Drug effect-time profile (cont'd)

Causes of hysteresis in the conc-effect relationship:

Drug metabolites: Formation of drug metabolite(s) that have pharmacological effect similar to that of the parent drug will result in counterclockwise hysteresis if the metabolite half life is longer than the parent drug half life.

Tolerance: When drug administration causes tolerance (the effect decrease with time even if the drug conc does not change). This can lead to clockwise hysteresis.

Sensitization: When drug administration causes sensitization (the effect increase with time even if the drug conc does not change). This can lead to counterclockwise hysteresis.

Indirect pharmacological effect: When drug effect results from inhibition or stimulation of a mediator that will in turn cause the effect. For example oral anticoagulants cause their effect by inhibition of the new synthesis of clotting factors. The anticoagulant effect starts to appear when the existing clotting factors are depleted which may take few days.

Modeling the drug concentration-effect relationship in these cases may necessitate the incorporation of an effect compartment in the model or by using indirect pharmacodynamic models.

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