 (4) ◽

pp. 726-736 ◽

Cited By ~ 2

Author(s):

A. Aranda ◽

F. Hervás ◽

G. Morreale de Escobar ◽

F. Escobar del Rey

Keyword(s):

Single Dose ◽

Thyroid Hormones ◽

Maintenance Dose ◽

Male Rats ◽

Time Intervals ◽

Specific Radioimmunoassay ◽

Small Doses ◽

Different Doses ◽

Daily Maintenance Dose

ABSTRACT Pituitary LH was studied by means of a specific radioimmunoassay (RIA) in male rats at different time intervals after thyroidectomy (T̄), and in rats which were T̄ at least 30 days before and were then treated with different doses of L-thyroxine or triiodo-L-thyronine. A decrease in the pituitary LH of the T̄ animals, with respect to the intact age-paired controls, was demonstrable from 13 days after the operation, when total pituitary LH content was taken into consideration, or from 5 days after T̄, when the LH concentration (μg/mg pituitary) was considered. Doses of thyroid hormones lower than the daily maintenance dose for the rat produced very little effect on the pituitary LH levels of T̄ animals. However, a single dose of 1.75 μg of T4 or 0.2 μg of T3 (doses approximately equivalent to the T4 and T3 maintenance dose for T̄ rats) induced such a rapid and intense increase in the pituitary LH content that it no longer differed from that of the intact age-paired controls by 12 hours. Surprisingly, 5.0 μg of T4 and 1.0 μg of T3 did not produce any increase in the pituitary LH content of T̄ rats.

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Digitalis Toxicity and Serum Levels

PEDIATRICS ◽

10.1542/peds.63.3.503 ◽

1979 ◽

Vol 63 (3) ◽

pp. 503-504

Author(s):

William Berman

Keyword(s):

Serum Level ◽

Maintenance Dose ◽

Magic Number ◽

Serum Levels ◽

Drug Clearance ◽

Drug Dose ◽

Infants And Children ◽

Digitalis Toxicity ◽

Lack Of Information ◽

In Infants And Children

The article by Halkin et al (Pediatrics 61: 184, February 1978) alerts pediatricians to the prevalence of toxicity to dligoxin in infants and children. However, I am concerned that casual reading of the article will lead some to conclude that tolerance to digoxin does not vary with age and that a serum level of digoxin of 2 ng/ml is a "magic number." Neither of these conclusions is substantiated by the data in the manuscript. The findings of the series are clouded somewhat by the broad criteria used for diagnosing toxicity, the time at which serum specimens were obtained (eight hours after the preceding maintenance dose), and the lack of information about drug clearance as it relates to drug dose and the serum levels achieved.

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Substitution Therapy in Haemophilia B

Thrombosis and Haemostasis ◽

10.1055/s-0038-1654572 ◽

1961 ◽

Vol 6 (02) ◽

pp. 391-410 ◽

Cited By ~ 11

Author(s):

E. A Loeliger ◽

A Hensen ◽

M. J Mattern ◽

E. E. J Alsbach

Keyword(s):

Maintenance Dose ◽

Factor Ix ◽

Major Surgery ◽

Substitution Therapy ◽

Rapid Infusion ◽

Haemophilia B ◽

Human Factor Ix ◽

Daily Dose ◽

Daily Maintenance Dose

Conclusions1. Substitution therapy in haemophilia B without daily control of the Factor IX level in vivo by means of a reliable Factor IX assay cannot be adequate.2. The level of the Factor IX activity which, in cases of haemophilia B, ensures safe haemostasis after major trauma or in major surgery is at least 25% of normal.3. Assuming a normal t½ for Factor IX of 30 hours and a distribution pool of 7 l (normal adult), in cases of severe haemophilia the minimum amount of Factor IX to be rapidly transfused at the beginning of substitution (loading up of the pool up to 25%) is the amount present in 1.75 l of freshly drawn normal net plasma. The minimum daily dose necessary to maintain the 25% level is contained in 1 l. Due to the influence of body temperature, the required daily maintenance dose increases probably up to 2.4 l.4. Since rapid infusion of more than 1 l net plasma is not tolerated and since a daily dose of 2.4 l net plasma can hardly be achieved by means of exchange transfusion, partially purified and concentrated human Factor IX must be available. The plasma product PPSB, prepared by the “Centre National de Transfusion Sanguine” in Paris, contains, according to in vivo assays, about 10 times the activity of normal plasma for comparable volumes. The t½ of the Factor IX from PPSB appeared to be the same as from fresh plasma. The disappearance rate of the concentrated Factor IX from serum (CSB), prepared by the same institute, has not been estimated experimentally. According to clinical experience, however, the activity of CSB seems to be of a similar magnitude as that of PPSB. Adequate substitution with PPSB alone would require as initial loading-up dose 175 ml and as daily maintenance dose 100—240 ml of a 10-fold concentrated product, to be given in a continuous drip-infusion.5. In a case of mild haemophilia B (Factor IX ≅ 20%), transfusion of 0.8 l freshly drawn net plasma daily resulted in Factor IX levels of between 23 and 28% instead of the expected 35% of normal. This observation suggests that, for substitution therapy, mild cases of haemophilia B must be considered as rather severely affected.

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1576. Delaying the Start of Maintenance Vancomycin After a Loading Dose to Avoid a High 0–24h AUC

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1440 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S575-S576

Author(s):

Judy T Y Lee ◽

Steven C Ebert

Keyword(s):

Maintenance Dose ◽

Bacterial Infections ◽

Time Curve ◽

Dosing Interval ◽

Concentration Time ◽

Time Period ◽

Increased Risk ◽

Daily Dose ◽

Therapeutic Doses ◽

Daily Maintenance Dose

Abstract Background Vancomycin dosing guidelines recommend loading doses (LDs) (25–30 mg/kg TBW), and a maintenance regimen, usually started after a time period equal to the dosing interval. Studies of vancomycin exposure and nephrotoxicity conclude that a 0 to 24-hour area under the serum concentration–time curve (0–24AUC) > 677 mg-hour/L results in a 3- to 4-fold increased risk of nephrotoxicity (Zasowski EJ, Antimicrob Agents Chemother 2018). For vancomycin LDs we compare the calculated LD and the maintenance dose, and delay initiation of the maintenance regimen when the LD exceeds the daily maintenance dose by > 50%. This study assessed the pharmacokinetic outcomes from this technique. Methods We retrospectively reviewed 68 consecutive adult patients receiving therapeutic doses of vancomycin. Patient age, sex, height, weight, serum creatinine, and indication were used to calculate the daily dose/intervals for a steady-state 24-hr AUC of 400 or 600 mg-hour/L. The total 0–24AUC was calculated by adding the 0–24 AUC from a 25 mg/kg LD (max: 3 gm) to the 0–24AUC(s) for maintenance dose(s) within the first 24 hours. We compared the total 0-24AUC when the first maintenance dose was timed for the next dosing interval (“scheduled”) to that when the maintenance dose was delayed according to our protocol (“delayed”). We tested the proportion of patients who would be exposed to a vancomycin 0-24AUC > 677 mg-hour/L. Results 16/68 patients were diagnosed with SSTI (goal 24 hr AUC: 400 mg-hour/L) and 52/68 with sepsis, bacteremia/endocarditis, or pneumonia (24 hr AUC: 600 mg-hour/L). Median daily maintenance dose was 1750 mg (range: 875–4,000 mg). For patients with a goal AUC of 400, the 0-24AUC was > 677 mg-hour/L in one patient using the “scheduled” process and in none of the patients using the “delayed” protocol. However, for patients with a goal AUC of 600, the 0-24AUC was > 677 mg-hour/L in 22/52 patients via the “scheduled” process vs. 4/52 patients via the “delayed” protocol. Conclusion For patients with severe gram-positive bacterial infections requiring aggressive dosing of vancomycin, delaying the start of maintenance dosing following a large LD is an effective way to ensure attainment of goal therapeutic AUC within the first 24 hr without placing the patient at increased risk for nephrotoxicity. Disclosures All authors: No reported disclosures.

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