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A drug nomogram may be used to determine an initial dosing regimen. The calculation of this initial dosing regimen may be based on the patient weight or height. Other covariates such as renal function, cardiac function, liver status or smoking status might be considered. Mullen (1978) proposed a direct linear plot method (Figure 21.5.1) using data collected after two phenytoin steady state dosing regimens, .
Another approach is the use of therapeutic drug monitoring (TDM). Briefly, this involves collecting one or more blood samples from the patient after their initial dose or dosing regimen. These samples are quickly assayed and analyzed for pharmacokinetic parameters. These parameter values may be supported by Bayesian estimation which includes population parameter values and their uncertainty (standard deviation or variance) as well as the individual subject data in the analysis.
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