A wide range of effective antiretroviral therapy (ART) regimens with favourable side effects are available. More than 70% HIV care costs in the Netherlands attributed to ART. We developed an ART algorithm proactively switch virologically suppressed individuals a more cost-effective treatment. This prospective study implemented our two large Dutch clinics, where pharmacist screened for 1 year. Individuals were considered suitable if their current exceeded €600 per month, considering renal...

Background: Pseudomonas aeruginosa (Pa) is the predominant pulmonary pathogen in persons with Cystic Fibrosis (CF). Nebulization tobramycin or colistin mostly applied but has a significant treatment burden. Dry powder (DP) inhalation may offer an attractive alternative. The aim of this study was to assess local tolerability and systemic pharmacokinetic parameters increasing doses dry tobramycin. Methods: This evaluation pilot DP three different inhaled through Cyclops (30, 60, 120 mg) ten...

Summary Background Tioguanine (or thioguanine) is an alternative drug for IBD patients who fail prior conventional immunomodulating therapy. Aim To report effectiveness, safety and therapeutic monitoring in a cohort of with prolonged tioguanine maintenance Methods In this nationwide, multicentre study, medical records tioguanine‐ using were retrospectively reviewed. Response to therapy was defined as clinical effectiveness without (re)initiation corticosteroids, concurrent biological or...

HIV-infected travellers frequently use atovaquone/proguanil as malaria prophylaxis. We compared pharmacokinetics between healthy volunteers and patients taking efavirenz, lopinavir/ritonavir or atazanavir/ritonavir. The geometric mean ratio (95% confidence interval) area under the curve (AUC)0-->t for atovaquone relative to was 0.25 (0.16-0.38), 0.26 (0.17-0.41) 0.54 (0.35-0.83) on atazanavir/ritonavir, respectively. Proguanil plasma concentrations were also significantly lower (38-43%)....

To establish whether efavirenz dose reduction in patients with high plasma concentrations prevents toxicity-induced discontinuations.HIV-infected a concentration (>or=4.0 mg/L) while using 600 mg once daily as part of their highly active antiretroviral therapy regimen were selected from the AIDS Therapy Evaluation The Netherlands cohort study. These classified into 2 groups. reduced-dose group contained all who underwent after measurement; standard-dose consisted had no reduction....

Antiretroviral therapy (ART), which is increasingly used by people with HIV, accounts for significant care costs, particularly because of single-tablet regimens (STRs). This study explored de-simplification to a two-tablet regimen (TTR) cost reduction. The objectives this were: (1) acceptance de-simplification, (2) patient-reported outcomes, and (3) savings.

Therapeutic drug monitoring is frequently used in several European countries, and international guidelines recommend it selected cases. We discuss the main arguments for against therapeutic HIV infection.Accumulating evidence favours use of management concentration-related toxicities. Interindividual variability pharmacokinetics antiretroviral drugs at least partially caused by genetic polymorphisms. Additionally, body weight, sex ethnicity have been identified as independent predictors...

The authors studied the effect of raltegravir on pharmacokinetics antiepileptic agent lamotrigine. Twelve healthy volunteers (group A) received 400 mg twice daily from days 1 to 5. On day 4, a single dose 100 lamotrigine was administered. After washout period, participants second but now without (day 32). In group B, 12 same treatment as in A reverse order. 4 and 32, 48-hour pharmacokinetic curves were drawn. Geometric mean ratios (+90% confidence intervals [CIs]) area under plasma...

Valproic acid (VPA) is an effective antiepileptic drug and mood stabilizer. A key characteristic of VPA its high saturable protein binding at higher concentrations. Although the unbound concentration responsible for pharmacological activity, total concentrations are monitored in routine clinical practice. Therapeutic monitoring (TDM) recommended specific situations. The goal this study was to evaluate TDM requests practice.All our laboratory 2014 2015 were evaluated retrospectively. In...

Co1nflicting data exist regarding the effect of efavirenz (EFV) plasma concentrations on central nervous system (CNS) toxicity. We aimed to determine whether patients with high EFV have an increased likelihood toxicity-driven discontinuations.EFV were measured from in EuroSIDA study starting after 1 January 1999. Patients a concentration available divided into those that discontinued because any toxicity or by choice patient physician within 2 years (TOXPC group) and continued for > = (no...

A 46-year old man with a chronic hepatitis C virus infection received triple therapy ribavirin, pegylated interferon and telaprevir. The patient also simvastatin. One month after starting the antiviral therapy, was admitted to hospital because he developed rhabdomyolysis. At admission simvastatin all drugs were discontinued toxicity due drug-drug interaction suspected. creatine kinase peaked at 62,246 IU/L treated intravenous normal saline. patient’s renal function remained unaffected....

ObjectivesTo manage the interaction between fosamprenavir/ritonavir and posaconazole, we hypothesized that ritonavir can be replaced by posaconazole as an alternative booster of fosamprenavir with no significant influence on pharmacokinetics.

To evaluate the potential drug-drug interaction between raltegravir and pravastatin.This was an open-label, randomized, 3-period, cross-over, single-centre trial in 24 healthy volunteers. Subjects received following treatments: pravastatin 40 mg every day for 4 days, 400 twice a + days. The treatments were separated by washout periods of 10 On each treatment period, blood samples pharmacokinetics collected throughout 24-hour period.Geometric mean ratios (90% confidence interval) versus alone...

There is an ongoing debate regarding whether low-level viremia (LLV), in particular persistent LLV, during HIV treatment with optimal adherence originates from viral replication, production, or both. We performed observational study 30 individuals LLV who switched to a boosted darunavir (DRV)-based therapy. In-depth virological analyses were used characterize the population and (activity) of reservoir. Immune activation was examined using cell-bound soluble markers. The primary outcome...

High variability in tacrolimus pharmacokinetics directly after lung transplantation (LuTx) may increase the risk for acute kidney injury (AKI) and transplant rejection. The primary objective was to compare pharmacokinetic patients receiving orally versus intravenously early LuTx.

Abstract Background Low-dose weekly methotrexate (MTX) is the mainstay of treatment in juvenile idiopathic arthritis. Unfortunately, a substantial part patients has insufficient efficacy MTX. A potential cause this inadequate response suboptimal drug adherence. The aim study was to assess MTX adherence arthritis by quantification concentrations plasma. Secondly, association between and either self-reported issues, or concomitant use biologics examined. Methods This retrospective,...

Vancomycin has been reported to cause vancomycin flushing reaction (VFR), a hypersensitivity that mostly occurs after intravenous administration. The incidence of VFR in patient receiving intraperitoneal is rare. We report case female peritoneal dialysis (PD) with PD-related peritonitis who developed administration 2000 mg vancomycin. Seventy-five minutes instillation, she flushing, pruritic erythema on the upper body and swelling lips. Blood results revealed plasma concentration 54.8 mg/L...

Cefiderocol is a broad-spectrum cephalosporin antibiotic and indicated in patients with difficult-to-treat Gram-negative bacterial infections. applied as 2-4-times daily prolonged 3-h infusion. The therapeutic target of cefiderocol suggests that continuous infusion (CI) may be advantageous, since it more likely to achieve 100% time the unbound concentration above minimal inhibitory (MIC). However, limited information on CI has been assessed. We present case critically ill 37-year-old woman...

Therapeutic drug monitoring (TDM) is recommended in several international HIV treatment guidelines. The adherence of clinicians to these recommendations unknown. authors evaluated the Dutch TDM guideline 2005.From ATHENA cohort study, three scenarios were selected for which TDM: 1) start a combination lopinavir/ritonavir + efavirenz or nevirapine (drug-drug interaction); 2) (routine TDM); and 3) use nelfinavir during pregnancy. For each scenario, we determined proportion patients whom was...

The effect of the Dutch nationwide adjustment reducing 6-thioguanine nucleotide (6-TGN) target values (from 600-1200 to 320-630 pmol/8 × 108 red blood cells [RBC]) on toxicity and clinical outcome thiopurine treatment in patients with inflammatory bowel disease has not yet been established. Therefore, authors determined incidence toxicity-induced discontinuations efficacy at both concentrations.This retrospective study was performed treated azathioprine or mercaptopurine. Two groups were...

Abstract Background For the analysis of 6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine ribonucleotides (6-MMPR), no external quality assessment scheme (EQAS) is currently available control samples can be made because absence pure substances. An experimental design tested to compare laboratory analytical results. Methods In this EQAS, participating laboratories were asked select patient from their routine exchange these with a coupled laboratory. Because large differences in...