Rapid XXXX dose adjustment using 24-hour levels.

@entity1 @entity308 @entity5829
Prior work indicates that plasma tricyclic levels obtained 24 hours after a single dose correlate well with steady state levels achieved. Although this suggests that 24-hour levels could be used to predict the dose needed to reach a desired plasma level, this method has seldom been tested prospectively. In the current study we test this strategy and determine @entity1 ' tolerance of rapid dose adjustment. First, the relationship of 24-hour levels and steady state levels in a sample of 16 inpatients was determined using a fixed dose paradigm. In a second sample of 26 @entity308 inpatients, plasma @entity5829 levels obtained 24 hours after a single test dose were applied to the regression equation derived from the first sample in order to estimate the dose needed to achieve a steady state level of 140 ng/ml. Once determined, the full dose was then rapidly administered. Sixteen of the 18 (89%) @entity1 who completed the dose adjustment study had steady state drug concentrations within a target range of 125 to 300 ng/ml. This distribution of levels differed significantly from that previously reported for a fixed dose sample in which only 19 of 83 (23%) @entity1 had levels within this range. Dose adjustment using 24-hour levels was well tolerated and should help to attain a more rapid response to antidepressant treatment. This has important implications for reducing lengths of hospitalization for @entity308 inpatients. The technique should also prove useful in research where a uniform plasma level paradigm is desirable.
