Ambulatory patients taking NTR drugs

not undergone blood monitored

• Researchers retrospectively examined the monitoring of NTR drugs :

– 17,748 ambulatory patients at 10 health maintenance
organizations receiving ongoing continuous therapy with specific
NTR drugs > 12 months (Jan 1999 – Jun 2001).

• They assessed serum drug concentration monitoring from

administrative data & medical record data.

Raebel MA et al - Am J Managed Care, May 2006, 12, pp. 268-274

 Ambulatory patients taking NTR drugs
not undergone blood monitored – cont’d

Findings :

• 50 % or more of patients on digoxin, theophylline,

procainamide, quinidine, or primidone were not monitored.
• 25 - 50% on divalproex, carbamazepine, phenobarbital,
phenytoin, or tacrolimus were not monitored.

• In contrast, lithium & cyclosporine drug serum concentrations

were monitored in most patients.

Raebel MA et al - Am J Managed Care, May 2006, 12, pp. 268-274

Tolerance to drug effect •Effectiveness of drugs can
after repeated dosing decrease with continued
use (called tolerance)
• Tolerance may be caused
by PK factors, eg increased
drug metabolism that
decrease concentrations
after a given dose.
• There can also be PD
tolerance, which occurs
when the same
concentration at receptor
site results in a reduced
effect with repeated
exposure.