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Related Concept Videos

Dosage Regimen: Individualization01:24

Dosage Regimen: Individualization

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Individualization in dosing regimens is the customization of medication doses for individual patients. Its necessity arises from the goal of maximizing therapeutic benefits while minimizing risks. This approach is pivotal because human responses to drugs can vary widely; what is effective for one person may be inadequate or excessive for another. Interpatient (intersubject) variability refers to differences in drug responses between individuals, while intrapatient (intrasubject) variability...
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Drug Accumulation During Multiple Dosing: Intermittent IV Infusions01:24

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Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
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Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

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Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
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Nonlinear Pharmacokinetics: Causes of Nonlinearity01:22

Nonlinear Pharmacokinetics: Causes of Nonlinearity

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Nonlinearity in drug pharmacokinetics is caused by various factors influencing how a drug is absorbed, distributed, metabolized, and excreted. Understanding these nonlinear processes is crucial for predicting drug behavior in the body and optimizing drug dosing regimens.
Nonlinear drug absorption can occur when the process is rate-limited by solubility, carrier-mediated transport systems, or saturation of the presystemic gut wall or hepatic metabolism. For instance, high doses of riboflavin...
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Drug Therapy01:28

Drug Therapy

376
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
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Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence01:22

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Generic intravenous (IV) drugs are considered bioequivalent to their branded counterparts due to their 100% bioavailability upon administration. However, variations in stability among different drug products can significantly influence their therapeutic performance, even if they are pharmaceutically equivalent.Cefuroxime, a prophylactic antimicrobial, is often used as a single-dose IV injection for patients undergoing coronary artery bypass grafting surgery. A 3 g dose typically provides...
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Updated: Mar 19, 2026

Improving IV Insulin Administration in a Community Hospital
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CNI Trough Variability Does Not Reliably Reflect Medication Adherence: Insights From a 3-Year Follow-Up Study.

Claire Villeneuve1,2,3, Jean-Phillipe Rerolle2,3,4, Lionel Couzi5,6

  • 1CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, Limoges, France.

Transplant International : Official Journal of the European Society for Organ Transplantation
|March 18, 2026
PubMed
Summary
This summary is machine-generated.

Calcineurin inhibitor (CNI) trough concentrations and variability do not reliably indicate adherence in kidney transplant patients. Self-reported adherence was not linked to CNI exposure metrics, suggesting limitations in using these as standalone adherence markers.

Keywords:
adherencecalcineurin inhibitor (CNI)kidney transplantationtrough concentrations (C0)variability

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Area of Science:

  • Nephrology
  • Pharmacology
  • Transplantation Medicine

Background:

  • Calcineurin inhibitor (CNI) trough concentrations and their variability are often used as proxies for adherence in kidney transplant recipients.
  • However, the validation of these metrics as reliable adherence indicators is limited.

Purpose of the Study:

  • To evaluate the association between self-reported adherence and CNI exposure, including trough concentrations (C0) and intra-patient variability (IPV), in kidney transplant patients.
  • To determine if CNI C0 variability can reliably detect non-adherence.

Main Methods:

  • Prospective analysis of 619 patients from two French cohorts with 14,829 CNI C0 measurements.
  • Adherence assessed using the MMAS-4 questionnaire.
  • CNI exposure evaluated via C0 levels, IPV (CV threshold = 30%), and underexposure rates using cross-sectional and longitudinal analyses.

Main Results:

  • No significant differences in CNI C0, IPV, or underexposure were found between adherent and non-adherent patients.
  • Longitudinal analysis showed similar IPV and proportion of patients with high IPV in both groups.
  • High IPV was not significantly associated with rejection at 3 years.

Conclusions:

  • Self-reported adherence is not reliably associated with CNI C0 levels or variability.
  • CNI C0 variability alone is insufficient to detect non-adherence and should not be used as a standalone adherence marker.
  • Multimodal strategies integrating pharmacokinetic data with validated self-report tools are necessary for accurate adherence assessment.