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Allergen Immunotherapy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Although local side effects (itching and swelling in the mouth) are common for a few days after initiation of SLIT, systemic reactions are uncommon and severe life threatening or fatal reactions have not been reported (Canonica et al. 2009). Due to its record of safety, it is customary, after the first dose is taken in the physician’s office, for subsequent doses to be administered by the patient at home, thus reducing the expense and inconvenience of regular visits to a medical center to receive injections. Furthermore, the maintenance dose is administered without build-up of dosing.
Antifungal use in transplant recipients: Selection, administration, and monitoring
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Richard H. Drew, Mary L. Townsend, Melanie W. Pound, Steven W. Johnson
Isavuconazole is administered as a water-soluble prodrug. It is available as an intravenous solution and oral capsule. Dosing is the same for both invasive mucormycosis and aspergillosis. A loading dose is required for the first 48 hours, then a maintenance dose follows 12–24 hours after the last loading dose (see Table 26.1). Bioequivalence between the intravenous and oral formulations has been demonstrated; therefore, dosing is the same and switching between formulations doesn’t require an additional loading dose. Dosing is not affected by renal impairment (including end-stage renal disease), hepatic impairment (mild or moderate), gastric pH, or age. Oral isavuconazole may be administered with or without food [113,114,176,270].
The patient is depressed
Published in Wesley C Finegan, Being a Cancer Patient’s Carer, 2018
If an antidepressant does help, it is usually given for some time. This is because, when we are depressed, essential chemicals are lost from the brain. These chemicals control our mood and it takes a few weeks to restore adequate levels. It may then be possible to gradually reduce to a lower ‘maintenance’ dose provided the symptoms do not return. The maintenance dose allows the body to build up its normal supplies of the chemical and allows time for recovery.
Introducing a simplified titration scheme for dimethylfumarate (DMF) in patients with moderate-to-severe psoriasis: a case series
Published in Journal of Dermatological Treatment, 2022
Ralph von Kiedrowski, Sebastian Diemert
A new, simplified dosing scheme, in which DMF is administered twice daily, was conceived of by the first author based on his clinical experience and administered during routine practice to a series of patients (Table 1). With the simplified scheme, DMF was up-titrated following a modified dose-escalation strategy until the maximum dose of 720 mg DMF was reached in week 7. If the therapeutic response was deemed sufficient, a lower dose (e.g. 480 mg) could be maintained without further escalation. As per treatment guidelines, a gradual decrease of maintenance dose is considered when necessary. To assess efficacy, absolute Psoriasis Area Severity Index (aPASI), affected body surface area (BSA) and Dermatology Life Quality Index (DLQI) were assessed at weeks 0, 12, and 24. AEs were monitored throughout and laboratory tests (lymphocyte and leukocyte count) were assessed at weeks 0, 12, and 24. All patients were informed of and agreed to the change to the titration schedule. All patients provided consent to the change of the titration schedule and publication of the results.
Impact of high on-treatment platelet reactivity after angioplasty in patients with peripheral arterial disease
Published in Platelets, 2021
Lucas Busch, Manuel Stern, Lisa Dannenberg, Philipp Mourikis, Michael Gröne, Göksen Özaslan, Yvonne Heinen, Christian Heiss, Roberto Sansone, Amin Polzin, Malte Kelm
This single-center study had several limitations. The number of patients was small and no power analysis was conducted. Therefore, clinical outcome in this study is only suggestive and no definite conclusion can be drawn. This was a hypothesis-generating study with the pharmacodynamic response to aspirin and clopidogrel as the primary endpoint. Clinical outcome parameters should be evaluated in large-scaled trials to warrant generalizability. It was not randomized, therefore in this cohort significant and even non-significant characteristics might have biased the results. Multivariate analysis was conducted to reduce the risk of bias, but CIs were wide. This is attributed to the well-known high variance of pharmacodynamic response to clopidogrel. Moreover, platelet function was measured only once, on day after endovascular treatment. It could be shown that antiplatelet responsiveness shows time course dependent alterations [32,47]. Additionally, alterations due to loading dose should be considered in comparison to the continued maintenance dose. Therefore, time-series analyses would have improved the study. Furthermore, baseline values were not assessed in order to reflect possibly increased platelet reactivity before loading. HTPR to clopidogrel was tested with VASP assay and to aspirin with LTA though multiple tests are available [27]. However, LTA still remains the gold standard for aspirin antiplatelet effects and VASP represents the pharmacologically most specific assay to evaluate clopidogrel treatment as it targets only the P2Y12 receptor [48].
ABCB1 2677G>T single nucleotide polymorphism influences warfarin dose requirement for warfarin maintenance therapy
Published in British Journal of Biomedical Science, 2019
Gopisankar Mg, Hemachandren M, Surendiran A
Warfarin, a commonly prescribed anticoagulant, minimises development and recurrence of thromboembolic episodes in conditions such as deep vein thrombosis, pulmonary embolism, cardiac valve replacement and atrial fibrillation. It is known to cause various adverse effects amongst which increased risk of bleeding is the most common and disabling adverse effect. The dose requirement of warfarin varies more than tenfold among patients [1]. Several factors involved in this are genetic and non-genetic. Non-genetic factors are mainly related to compliance. Other factors are age, diet, body weight, diagnosis and clinical status of the patient which may explain 17–20% of the overall variation in maintenance dose. Genotypes such as CYP2C9, VKORC1, CYP4F2, GGCX, etc. have been studied extensively and have a role in determining warfarin dose requirement. Models developed from these studies could explain around 50% of the variability of drug response. There are differences between Caucasians, African Americans, Asians and other ethnic populations in terms of genetic polymorphisms of drug metabolizing enzymes and other genes, thus population-specific algorithms need to be developed incorporating relevant genotypes [2,3].