Medication Blood Levels

Blood levels of medications drawn at a single time point to assess adherence may be misleading because medication level fluctuations are common and expected. The fluctuation of medication blood levels over time can provide a much more accurate assessment of adherence (Shemesh et al. 2004). The standard deviation of medication blood levels, which represents the fluctuation between individual blood levels, has been suggested as an adherence measure (Shemesh 2007; Shemesh et al. 2004,

2007; Venkat et al. 2008). This method assumes that medication blood levels are closely related to intake, which is not always the case. Individual medication blood levels may vary from one patient to another because of individual differences in metabolism or absorption that are unrelated to adherence. However, looking at the degree of fluctuation of medication blood levels over time within the same subject is less prone to be influenced by these factors. Unfortunately, many medications do not have an assay that is readily available for routine clinical use. When such information is available, information about the degree of fluctuation of medication blood levels over time appears to be a promising direct measure of adherence.

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