Wearing Off

Description

Wearing-off refers to symptom breakthrough towards the end of a dosing interval, prior to the next dose. This can be seen with any drug, but it has become of interest for targeted or immunoglobulin therapies which typically have very long half-lives.

Clinical findings:

(1) The appearance of symptoms typical for the treated condition.

(2) The onset is late in the dosing interval (trough).

(3) No other explanation for the findings.

(4) Resolution of symptoms after the next dose.

Issues to consider:

(1) too low a dose

(2) worsening of the condition

(3) increased drug clearance

(4) need for a shorter dosing interval (more frequent dosing)

(5) need for a formulation with extended release

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