如果患者漏服了一剂药物，该怎么办？思考方式
What should patients do if they miss a dose of medication? A theoretical approach
摘要：
药物依从性是需要长期药物治疗的慢性疾病患者的主要问题。许多未回答的问题围绕着依从性，包括依从率如何转化为治疗效果，以及如何处理错过的药物剂量。为了解决这些问题，我们制定和分析一个数学模型的药物浓度在一个病人不完美的遵守。我们发现精确的药物浓度统计公式，包括平均值，变异系数，并从完美的坚持偏差。我们确定了依从率如何转化为药物浓度，以及这如何取决于药物半衰期，给药间隔以及如何处理错过的剂量。虽然临床建议需要广泛的验证，并应取决于药物和患者的具体情况，作为一个一般原则，我们的理论表明，如果药物的半衰期很长，最好通过在错过剂量后服用双倍剂量来减轻不依从性。这一结论与现有的一些建议相矛盾，这些建议将长药物半衰期作为避免漏服剂量后加倍剂量的原因。此外，我们表明，如果药物半衰期长，在错过剂量后服用双倍剂量的患者体内的药物最多只能比完全依从的患者多一点点。我们还研究了处理漏服剂量的其他方法，包括在漏服剂量后服用额外的部分剂量。我们讨论我们的结果的背景下，甲状腺功能减退症患者服用左旋甲状腺素。
英文摘要：
Medication adherence is a major problem for patients with chronic diseases that require long term pharmacotherapy. Many unanswered questions surround adherence, including how adherence rates translate into treatment efficacy and how missed doses of medication should be handled. To address these questions, we formulate and analyze a mathematical model of the drug concentration in a patient with imperfect adherence. We find exact formulas for drug concentration statistics, including the mean, the coefficient of variation, and the deviation from perfect adherence. We determine how adherence rates translate into drug concentrations, and how this depends on the drug half-life, the dosing interval, and how missed doses are handled. While clinical recommendations require extensive validation and should depend on drug and patient specifics, as a general principle our theory suggests that nonadherence is best mitigated by taking double doses following missed doses if the drug has a long half-life. This conclusion contradicts some existing recommendations that cite long drug half-lives as the reason to avoid a double dose after a missed dose. Furthermore, we show that a patient who takes double doses after missed doses can have at most only slightly more drug in their body than a perfectly adherent patient if the drug half-life is long. We also investigate other ways of handling missed doses, including taking an extra fractional dose following a missed dose. We discuss our results in the context of hypothyroid patients taking levothyroxine.
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