Individualising Drug Therapy
Choice of drug and dose must take patient characteristics into account.
- Is the diagnosis correct?
- What are the therapeutic objectives for the patient, e.g. to cure, relieve symptoms, replace deficiencies, prevent disease, or slow disease progression?
- Is drug therapy necessary?
- What is the right drug based on good evidence for this condition? See Hospital HealthPathways. Is this drug appropriate for this patient?
- Is a loading dose or low initial dose necessary?
- Does the maintenance dose or frequency need to be adjusted for this patient, e.g. frail or renal impairment? Note: Low therapeutic index drugs are more likely to need dose adjustment.
- Is the route appropriate? Use the oral route where possible.
- Is the formulation right for this patient? For example, liquids are often better for paediatric patients.
- What is the duration of therapy?
- How are efficacy and toxicity going to be monitored? Consider measure of desired effects, adverse effects, drug concentrations, and biomarkers.
- When will the patient be reviewed?
- Is adherence likely to be a problem? Discuss therapy with the patient, keep regimens simple, and/or use compliance aids.
- On stopping, what is the best way to deprescribe? For example, tapering is often necessary to avoid withdrawal reactions.
General
- Know a few drugs well and use these preferentially.
- Use the lowest dose of as few drugs for as short a time as possible.
- Review therapy regularly with appropriate follow-up.
To revise your understanding of pharmacokinetics, visit the Clinical Pharmacology website.
Topic Code: 90739
