Missed dose: difference between revisions
Diff·revision 3 → 4·13:36, 28 Oct 2024
Difference between revision 3 and revision 4 of Missed dose. 6 lines changed; the page grew by 1,081 bytes.
| Revision 3 — 10:13, 17 Oct 2024 Chromatokid (talk) add the preservative point: unpreserved diluent changes the interval 2,029 bytes +597 | Revision 4 — 13:36, 28 Oct 2024 PuffRemoverPax (talk) add the dead-space volume to the worked example 3,110 bytes +1,081 | ||
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| 10 | For a weekly agent with a half-life of several days, the concentration at the end of a normal dosing interval has fallen to a substantial fraction of its peak, and a missed week extends that decline rather than producing a sudden loss of exposure. For a daily agent with a half-life of hours, a missed day is a larger proportional change but is corrected within a day or two of resuming.{{r|knudsen2019}} | 10 | For a weekly agent with a half-life of several days, the concentration at the end of a normal dosing interval has fallen to a substantial fraction of its peak, and a missed week extends that decline rather than producing a sudden loss of exposure. For a daily agent with a half-life of hours, a missed day is a larger proportional change but is corrected within a day or two of resuming.{{r|knudsen2019}} |
| 11 | 11 | ||
| + | 12 | Prescribing information for individual products states how a missed dose is to be handled, and those statements differ between products; general treatment guidance does not attempt to supply a single rule.{{r|ada2024}} This article describes the pharmacokinetic reasoning; it is not medical advice, and it is not a substitute for the labelling of any particular product. See [[Prescribing information]].{{r|drucker2018}} | |
| + | 13 | ||
| 12 | == The governing arithmetic == | 14 | == The governing arithmetic == |
| 13 | After a dose, concentration falls by half each half-life. For a peptide with a half-life of seven days on a weekly schedule, trough concentration is about half the peak and steady-state accumulation is roughly two-fold. Omitting one dose allows a further halving before the next dose is taken.{{r|knudsen2019}} | 15 | After a dose, concentration falls by half each half-life. For a peptide with a half-life of seven days on a weekly schedule, trough concentration is about half the peak and steady-state accumulation is roughly two-fold. Omitting one dose allows a further halving before the next dose is taken.{{r|knudsen2019}} |
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| 20 | | ≈2.4 hours | Twice daily | Essentially complete | | 22 | | ≈2.4 hours | Twice daily | Essentially complete | |
| 21 | 23 | ||
| + | 24 | The final row explains why short-acting agents lose effect promptly on omission and long-acting agents do not. It also explains why a resumed long-acting agent does not need re-titration after a short gap while a resumed short-acting one may.{{r|drucker2018,lau2015}} | |
| + | 25 | ||
| 22 | == References == | 26 | == References == |
| 23 | {{reflist}} | 27 | {{reflist}} |
| 24 | <ref name="drucker2018">Drucker DJ. "Mechanisms of action and therapeutic application of glucagon-like peptide-1." ''Cell Metabolism'' 27(4):740–756 (2018). PMID 29617641.</ref> | 28 | <ref name="drucker2018">Drucker DJ. "Mechanisms of action and therapeutic application of glucagon-like peptide-1." ''Cell Metabolism'' 27(4):740–756 (2018). PMID 29617641.</ref> |
| 25 | <ref name="knudsen2019">Knudsen LB, Lau J. "The discovery and development of liraglutide and semaglutide." ''Frontiers in Endocrinology'' 10:155 (2019). PMID 31031702.</ref> | 29 | <ref name="knudsen2019">Knudsen LB, Lau J. "The discovery and development of liraglutide and semaglutide." ''Frontiers in Endocrinology'' 10:155 (2019). PMID 31031702.</ref> |
| + | 30 | <ref name="ada2024">American Diabetes Association. "Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes." ''Diabetes Care'' 47(Suppl 1) (2024).</ref> | |
| + | 31 | <ref name="lau2015">Lau J, Bloch P, Schäffer L, et al. "Discovery of the once-weekly glucagon-like peptide-1 analog semaglutide." ''Journal of Medicinal Chemistry'' 58(18):7370–7380 (2015). PMID 26308095.</ref> | |
| 26 | 32 | ||
| 27 | {{DEFAULTSORT:Missed dose}} | 33 | {{DEFAULTSORT:Missed dose}} |