Lecture 22 Variability in Drug Response

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22 Apr 2012
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Lecture 22 Variability in Drug Response
Compliance
Extent to which a person’s behavior coincides with medication or health advice
oCorrect dose, time, avoiding prohibited substances
oPoor compliance: dose omission/supplementation, wrong time, stopping/not
starting therapy
Consequences
Worsening symptoms
Develop complications, premature disability
Inappropriate dose adjustments
Increased hospitalizations, costs of healthcare
Poor Compliance
Common with chronic therapy, preventative treatment
Rates are relatively higher t acute conditions, short term therapies
What affects compliance?
Patient Related Factors
Demographic NOT predictive of compliance
Age not significant, but associated with polypharmacy, physical/cognitive
limitations, access to medications, co-morbidities
Predictive factors
oPsychological problems
oCognitive impairment
oSocial isolation
oPerception of illness, treatment efficacy, adverse effects
Disease Related Factors
Poor compliance with no/mild symptoms, chronic diseases, delayed repercussions,
preventative treatment
Serious condition doesn’t mean patient will comply
oPatient perception of “seriousness” of prognosis, drug efficacy are better
predictors of compliance
Disease itself may interfere with compliance
Treatment Related Factors
Complexity of dosing regimen
oBetter: 1 or 2 times per day, avoid interruption of normal routines,
inconvenience
oNumber of drugs (polypharmacology)
Combination pills lose flexibility of different doses
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