Abstract
Clinical pharmacokinetics is an expanding scientific discipline which can make an impact on treatment in coronary care, intensive care, paediatrics, general medicine and surgery, and general practice. The aim of this study was to establish a rapid system of drug assay, to report the result, to assess the influence of pathological and clinical factors on the pharmacokinetics of certain drugs, and to use a computer to determine the optimum dosage of drugs. The clinical pharmacokinetics laboratory in Stobhill is available to all clinical departments and to general practitioners in the area. Digoxin, theophylline, and phenytoin have been assessed. Initial samples of these drugs showed that only about a third were in the therapeutic range; samples obtained after the issue of the laboratory report showed an improvement. The predictive performance of the computer program improved with feedback of one or two drug concentrations. Dosages of drugs chosen on an empirical basis may not lead to optimum treatment, and by testing samples early the dosage of the drug can be adjusted. It is hoped that the results achieved will encourage other clinical, pharmaceutical, and scientific colleagues to develop laboratories along similar lines.
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Selected References
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- Jusko W. J., Gardner M. J., Mangione A., Schentag J. J., Koup J. R., Vance J. W. Factors affecting theophylline clearances: age, tobacco, marijuana, cirrhosis, congestive heart failure, obesity, oral contraceptives, benzodiazepines, barbiturates, and ethanol. J Pharm Sci. 1979 Nov;68(11):1358–1366. doi: 10.1002/jps.2600681106. [DOI] [PubMed] [Google Scholar]
- Kelman A. W., Whiting B., Bryson S. M. OPT: a package of computer programs for parameter optimisation in clinical pharmacokinetics. Br J Clin Pharmacol. 1982 Aug;14(2):247–256. doi: 10.1111/j.1365-2125.1982.tb01969.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ludden T. M., Allen J. P., Valutsky W. A., Vicuna A. V., Nappi J. M., Hoffman S. F., Wallace J. E., Lalka D., McNay J. L. Individualization of phenytoin dosage regimens. Clin Pharmacol Ther. 1977 Mar;21(3):287–293. doi: 10.1002/cpt1977213287. [DOI] [PubMed] [Google Scholar]
- Mullen P. W. Optimal phenytoin therapy: a new technique for individualizing dosage. Clin Pharmacol Ther. 1978 Feb;23(2):228–232. doi: 10.1002/cpt1978232228. [DOI] [PubMed] [Google Scholar]
- Rambeck B., Boenigk H. E., Dunlop A., Mullen P. W., Wadsworth J., Richens A. Predicting phenytoin dose - a revised nomogram. Ther Drug Monit. 1979;1(3):325–333. doi: 10.1097/00007691-197901030-00007. [DOI] [PubMed] [Google Scholar]
- Sheiner L. B., Beal S. L. Bayesian individualization of pharmacokinetics: simple implementation and comparison with non-Bayesian methods. J Pharm Sci. 1982 Dec;71(12):1344–1348. doi: 10.1002/jps.2600711209. [DOI] [PubMed] [Google Scholar]
- Sheiner L. B., Beal S. L. Some suggestions for measuring predictive performance. J Pharmacokinet Biopharm. 1981 Aug;9(4):503–512. doi: 10.1007/BF01060893. [DOI] [PubMed] [Google Scholar]
- Sheiner L. B., Beal S., Rosenberg B., Marathe V. V. Forecasting individual pharmacokinetics. Clin Pharmacol Ther. 1979 Sep;26(3):294–305. doi: 10.1002/cpt1979263294. [DOI] [PubMed] [Google Scholar]
- Vozeh S., Muir K. T., Sheiner L. B., Follath F. Predicting individual phenytoin dosage. J Pharmacokinet Biopharm. 1981 Apr;9(2):131–146. doi: 10.1007/BF01068078. [DOI] [PubMed] [Google Scholar]