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Published in Henry J. Woodford, Essential Geriatrics, 2022
Prescribing guidance for younger adults (seeTable 22.1) may need minor adjustment for frail older people. Valproate may be a good option for focal and general epilepsy due to the demonstrated efficacy, rapidity of drug titration and lower risk of cognitive adverse effects. Monotherapy is preferable, older people taking more than one anticonvulsant drug have a higher risk of cognitive adverse effects.39 Older people also typically respond to lower doses of AEDs than people with onset in earlier age. Drug-resistant focal epilepsy can be associated with some pathologies, such as intracranial tumours or paraneoplastic limbic encephalitis.46 Drug resistance also raises the possibilities of incorrect diagnosis, medication non-adherence or alcohol misuse.
Pre-hospital care
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
Additionally, the kind of drug required varies according to the main clinical feature of the disaster. It is easy to understand that a mass poisoning by a chemical plant explosion requires a different pharmacological approach compared to a building collapse. Moreover, the correct use of drugs depends on several conditions that are often very hard to assess in a mass emergency situation: storage temperature, drug dilution, drug titration, means of administration, and so on.
Neurocognitive Disorders: Delirium, Dementia, and Traumatic Brain Injury
Published in Thomas L. Schwartz, Practical Psychopharmacology, 2017
Similar to previous chapters, the goal here is to teach the clinician to quickly make an accurate diagnosis and choose an approved psychotropic. All of psychiatric prescribing at this beginning level is based on regulatory findings, approvals, and indications that are psychiatric disorder specific. Be warned: much of treating delirium, dementia, and TBI is off-label, with limited evidence base to guide treatment. Similar to treating personality disorder, clinicians are urged to use FDA approvals and the evidence base where possible, but a strategic approach of choosing a specific target symptom to alleviate is warranted. Defining and measuring these symptoms pre- and post-drug titration is critical in avoiding inappropriate polypharmacy.
Additional efficacy analysis of avatrombopag phase III data for the treatment of adults with immune thrombocytopenia
Published in Platelets, 2023
Shivi Jain, Terry Gernsheimer, Scott Kolodny, Chelsea Bernheisel, Michael Vredenburg, Sandhya R. Panch
These post-hoc analyses included patients enrolled in a multicenter, randomized, double-blind, parallel group phase III study evaluating the efficacy and safety of avatrombopag in adult patients with chronic ITP for 6 months (NCT01438840).8 Full details of the phase III study have been previously published.3 The core study design included a 6-week study drug titration period, a 12-week concomitant ITP medication reduction period, and an 8-week maintenance period. Patients who completed the maintenance phase of the core study or discontinued early because of lack of treatment effects were eligible for the extension phase, during which all patients received open-label avatrombopag once daily (20 mg initial dose that could be titrated from 5 to 40 mg) and underwent a 6-week conversion period and a 90-week maintenance period. During the core study, visits were weekly or biweekly depending on the phase of the study, with 21 visits occurring over 26 weeks. In the extension phase, visits were every 3–4 days, weekly, biweekly, or monthly, with 31 planned over 96 weeks. Overall, the core study enrolled 32 patients with ITP in the avatrombopag group and 17 in the placebo group and 39 were enrolled in the optional open-label extension phase (avatrombopag, n = 24; placebo, n = 15).
Comparison of the retention rate, safety, and efficacy of two different titration protocols for lamotrigine in newly diagnosed epilepsy patients
Published in Expert Review of Neurotherapeutics, 2022
Ning Zhang, Debo Yang, Cailang Niu, Penghong Li, Huiqin Wang, Xinyi Li, Wei Jing
Lamotrigine (LTG) is a broad-spectrum ASM administered to both adults and children with epilepsy; this drug is approved for both focal seizures and primary generalized tonic–clonic seizures. LTG exhibits first-order linear pharmacokinetics and is efficiently absorbed, with bioavailability approaching 100%. Absorption is not a first-pass metabolism. The volume of distribution is between 1.25 and 1.47 L/kg and is similar between single- and multiple-dose administration. The peak concentration increases linearly in proportion to the dose, and the peak plasma concentration is attained at 1–3 hours post-dose, consistent with an effective half-life of 24.1 to 35 hours [10]. LTG has a high risk of idiosyncratic adverse reactions during rapid drug titration, hence the requirement for a slow titration protocol. According to the drug instructions, LTG is a once-daily or twice-daily oral ASM used for the treatment of epilepsy and is categorized as suitable for either monotherapy or adjunctive therapy in China. Clinicians administer LTG to patients in varying doses at different titration protocols according to their own preferences. To date, there are no studies in which researchers aim to determine whether the administration of LTG using different titration protocols will affect the efficacy, safety and retention rate of patients. Therefore, in this study, we aimed to evaluate the efficacy, safety, and retention rate of LTG monotherapy for newly diagnosed epilepsy patients receiving two different titration protocols.
What are the main considerations when prescribing pharmacotherapy for Parkinson’s disease?
Published in Expert Opinion on Pharmacotherapy, 2022
Moreover physicians, involved in direct patient care, must take into account patients’ and caregivers’ coping strategies with PD and their personality features. All of them may also influence adherence to PD drug application. Unfiltered information, i.e. provided by social media in the internet, contributes to a growing knowledge of patients and their care partners on therapy in PD [5]. The role of the PD specialist changes the demand rises for time-consuming discussions on pro’s and con’s of available PD treatments. Predominantly, young, early onset PD patients with a high educational level ask for more advice and have the tendency to influence PD drug regimen on their own. Such a more interactive relationship counteracts a more authoritarian and easier to perform behavior of the neurologist. Nevertheless treatment of PD patients asks physicians to establish a long-lasting relationship to patients, often combined with continuous counseling of care partners. Essential basic characteristics are respect, trust, accountability, and transparency [5]. A good interpersonal level is the precondition for compliance, which is a problem of many PD patients. It may partially be improved by easy to perform and simple PD drug intake regimen [6]. Additionally, slow and careful drug titration with concomitant, perpetual surveillance of the individual drug treatment tolerability and safety is essential for the long-term success.