Individualization of Dosage Regimen-an Approach Towards Improved Clinical Outcomes

Dosage regimen plays the most important role in obtaining the desired therapeutic outcomes. The focus perpetually is on the design of doses, their intervals and duration to acquire the optimum response. Many factors like age, gender, weight, body surface area, pathological state play a role in formulating these regimens and each factor is given importance in deciding regimen that gives the optimum response. The experiments gradually reveal the correct regimens after repeatedly being worked upon. Different parameters such as Cmax, Tmax, are calculated and estimated in order to decide by which dose and its interval the therapeutic level is maintained in the blood. Therapeutic drug monitoring is one of the most important aspects in dosage regimen where the narrow therapeutic index drugs are given and designed in such a way as to get the therapeutic response with minimized toxicity.

NARROW THERAPEUTIC INDEX DRUGS;

Introduction: There are several clinically significant outcomes of drug-druginteractions (DDIs) which have been classified as one of the serious forms of adverse drugreactions that may lead to prolongation of hospital stays along with severe cases of mortality andmorbidities. It may cause due to the selection of two or more interacting drugs to be prescribedto patient. Objectives: Therefore it is indispensable to attain a collective level of therapeuticdecision making so that any potential DDIs can be minimized that ultimately turn out to be safeand beneficial to patient. Study Design: The current study is based upon surveys to evaluateutilization of medications that have a narrow therapeutic range with high incidence to developDDIs and to access the knowledge, attitude as well as practice of using such drug productsin relation to these facts, though very few such studies have been identified, yet the relevantdata is insufficient locally. The study design was selected to be qualitative and cross sectional.Period: January 2016 till August 2016 in Karachi, Pakistan. Settings: The questionnaire waswell constructed for physicians, pharmacists as well as nurses who were selected as theparticipant of the study and a former consent from the respondents was obtained. Method:Coefficient of spearman correlation & Cronbach’s α values were calculated in order to validatethe questionnaire (α = 0.927 and p = 0.918). The information based on practice along withdemographics of study participant was included as first segment of questionnaire while theirknowledge regarding drug interactions was included as second part. Mean scores werecalculated and responses were analysed by ANOVA in relation to the knowledge of membersrelating to drug interactions of vancomycin, warfarin and valproic acid. Results: Mean scores ofperception were found in order of 1.590.16, 1.549.02 and 2.020.83 for physicians, pharmacistsand nurses. No significant differences were observed between physicians and pharmacistscohorts in identifying the drug interactions whereas noteworthy variations were observed inthe group of nurses (p < 0.05). Conclusion: Such investigations are vital in their prospect tohighlight the importance for the design, implementation and monitoring of an effectual toolfor the guidance of various healthcare members involved in identification and management ofDDIs. Furthermore, results also signify the need of sophisticated support systems for valuableclinical judgments.