Patterns and Predictors of Generic Narrow Therapeutic Index Drug Use Among Older Adults

2013 ◽  
Vol 61 (9) ◽  
pp. 1586-1591 ◽  
Author(s):  
Joshua J. Gagne ◽  
Jennifer M. Polinski ◽  
Aaron S. Kesselheim ◽  
Niteesh K. Choudhry ◽  
David Hutchins ◽  
...  
Keyword(s):  
Older Adults ◽  
Drug Use ◽  
Therapeutic Index ◽  
Narrow Therapeutic Index ◽  
Narrow Therapeutic Index Drug

scholarly journals PHP4 GENERIC NARROW THERAPEUTIC INDEX DRUG USE: 1996–1998

2002 ◽  
Vol 5 (3) ◽  
pp. 139 ◽  
Author(s):  
J Chao ◽  
SD Taylor ◽  
PL McKercher ◽  
DM Kirking
Keyword(s):  
Drug Use ◽  
Therapeutic Index ◽  
Narrow Therapeutic Index ◽  
Narrow Therapeutic Index Drug

scholarly journals Tablet Splitting of a Narrow Therapeutic Index Drug: A Case with Levothyroxine Sodium

2010 ◽  
Vol 11 (3) ◽  
pp. 1359-1367 ◽  
Author(s):  
Rakhi B. Shah ◽  
Jarrod S. Collier ◽  
Vilayat A. Sayeed ◽  
Arthur Bryant ◽  
Muhammad J. Habib ◽  
...  
Keyword(s):  
Therapeutic Index ◽  
Levothyroxine Sodium ◽  
Narrow Therapeutic Index ◽  
Tablet Splitting ◽  
Narrow Therapeutic Index Drug

scholarly journals The art and science of drug titration

2020 ◽  
Vol 11 ◽  
pp. 204209862095891
Author(s):  
Aisling R. Caffrey ◽  
Eric P. Borrelli
Keyword(s):  
Real World ◽  
Therapeutic Index ◽  
Clinical Expertise ◽  
Coordination Of Care ◽  
Patient Centered ◽  
Narrow Therapeutic Index ◽  
Drug Dosing ◽  
Scientific Principles ◽  
Suboptimal Adherence ◽  
Personalized Approach

A “one-size-fits-all” approach has been the standard for drug dosing, in particular for agents with a wide therapeutic index. The scientific principles of drug titration, most commonly used for medications with a narrow therapeutic index, are to give the patient adequate and effective treatment, at the lowest dose possible, with the aim of minimizing unnecessary medication use and side effects. The art of drug titration involves the interplay of scientific drug titration principles with the clinical expertise of the healthcare provider, and an individualized, patient-centered partnership between the provider and the patient to review the delicate balance of perceived benefits and risks from both perspectives. Drug titration may occur as up-, down-, or cross-titration depending on whether the goal is to reach or maintain a therapeutic outcome, decrease the risk of adverse effects, or prevent withdrawal/discontinuation syndromes or recurrence of disease. Drug titration introduces additional complexities surrounding the conduct of clinical trials and real-world studies, confounding our understanding of the true effect of medications. In clinical practice, wide variations in titration schedules may exist due to a lack of evidence and consensus on titration approaches that achieve an optimal benefit-harm profile. Further, drug titration may be challenging for patients to follow, resulting in suboptimal adherence and may require increased healthcare-related visits and coordination of care amongst providers. Despite the challenges associated with drug titration, it is a personalized approach to drug dosing that blends science with art, and with supportive real-world outcomes-based evidence, can be effective for optimizing pharmacotherapeutic outcomes and improving drug safety.

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