Drug Compliance In Patients Research Articles

Therapeutic drug monitoring of sertraline: variability factors as displayed in a clinical setting.

This report describes sertraline pharmacokinetics derived from routine therapeutic drug monitoring (TDM) data. A high-performance liquid chromatographic method with ultraviolet detection was established for routine sertraline TDM, and 924 analyses were performed from April 1995 to May 1997. Extensive predefined inclusion/exclusion criteria were applied to increase the validity of scientifically evaluated data. Subsequently, 605 samples (65.5%) were excluded. The remaining 319 samples from 319 patients, representative of steady state trough specimens and accompanied by essential clinical information provided on request forms, were scrutinized. A pronounced interindividual variability was observed. Smokers had significantly lower concentration-to-dose (C/D) mean ratios of serum sertraline (s-sert) and its main metabolite desmethylsertraline (s-dsert) than nonsmokers. Higher s-sert and s-dsert C/D mean ratios were found in elderly patients than in adults aged less than 65 years. In a subset of 20 patients in whom repeated TDM analyses were performed, observed intraindividual sertraline TDM outcome variability was low. The results highlight sertraline TDM as a tool for individual dose optimization and evaluation of patient drug compliance as well as drug-drug interactions.

An evaluation of the impact of health worker and patient education on the care and compliance of patients with epilepsy in Zimbabwe.

The use of primary health care personnel to identify cases of epilepsy and initiate simple treatment protocols has been advocated as a solution to the numeric inadequacy and uneven distribution of medical manpower available for the management of epilepsy in developing countries. This study sought to evaluate the effectiveness of primary health care nurses in the diagnosis and management of epilepsy, as well as the impact of patient-information pamphlets on drug compliance and clinic attendance of patients with epilepsy. Primary health care workers from 24 clinics in the Zvimba district in Zimbabwe attended a workshop to improving their knowledge in the diagnosis and management of generalized tonic-clonic seizures. Half of these clinics (experimental group) subsequently received patient-information pamphlets for distribution to patients and relatives, whereas the other half (control group) did not. Frequency of clinic attendance, mean seizure frequencies, and mean serum levels of phenobarbitone were compared at baseline and at 6 months after intervention in patients within each group, and at 6 months after intervention between both groups. Community health worker education led to a 74% increase in patient recruitment as well as a marked improvement in patient drug compliance over the 6-month study period. The use of patient-information pamphlets led to a marked reduction in patient default from clinic follow-up, but did not appear to influence drug compliance or seizure frequency. The benefits of these simple and inexpensive interventions make a strong case for their widespread implementation for improved epilepsy care not only in Zimbabwe, but also in other developing countries.

Relationship between Patients' Clinical Background and Lithium Concentration in Plasma: An Analysis of TDM Database in a University Hospital in Japan.

The purpose of the present study was to clarify the relationship between Japanese patients' clinical background and the lithium concentration in plasma. We extracted patient data for 4 years from our database (April 1, 1993 through March 30, 1997) in the Clinical Pharmacology Center of Oita Medical University Hospital, under the conditions that 1) the patient's body weight, sex and age were known, 2) the patient's lithium concentration in plasma was confirmed to be in steady state at more than 30 days after initial drug administration, and 3) the sample was taken at trough level at exactly 12 hours after the previous drug intake. Sixty-four out of 752 samples met the criteria. The ratios of the lithium concentration in plasma to the dose per kilogram body weight (C/ D ratio) were compared according to the patients' background factors ; 1) in/outpatient status and 2) age. The mean C/D ratio of inpatients was higher than that of outpatients. The C/D ratio increased with age, and it tended to increase more in inpatients. The correlation of the concentration to the dose was higher with the higher age. We propose by analyzing the patients' C/D ratios, that the patient's clinical background correlates with the patient's drug compliance, or pharmacokinetics. The C/D ratio may be a useful indicator to evaluate the patient's drug compliance and pharmacokinetics in daily bedside therapeutic drug monitoring.

Detection of Fluoroquinolones in Urinary Specimens from Patients Undergoing Anti-Tuberculous Therapy

A paper strip impregnated with ferric chloride has been developed for visual detection of fluoroquinolones in urine based on a change of colour due to the chelation of the transition metal ion to the β-oxo acid array in the 4-oxo-1,4-dihydropyridine-3-carboxylic acid moiety of the fluoroquinolone molecule. In urine specimens, the detection limit of the strip was 100 mg/l for pefloxacin, 200 mg/l for ciprofloxacin, fleroxacin, levofloxacin, norfloxacin, ofloxacin and sparfloxacin, and 300 mg/l for trovafloxacin. In 193 urine specimens taken from 138 patients on ofloxacin therapy and 55 controls preliminary evaluation of the strip showed that all the 55 specimens from control patients were negative, while 112 out of the 138 ofloxacin-treated patients were positive. Quantitative analysis by high-performance liquid chromatography of the 26 strip-test-negative specimens taken from patients with ofloxacin treatment indicated that these urinary specimens contained less than 200 mg/l of the antimicrobial, mostly because of poor renal function and in some occasions, non-compliance. This strip method would provide a convenient way of monitoring drug compliance in patients who receive fluoroquinolone therapy for tuberculosis.

A study of the utilization of non‐steroidal anti‐inflammatory drugs using a pharmacy‐based approach

AbstractThe extent of compliance and drug exposure characteristics among NSAID users has not been extensively studied. We measured drug compliance in patients who obtained a NSAID in one of four German pharmacies, by an interview four weeks later.The study population consisted of 526 persons with an average age of 57 years, and two‐thirds of the participants were women. We observed that only half of the patients had followed the recommended dosage regimen for the NSAID. Persons with complaints lasting three months or less were more likely to be compliant than chronically ill patients (OR = 5.0, 95 per cent CI: 3.0–8.2).We concluded that this heterogeneity in drug utilization must be considered in the design of observational studies.

患者への医薬品情報伝達における患者用服薬カードについて Ｉ． その作成と問題点

患者への医薬品情報伝達における患者用服薬カードについて Ｉ． その作成と問題点

Towards better patient drug compliance and comprehension: A challenge to medical and pharmaceutical services in Zimbabwe

Based on in-depth interviews of hypertensive and diabetic patients attending out-patient clinics at a central hospital in Zimbabwe, it was found that patients had different ideas and attitudes about the use of medicine. Well over 60% of the patients interviewed lacked comprehension of their disease and the use of the medicine prescribed to them. Some had been to a traditional healer with their problem. The findings show that medicine-taking is a highly individualistic phenomenon. Several factors, for example education attitude and belief, have to be taken into account when trying to educate the public on the use of medicines. Everyone in the medical profession, should be involved in this type of health education. The traditional healers who still enjoy a fairly high status in the Zimbabwean society could be trained and be involved in the health education programme. Health education is the foundation of good therapy and preventive medicine.

Street drug interactions with ethyl alcohol circadian and lunar lethality rhythms

Street drug susceptiblity rhythms are demonstrated in mice when taken alone or in combination with ethyl alcohol (Etoh). Morphine increase Etoh lethality during new moon and decreases Etoh lethality during full moon with a phase shift in acrophases. Chlordiazepoxide (CDP) exhibits circadian and lunar rhythms similar in timing and sensitivity to those of Etoh, including when given in combination with Etoh during full moon. At new moon there is a phase shift of the acrophase when Etoh and CDP are combined. As in man, mice exhibit a striking increase in CDP lethality when combined with Etoh. This potentiation is most striking at new moon. Cocaine circadian lethality peaks in the early activity period but when in combination with Etoh induces maximum lethality at mid-rest period, more in line with the acrophase for Etoh than cocaine. Phencyclidine combined with Etoh produces a striking increase in lethality. However, the combination acrophase occurs in very early rest period. Caffeine circadian lethality peaks during the early activity period (similar to cocaine) and significantly increases Etoh lethality when used in combination with Etoh. These data should be of particular interest to emergency room personnel treating street drug overdose victims, since the most common second drug in such overdose cases is nearly always ethyl alcohol. Furthermore, developing an awareness that most body responses as well as drug responses exhibit circadian and lunar rhythms, and not homeostatic constancy, should improve patient drug compliance, treatment efficacy and successful patient prognosis.