Farmaceutisch onderzoek

862 artikelen

08 nov 2019

Verhoogd risico op een methotrexaatintoxicatie op oudere leeftijd

  • Rubriek:
    Casuïstische mededeling
  • Identificatie:
    2019;4:a1714
  • Auteur(s):
    Laure J.M.J. Vorstenbosch a*, Marieke Kerskes b en Michiel W.H. van Beek c

Verhoogd risico op een methotrexaatintoxicatie op oudere leeftijd

Increased risk of methotrexate intoxication in the elderly

INTRODUCTION

Over two decades, low dose methotrexate (MTX) has been used as a therapy for rheumatoid arthritis and psoriasis [1,2]. The biggest risk of MTX therapy is the development of toxicity with associated side effects and ultimately mortality. Low dose methotrexate use in elderly patients more often leads to MTX intoxication with serious consequences. For atypical complaints in frail older people using methotrexate, the MTX intoxication should be in the differential diagnosis. In this article we describe a patient presenting with atypical complaints as a result of an MTX intoxication.

DESCRIPTION

A 76-year-old female presents with severe dyspnea, during rehabilitation therapy of a recently experienced stroke. She has heart failure NYHA class II and rheumatoid arthritis. She is treated with a low dose schedule of methotrexate, 10 mg per week combined with folic acid 5 mg three times per week and hydroxychloroquine (Plaquenil) 200 mg once daily.

Additional laboratory tests show abnormal values including increased liver values, impaired renal function and bone marrow suppression. Because of known MTX use in combination with the laboratory abnormalities found with unclear underlying cause, an MTX blood level is determined. This appears to be largely increased. Calcium folinate is started intravenously, despite improving blood results the patient does not improve and a palliative policy is followed.

DISCUSSION

For atypical complaints in frail older people using methotrexate, the MTX intoxication should be in the differential diagnosis. Measuring methotrexate levels is unusual in Dutch rheumatology, partly due to the short half-life of MTX. Literature study shows several cases in which inadequate intake of MTX – as well as adequate intake – leads to an MTX intoxication. Decreased kidney function leads to an increased risk of MTX intoxication. Therefore it is, especially in elderly patients with MTX therapy, advisable to frequently check renal function. Dose adjustment should be made in case of impaired renal function and measurement of MTX levels should be considered. Elderly presenting atypical complaints is a common sight. Doctors should ensure that MTX therapy is adequately followed and MTX intoxication must be in the differential diagnosis in elderly with atypical complaint presentation.

CONCLUSION

The risk of developing MTX intoxication in frail elderly is increased despite prescription MTX use. In this category of patients, this often leads to an atypical complaint presentation. For atypical complaints in frail older people using methotrexate, the MTX intoxication should be in the differential diagnosis. Especially with a reduced kidney function, the risk of an MTX-intoxication is higher. In addition, with MTX use the dose regime and actual intake must be extensively requested to prevent fatal consequences.

24 okt 2019

De ontwikkeling van budesonidetabletten met nulde-orde-afgifte voor de behandeling van ileo-colonische inflammatoire darmziekten en vergelijking met huidige, commerciële preparaten

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1715
  • Auteur(s):
    Bahez Gareb ab*, Gerard Dijkstra c, Jos G.W. Kosterink ad en Henderik W. Frijlink b

De ontwikkeling van budesonidetabletten met nulde-orde-afgifte voor de behandeling van ileo-colonische inflammatoire darmziekten en vergelijking met huidige, commerciële preparaten

Development of novel zero-order release budesonide tablets for the treatment of ileo-colonic inflammatory bowel disease and comparison with formulations currently used in clinical practice

BACKGROUND

In patients with inflammatory bowel disease, the terminal ileum and colon is the most affected region. Oral budesonide is an effective treatment but in vitro as well as clinical data suggest that the formulations currently used in clinical practice are suboptimal to treat the entire ileo-colonic region.

OBJECTIVE and DESIGN

The aim of this in vitro study was to develop ileo-colonic-targeted zero-order sustained-release tablets containing 3 mg or 9 mg budesonide (ColoPulse 3 mg and 9 mg, respectively).

METHODS

Tablets were tested in a 10 hour gastrointestinal simulation system for site-specific release, zero-order release kinetics (R2 ≥ 0.95), release rate, and completeness of release (≥ 80%). Release profiles of the novel formulations were compared with Entocort, Budenofalk, and Cortiment (budesonide MMX).

RESULTS

None of these formulations currently used in clinical practice targeted the entire ileo-colonic region. However, ColoPulse 3 mg and 9 mg were targeted to the ileum, released the entire dose with zero-order release kinetics in the ileo-colonic region, and complied with a 6-month accelerated stability study.

CONCLUSION

Therefore, ColoPulse 3 mg and 9 mg are novel, interesting formulations for the treatment of the entire ileo-colonic region in inflammatory bowel disease.

04 okt 2019

Het effect van een uitgebreide medicatieverificatietool op het aantal onbedoelde klinisch relevante medicatiediscrepanties bij opname van de psychiatrische patiënt

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1711
  • Auteur(s):
    V. Akrum a*, M. Duisenberg-van Essenberg a, N. Veth b en B. Maat a

Het effect van een uitgebreide medicatieverificatietool op het aantal onbedoelde klinisch relevante medicatiediscrepanties bij opname van de psychiatrische patiënt

The effect of a customized medication verification tool on the amount of unintended clinically relevant medication discrepancies at hospital admission of psychiatric patients

BACKGROUND

Unintended medication discrepancies (UMDs) at admission is common in hospitalized patients. Studies have shown that medication verification at admission resulted in fewer UMDs. Medication reconciliation studies in psychiatric patients are scarce. At the time of this study, medication verification in the medical psychiatric unit (MPU) of the Elisabeth-Tweesteden Hospital was done by the attending physician. After evaluating this process a customized verification tool was developed.

OBJECTIVE

The effect of using a customized medication verification tool by a pharmacy technician on the prevention of clinically relevant UMDs in psychiatric patients admitted to the MPU of the Elisabeth-Tweesteden Hospital.

DESIGN

A randomized prospective intervention study.

METHODS

Patients admitted to the MPU – who met the inclusion criteria – were randomized in group A, B or C. In group A medication was verified by the attending physician. In group B and C medication was verified by a pharmacy technician using a standardized or customized verification tool, respectively. UMDs were assessed within 24 hours of admission. A panel determined clinical relevancy of the UMDs using the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) index. Categories E till I were considered clinically relevant.

RESULTS

The interim analysis showed 33 UMDs in group A (n = 31), 59 in group B (n = 44), and 88 in group C (n = 42). The amount of clinically relevant UMDs per patient in group A, B, and C was 0.32, 0.27, and 0.57, respectively. The majority of the UMDs were omissions and included mostly non-psychiatric medication.

CONCLUSION

The interim analysis shows relatively more clinically relevant UMDs per patient when medication was verified by a pharmacy technician using a customized verification tool. It is possible that medication verification with a customized verification tool by a pharmacy technician results in the prevention of clinically relevant unintended medication discrepancies.

25 sep 2019

Variabiliteit in farmacokinetiek van intraveneuze paracetamol bij gezonde ouderen

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1713
  • Auteur(s):
    P. Mian a*, M.J. van Esdonk b, B.C.M. de Winter c, I. Spriet d, D. Tibboel e, M. Petrovic f, K. Allegaert gh en B.C.P. Koch h

Variabiliteit in farmacokinetiek van intraveneuze paracetamol bij gezonde ouderen

Variability in pharmacokinetics of intravenous paracetamol in healthy older people

BACKGROUND and OBJECTIVE

Paracetamol is the most used analgesic in older people. The physiological changes occurring with ageing influence the pharmacokinetics of paracetamol and its variability. A population pharmacokinetic analysis to describe the pharmacokinetics of intravenous paracetamol in fit older people was performed. Thereafter, simulations were conducted to illustrate target attainment and variability of paracetamol exposure following current dosing regimens (1000 mg q6h, q8h) using steady-state concentration (Css-mean) of 10 mg/L as target for effective analgesia.

DESIGN and METHODS

A population pharmacokinetic-analysis, using NONMEM 7.2, was performed based on 601 concentrations of paracetamol from 30 fit older people (median age = 77.3 years [61.8- 88.5], body weight = 79 kg [60-107]). All had received an intravenous paracetamol dose of 1000 mg – over 15 min – after elective knee surgery.

RESULTS

A two-compartment pharmacokinetic-model best described the data. Volume of distribution of paracetamol increased exponentially with body weight. Clearance was not influenced by any covariate. Simulations of the standardized dosing regimens resulted in a Css-mean of 9.2 mg/L (q6h) and 7.2 mg/L (q8h). Variability in paracetamol pharmacokinetics resulted in a Css-mean above 5.4 (q6h) and 4.1 mg/L (q8h) in 90%, and above 15.5 (q6h) and 11.7 mg/L (q8h) in 10% of the population.

CONCLUSION

The target concentration was achieved in the average patient with 1000 mg q6h, while q8h resulted in underdosing for the majority of the population. Due to large unexplained inter-individual variability in paracetamol pharmacokinetics a relevant proportion of the fit older people remained either under- or overexposed.

16 sep 2019

Associatie van single-nucleotide polymorphisms in UGT1, NR1I2, ABCC2, ABCC5 en ABCG1 met irinotecangeïnduceerde toxiciteit in colorectaalkanker

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1702
  • Auteur(s):
    Sander Ketzer *, Henk-Jan Guchelaar en Jesse Swen

Associatie van single-nucleotide polymorphisms in UGT1, NR1I2, ABCC2, ABCC5 en ABCG1 met irinotecangeïnduceerde toxiciteit in colorectaalkanker

Association of single-nucleotide polymorphisms in UGT1, NR1I2, ABCC2, ABCC5 and ABCG1 with irinotecan-induced toxicity in colorectal cancer

BACKGROUND

Irinotecan is used in the palliative treatment of metastatic colorectal cancer. Its metabolism is complex with many different transporters and enzymes involved. For UGT1A1*28 (rs8175347), an association with irinotecan-induced toxicity has been established. Recent studies suggested that other single-nucleotide polymorphisms (SNPs) within genes encoding irinotecan-related enzymes and transporters can lead to reduced or increased irinotecan-induced toxicity, mainly diarrhoea and neutropenia.

OBJECTIVE

In this study we aim to replicate associations between SNPs related to UGT1 rs11563250; NR1I2 rs10934498, rs2472677, rs3814055 and rs1523127; ABCC5 rs10937158, rs3749438, rs562 and rs2292997; ABCG1 rs225440 and ABCC2 rs717620 and grade 3 to 4 diarrhoea and febrile neutropenia in a population of 221 mCRC patients treated with irinotecan. The well-known UGT1A1*28 variant is also evaluated.

DESIGN

Retrospective clinical association study.

METHODS

DNA samples used for this study were obtained from patients participating in the CAIRO study (NCT00312000). The DNA samples were genotyped for twelve SNPs, selected on the basis of the results of previously published studies. For the main analysis, associations between SNPs and toxicity data were tested with logistic regression.

RESULTS

ABCC2 rs717620T is significantly associated with grade > 3 febrile neutropenia (OR = 2.72; P = 0.025). UGT1A1*28 shows significant associations with an increased risk on grade 3 to 4 diarrhoea (OR = 1.76, P = 0.035) and grade 3 to 4 febrile neutropenia (OR = 3; P = 0.01).

CONCLUSION

The outcomes of previous studies could not be replicated, except for UGT1A1*28. Moreover, we found an association with the opposite direction of effect between ABCC2 rs717620T and severe neutropenia. Based on the outcomes of this study genotyping for the tested variants – with exception of UGT1A1*28 – cannot be recommended.

06 sep 2019

Therapeutisch gedoseerde laag-molecuulgewicht heparines bij patiënten met obesitas: doseren op basis van lichaamsgewicht zonder afkapgrens

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1708
  • Auteur(s):
    G.T. de Vries a*, A.L. van Ojik b, M. Hoogendoorn c en E.N. van Roon de

Therapeutisch gedoseerde laag-molecuulgewicht heparines bij patiënten met obesitas: doseren op basis van lichaamsgewicht zonder afkapgrens

Therapeutic use of low molecular weight heparins in obese patients: dosing based on body weight without cut-off limit

BACKGROUND

The correct dose of therapeutic low molecular weight heparins (LMWHs) in patients with a body mass index ≥ 30 kg/m2 is uncertain. Literature and guidelines are not clear and consistent about the correct dose.

DESIGN and METHODS

In this review, an overview of the literature on therapeutic use of LMWHs in this population is provided. Sixteen pharmacokinetic and pharmacodynamic or clinical studies were included.

RESULTS

Based on these results, obese patients should receive therapeutic doses of LMWHs, based on their total body weight without a dose cap as recommended in the Summary of Product Characteristics. In patients with morbid obesity, anti-Xa level monitoring and subsequently an adjusted dosage on the base of supratherapeutic anti-Xa levels is recommended.

28 aug 2019

Kunnen tabletten op een betrouwbare manier handmatig worden gehalveerd?

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1712
  • Auteur(s):
    Froucke van Gosliga a, Lisa Burgler b, Maartje Heijnen b, Theo Last b, Erik van Zanten c* en Jan Peter Yska d

Kunnen tabletten op een betrouwbare manier handmatig worden gehalveerd?

Can tablets be split in half manually in a reliable manner?

BACKGROUND

Since 2017 the Dutch Health and Youth Care Inspectorate does not allow compounding pharmacies to produce tablets with half dosage strength when the same dosage can also be reached by splitting a marketed tablet – with scoring meant for dividing the tablet into two equal parts – in half.

OBJECTIVE

To determine whether it is possible to manually split tablets in half using a reliable and validated method.

DESIGN and METHODS

In this exploratory study six different tablets were manually split in half and tests for loss of mass and loss of uniformity were performed. The influence of different tablet characteristics on the splitting process was assessed.

RESULTS

All six tablets met the requirements of the test for loss of mass (< 3%). Two of the six tablets met the requirements of the European Pharmacopoeia test for loss of uniformity. Type of scoring and the thickness of the tablet seem to be factors influencing the process of tablet splitting.

CONCLUSION

Tablet splitting by hand in the pharmacy is not feasible because for most tablets it will not be possible to develop a reliable and validated method. It will also be difficult to comply with legislation with regards to working conditions. The possibility of mechanical splitting of tablets should be studied and other alternatives should be considered.

20 aug 2019

Het effect van een Kwetsbare Ouderen Team op geneesmiddelgerelateerde problemen na ontslag uit het ziekenhuis

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1701
  • Auteur(s):
    G.H.M. Ponjee a*, H.W.P.C. van de Meerendonk b, M.J.A. Janssen c en F. Karapinar-Çarkit d

Het effect van een Kwetsbare Ouderen Team op geneesmiddelgerelateerde problemen na ontslag uit het ziekenhuis

The effect of a Geriatric Stewardship on drug-related problems after hospital discharge

OBJECTIVE

To assess the effect of a Geriatric Stewardship on drug-related problems (DRPs) reported by patients after discharge.

DESIGN

An implementation study (pre-post design).

METHODS

Hospitalized patients aged ≥ 65 years with polypharmacy and a risk factor for frailty were included from February 2017 until August 2018. The pre-group received usual care (control: no medication review). The post-group received the Geriatric Stewardship intervention. This consisted of an extended medication review based on a (1) review of the medication list and clinical records to draft initial recommendations, (2) consultation with the general practitioner and community pharmacist to discuss the hospital based recommendations, (3) patient interview to assess patient needs, and (4) multidisciplinary evaluation of all the previous steps by a hospital pharmacist and a geriatrician to draft final recommendations.

Two weeks post-discharge, patient-reported DRPs were assessed by telephone using a validated questionnaire. DRPs were classified into: drug-related complaints, practical problems, and questions about medication. The primary outcome was the number and type of DRPs per patient.. Secondary, in the intervention group the number of initial recommendations that were altered after consultations with PCPs and patient interviews was assessed. A poisson regression was used to compare the groups on the primary outcome.

RESULTS

In total, 127 patients were analyzed (control: 74, intervention: 53). Intervention patients reported fewer DRPs compared to control, 2.8 versus 3.3 per patient (RRadjusted = 0.83, 95% CI = 0.66-1.05). The difference was due to a halving in drug-related complaints (P < 0.05). Nearly 30% of the initial recommendations based on the patient’s medication list and clinical records were discarded or modified after consultations with primary care providers and patient interviews.

CONCLUSION

The implementation of a Geriatric Stewardship tends to reduce DRPs after discharge, which provides a good indication for further research. One in three initial medication review recommendations were altered due to PCPs and patient input. This shows that medication reviews should not be based on clinical records only. Patient participation and consultations with primary care providers contributes to a medication review that is tailored to the patient’s individual preferences and medical history.

15 aug 2019

Effect van beslissingsondersteuning op het verminderen van interacterende medicatiecombinaties op de intensive care

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1703
  • Auteur(s):
    M.S. Ongering a*, T. Bakker b, D.A. Dongelmans c, N.F. de Keizer b, A. Abu-Hanna b en J.E. Klopotowska b

Effect van beslissingsondersteuning op het verminderen van interacterende medicatiecombinaties op de intensive care

Effect of a clinical decision support system on reducing drug-drug interactions in the intensive care unit

BACKGROUND

Patients in the intensive care unit (ICU) are at a higher risk of medication-related harm due to potential drug-drug interactions (DDIs). This increased risk is related to the high number of drugs administered. Clinical decision support systems (CDSSs) have the potential to reduce potential DDIs (pDDIs) and improve medication safety.

OBJECTIVE

To evaluate the effect of a CDSS on the incidence of serious pDDIs in the ICU of an academic hospital.

DESIGN and METHODS

This study was conducted at the ICU department of the Amsterdam UMC (location AMC) in the Netherlands. Interrupted time series analysis was used to evaluate the effect of a CDSS. This CDSS generated pDDI alerts during prescribing. Data on medication administrations, pDDIs and pDDI alerts were gathered a year before and a year after implementation of the CDSS from April 2011 till April 2013. The primary outcome was the rate of serious pDDIs per 100 medication administrations. Secondary outcomes were the proportions of overridden pDDI alerts and monitoring actions related to pDDI alerts.

RESULTS

In total 2711 patients having 58.455 drugs administered were included. The rate of serious pDDIs did not significantly change after CDSS implementation (P = 0,098). The mean proportion of overridden pDDI alerts was high: 97% (total: 11.592 alerts). The mean proportion of pDDI alerts followed by a monitoring action varied between alert types (5,8-44,9%).

CONCLUSION

The implementation of a CDSS did not result in a decrease of serious pDDIs at the ICU. Lack of agreement on which pDDIs are clinically relevant for the ICU may explain our findings, since almost all alerts were overridden. Future research should focus on identifying which pDDIs are important in the ICU setting.

13 aug 2019

Melk is goed voor elk?

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1689
  • Auteur(s):
    Herman Vromans

Melk is goed voor elk?

08 aug 2019

Optimale pijnstilling bij laparoscopische darmchirurgie met focus op intrathecale toediening van morfine

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2019;4:a1710
  • Auteur(s):
    Mark V. Koning a* en Liesbeth J. Ruijgrok b

Optimale pijnstilling bij laparoscopische darmchirurgie met focus op intrathecale toediening van morfine

Optimal analgesia after laparoscopic segmental colon resections with a focus on intrathecal morphine

BACKGROUND

Analgesia after laparoscopic segmental colon resections remains controversial. Epidural analgesia and systemic opioids per patient-controlled analgesia (PCA) are commonly used methods of analgesia in The Netherlands. A promising method of analgesia is intrathecal morphine because its analgesic properties fit the pain after laparoscopic surgery.

METHODS and RESULTS

Recently, a Dutch randomized controlled trial showed an enhanced recovery with intrathecal morphine when compared to an intravenous loading dose and a PCA pump of piritramide. Furthermore, the patients reported lower pain scores in the intrathecal morphine group. Still, the side effects warrant prophylactic measures for pruritus, nausea and vomiting. Late respiratory depression does not occur when a low dose (< 500 µg) is used and no concomitant sedatives are administered. If one adopts this analgesic technique, one should be cautious of the administered concentration since dilution could lead to dosing errors.

06 aug 2019

Het gebruik van restanten van monoklonale antilichaamproducten; een studie naar de microbiologische veiligheid

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1688
  • Auteur(s):
    Herman Vromans

Het gebruik van restanten van monoklonale antilichaamproducten; een studie naar de microbiologische veiligheid

01 aug 2019

Het effect van medicatieverificatie bij poliklinische internegeneeskundepatiënten

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1709
  • Auteur(s):
    Suzanne van der Gaag a, dr. Marjo J.A. Janssen b, Hanneke Wessemius c, dr. Carl E.H. Siegert d en dr. Fatma Karapinar-Çarkit e*

Het effect van medicatieverificatie bij poliklinische internegeneeskundepatiënten

An evaluation of medication reconciliation at an outpatient internal medicines clinic

BACKGROUND

Several international guidelines recommend the implementation of medication reconciliation.

OBJECTIVE

To evaluate the impact of medication reconciliation at an outpatient internal medicines clinic.

DESIGN

A prospective before-and-after study was conducted in the OLVG hospital, Amsterdam.

METHODS

At the internal medicines clinic, all adults (≥ 18 years of age) with a written informed consent and using more than one drug chronically (≥ 3 months) were included. In the usual care group no structural medication reconciliation was performed. In the intervention group, one week before the visit, the patient’s actual medication use (name, dosage, frequency) was assessed by phone by a pharmacy technician.

The primary outcome was the proportion of patients with unintentional discrepancies between documented and actual medication use. Secondary outcomes were the time needed by the physician to discuss medication-related topics during the outpatient visit, patient knowledge of medication changes, and patient satisfaction. Descriptive analysis and logistic regression was used to analyze the outcomes.

RESULTS

A total of 308 patients were included: 157 usual care, 151 intervention. The proportion of patients with an unintentional discrepancy decreased significantly by medication reconciliation: usual care 83%, intervention 39% (adjusted OR = 0.14, CI = 0.08-0.25). The physician used similar amounts of time to discuss drug-related topics in both groups (P = 0.316). Patients’ knowledge regarding medication changes increased non-significantly from 71% to 84% after medication reconciliation in the intervention group (P =0.058, adjusted OR = 1.35, CI = 0.64-3.64). Patients in both groups were equally satisfied with the physicians’ communication.

CONCLUSION

Similar to previous studies, medication reconciliation significantly decreased discrepancies with 50%. Further research is needed to assess the impact of medication reconciliation on clinical outcomes (e.g. adverse drug events).

30 jul 2019

Een alternatief voor capecitabine bij handvoetsyndroom

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1690
  • Auteur(s):
    Jacqueline Hugtenburg

Een alternatief voor capecitabine bij handvoetsyndroom

25 jul 2019

Hoe doseer je geneesmiddelen bij obese patiënten? 2

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2019;4:a1705
  • Auteur(s):
    Elena C. Warmerdam, MSc a* en dr. Lisanne L. Krens b

Hoe doseer je geneesmiddelen bij obese patiënten?

How should drugs be dosed in obese patients?

BACKGROUND

Overweight and obesity are a common problem, however the dosing of drugs in obese patients is challenging due to the lack of dosing advice for these patients. In obese patients the bioavailability of drugs can be different. In general the volume of distribution increases with bodyweight and therefore drug metabolism may be changed in obese patients compared to normal-weight patients. Formulas to estimate kidney function may give an incorrect estimation in the obese; formulas indexed for body surface area – like MDRD and CKD-epi – underestimate the kidney function in obese patients. Moreover cytochrome P450 metabolism may also be altered in obese patients.

METHODS and RESULTS

For these reasons a simple, unambiguous, general advice on drug dosing in obese patient cannot be given. As a consequence a recommendation on dosing must be formulated for every single drug. In this manuscript we present a step-by-step plan which helps to formulate a pragmatic advice for drug dosing in obese patients when prescribing data is lacking.

19 jul 2019

Farmacogenetisch paspoort voor relevante genetische variatie met betrekking tot geneesmiddelgebruik

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1687
  • Auteur(s):
    Martina Teichert

Farmacogenetisch paspoort voor relevante genetische variatie met betrekking tot geneesmiddelgebruik