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Dosing medications and taking them at the right times is the key to overcoming the disease. We often forget how many factors influence the effective operation of preparations. Rafał Janiszewski, the owner of the Advisory Office providing services in the field of he althcare organization for he althcare entities and patients' rights, will talk about how to dose pharmaceuticals.
Anna Tłustochowicz: Let's be honest: some of us approach drug dosing quite loosely. It's dangerous, isn't it?
Rafał Janiszewski:Absolutely. I suggest that we discuss the various stages of the drug's action, from the moment of taking one dose to the possible taking of the second. This is interesting, important, and it will help us explain why the dosing regimen is so important.
The first step is?
Drug release. This is the moment when the active substance - or active substances, depending on whether we are talking about a simple or a combined drug - comes out of a given drug form, e.g. from a capsule or tablet. The next step is absorption. The drug is absorbed through the gastrointestinal tract into the circulatory system. In general, because there are such drugs - such as some antibiotics - that are not absorbed in this way at all and are not in an oral form either. They are administered intravenously or intramuscularly. Directly into the bloodstream.
And when the drug is in the bloodstream, what happens next?
The medicinal substance binds to our proteins. And now I will say something that may surprise at least some of our readers. Well, it is not true, what we sometimes hear in advertisements, that we take a pill and this pill is ideally suited to the place of pain.
And the syrup straight into the lungs?
Exactly. (laughs) This is also what the ads say, but it's not like the active substance from the stomach goes to the aching knee and acts directly in the knee! It's a bit of an infantile vision, isn't it?
If you think about it for a moment, it really is.
Let us therefore establish that the vast majority of drugs have a systemic effect. The active substance, as we have already said, binds to our proteins and begins its distribution in the body. If it is an antibiotic, it obviously has a specific task, e.g. anti-inflammatory andapparently it is supposed to cure inflammation of the upper respiratory tract.
Seemingly?
Yes, because it will not only affect the upper respiratory tract, but also other tissues! This is what the systemic action is all about. So if, in addition to inflammation of the upper respiratory tract, the patient also has a difficult to heal wound on the toe, this antibiotic can also heal it. Of course, on the condition that the bacterium that causes this difficult wound healing is sensitive to this antibiotic.
Fascinating!
Right? And all this because the active substance circulates in our bloodstream, and after all, both the lungs and the tissue of the toe are supplied with blood. Now let's move on to the next step: each drug has a specific distribution time. We took one dose and the entire amount of the active ingredient that was absorbed was also distributed throughout the body, i.e. into the tissues. Metabolism also takes place there. This is the natural course of things. This is the life cycle of cells: they absorb nutrients - mainly nutrients, but not only: the cells also absorb our active substance - and then they burn and excrete waste products. Most of the metabolic processes take place in the liver, and this is also where the drug is metabolized. The final stage of its path in the human body is excretion. Most often with urine. Medicines can also be excreted via the exhaled air. So we've followed the entire life cycle of a drug, and when you look at it, it lasts for a while. There is a certain time period - different for different drugs - at which time the drug lives in us. And it works. On the other hand, when it is metabolized and excreted, its action ends.
And then what?
In the case of continuous administration of the drug - we have to take the next dose. The duration of action of each specific drug has been determined in clinical trials. You can read about it in the leaflet and in the summary of product characteristics.
Summary of product characteristics is a document issued for each drug, which can be found, for example, on the website of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products. There is a search engine where you can find all registered drugs and download their characteristics, which usually contain more information than the leaflet. The leaflet is a document prepared for the patient, while the summary of the medicinal product - for specialists: doctors, pharmacists. We can also read there exactly what the duration of a given drug is. So we getinformation that taking the next dose at a later time will result in …
Therapeutic gap?
Yes. This will cause the concentration of the drug to drop, or even to disappear, in the body. There will be - in colloquial terms - a break in treatment. That is why, among others, doctors always emphasize that one should take antibiotics equally, every eight hours. But I also want to point out that it can also be dangerous to take the drug too early!
Why?
Because then there is too much drug concentration in the body. And since we are talking about it, it is worth knowing how it is with these doses. We have four types of drug dosage. The first is the minimum dose: this is the amount of the drug that produces the first noticeable changes in the body. Perceptible! Which doesn't mean it's enough to be cured. Sometimes, for example, we say that we took a headache pill and we got a little better, "but something else is mothy," right? It is possible that the minimum dose is simply too small for us. The second type of dose is the therapeutic dose, i.e. the amount of the drug that already has a therapeutic effect - as the name suggests. So the headache is gone. The third dose is the toxic dose. We enter too high doses that poison the body. And now we have come to a very important moment!
We are not talking, because only about a single too large dose. They could be overlapping precisely because we took the next dose too early. So if we took one headache tablet and "still moths" and we know that the healing effect lasts, for example, for six hours, it means that after one hour we should not take another two tablets right away! Why? Because then, for a few hours, our body will be affected by a double dose. Therefore, a toxic dose can be taken unconsciously by taking subsequent doses in a time shorter than the time specified for the duration of the active substance in the body!
And the fourth dose?
Fatal. Causes statistically death in at least half of its recipients.
The leaflet does not contain information about the lethal dose.
No, but we'll find information about the maximum dose. It clearly says what dose should not be exceeded. Sometimes I encounter statements titled, "Yes, yes! They write various things there, but I have already taken a higher dose and I was fine! ”. I strongly advise against!
Let's see that since the lethal dose is such that half of the people taking it have died, the first time I can be in the fifty percent- for example, fifty out of a hundred people - who survived, but the second time I can be in the other fifty. The general rule is that if we took the right dose and the drug did not help, it can be concluded that it "does not work" for us and then we should consult a doctor and use another drug.
And sometimes you have to wait for the effect of the drug.
Of course it is. In the case of some drugs, it is necessary to wait a few doses for the therapeutic effect. This is the case, for example, with antibiotics. If there is no improvement after the first dose, it does not mean that it is not working.
And is it true that an injection is the fastest drug?
It couldn't be otherwise, because any drug that enters the bloodstream must be metabolized. And metabolism takes place in the liver.
Yes. We take drugs in various forms and in fact the intravenous one - injections or drips - works the fastest, because the active substance gets directly into the bloodstream and very quickly reaches the cells. Injections can be intramuscular and subcutaneous. The latter penetrate the blood a little longer, but still faster than tablets. We also have inhaled medications. We take them, for example, by inhalation and these drugs also quickly enter the bloodstream, because they enter it directly from the alveoli. Then we have the suppositories, which are also fast acting as they dissolve right away in the intestinal mucosa. By the way, when a small child has a fever, the suppository will work faster than the antipyretic drug given in the syrup! Finally, we have various skin medications: ointments, gels, creams, patches, and these can only work topically. It does not enter the bloodstream.
Applying pain gel on the knee will only help the knee.
Sure. But I also listed the patches, including the transdermal ones!
What does this mean?
That they work systemically. The active substance in the patch adheres to the skin, which is vascularized, so the medicine - from the patch through the skin - enters the bloodstream. The patches are very often several days old because the drug substance is continuously absorbed through the skin. In this way, for example, hormone replacement therapy is used. The active substance enters the bloodstream slowly. Gradually.
And does not burden the liver?
Charges. Less than a drug taken in tablet form, but it weighs down.
To sum up our considerations today: we take medications with a watch in our hand!
- Regardless of the form in which we take the drug, it must be taken underconsider the dosage and stick to it. Drugs vary in speed, but they work! Therefore, taking the next dose must be balanced so that the next dose is neither too small nor too high, because both of these can be dangerous for us
Rafał Janiszewski, owner of the Advisory Office providing services in the field of he althcare organization to he althcare entities
Speaker, organizer of many trainings and conferences on he alth protection and patient rights. In the years 1998-1999 an employee of the Office of the Government Plenipotentiary for the Implementation of the General He alth Insurance. Author of over 20 books on he althcare organization and he alth care financing standards. In 2005-2007, he was an expert of the Presidium of the Parliamentary He alth Committee, as an advisor on he alth services. Co-author of the general study as part of the Pharmaceutical Pricing and Reimbursement project for the European He alth Commission.
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