Adherence with perindopril therapy: a pilot study using therapeutic drug monitoring of perindoprilat and an evaluation of the clearance estimation
Language English Country Netherlands Media print-electronic
Document type Clinical Trial, Journal Article
Grant support
Progres Q25
Univerzita Karlova v Praze
SVV 260373
Univerzita Karlova v Praze
PubMed
28791494
DOI
10.1007/s11096-017-0522-7
PII: 10.1007/s11096-017-0522-7
Knihovny.cz E-resources
- Keywords
- ACE inhibitors, Compliance, Creatinine, Cystatin C, Perindopril, Therapeutic drug monitoring,
- MeSH
- Medication Adherence * MeSH
- Cystatin C metabolism MeSH
- Glomerular Filtration Rate drug effects physiology MeSH
- Angiotensin-Converting Enzyme Inhibitors metabolism pharmacology MeSH
- Creatinine metabolism MeSH
- Humans MeSH
- Metabolic Clearance Rate drug effects physiology MeSH
- Drug Monitoring methods MeSH
- Perindopril metabolism pharmacology MeSH
- Pilot Projects MeSH
- Prospective Studies MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Names of Substances
- Cystatin C MeSH
- Angiotensin-Converting Enzyme Inhibitors MeSH
- Creatinine MeSH
- Perindopril MeSH
Background Although measurement of drug serum levels is an objective direct method for testing compliance, it can be distorted by "white-coat compliance" or by variations in drug elimination. Objective The aim of this prospective study was to evaluate the prevalence of noncompliance with perindopril therapy in adult out-patients using pharmacokinetic simulations. The additional aim was to compare the predictive performance of two glomerular filtration rate markers-creatinine and cystatin C. Setting Department of Cardiology, Tomas Bata Regional Hospital in Zlín, Czech Republic. Method Perindoprilat pharmacokinetic models individualized according to patient characteristics were compared with measured perindoprilat serum concentrations to document compliance. Linear regression was used to evaluate the relations between perindoprilat clearance and glomerular filtration rate estimated using creatinine and cystatin C. Main outcome measure Assessment of non-compliance with medication using drug concentration measurements reinforced with therapeutic drug monitoring. Results Non-detectable perindoprilat levels were observed in 26.1% of patients. Another 21.7% were classified as non-compliant based on therapeutic drug monitoring pharmacokinetic simulations. Volume of distribution, clearance and half-life median value (interquarti°range) for perindoprilat were 408.3 (360.4-456.8) L, 10.1 (4.9-17.0) L h-1 and 24.7 (19.4-62.7) h, respectively. Linear regression models showed tight relationship between cystatin C and perindoprilat clearance. Conclusions Assessment of adherence with medication reinforced with therapeutic drug monitoring and pharmacokinetic simulations is proposed as an optimal method reducing disadvantages of simple drug concentration measurements. Cystatin C proves to be better surrogate marker for perindoprilat elimination than creatinine.
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