Dose adjustments means modifying the drug dose, frequency or duration of therapy based on individualized patient body conditions to attain better therapeutic efficacy .
Why doses need to be adjusted?
There are several reasons like,
Renal Impairment , As many drugs are eliminated through kidney.So the dose are adjusted through Cockgroft gault equation.
Example:Aminoglycoside need dose adjustments to prevent nephrotoxicity
Antibiotics need dose adjustments in CKD patients.
Liver impairment
Most of the drugs are metabolized by liver enzymes so the dose are adjusted based on Child Pugh score
Then there is age factor where it differs for paediatric and geriatric patients.
Then it is of Body weight and body surface area as for most anticancer drug dose calculations.
Based on route of administration as the bioavailability of drugs differ in IV ,Oral or IM routes.
Clinical pharmacist plays major role in adjusting doses according to patients need and inprove therapeutic efficacy in the treatment.
As a clinical pharmacist it is one of my role to adjust the doses of drugs in patient treatment plan based on their condition.
Case scenario:
Here is a case where the patient was prescribed with the antibiotic MEROPENAM 1g TDS for his sepsis condition ,at the starting of the therapy his creatinine were normal but later he was AKI on CKD and the clearance was 15 ml/min .(Standford guidelines)
At this condition the dose should be 500 mg BD as a CP , I was escalated it to the physician and the dose was adjusted,
For adjusting the doses we also need to refer standard guidelines like Stanford guidelines, Lexicomp,Micromedex, Medscape and many more.
Dose adjustment isn’t just about reducing or increasing a drug, it’s about personalizing therapy.
It transforms “standard treatment” into patient-centered care.
MBH/PS