Since it is difficult to improve patient compliance to drug prescriptions, an alternative is to select a drug with less consequences for poor compliance, that is, a drug that has the capacity of ‘forgiveness’. Forgiveness is the property of a drug which, when compared with another medicine with different pharmacokinetics and/or concentration-effect relationships, blunts the consequences of missing one or two doses in a row, or has a greater variability in the timing of intake. Simulations show that drugs with a concentration-effect relationship modelled with an effect compartment, for example a delayed response, have more forgiveness. A marker of forgiveness would be of some help for doctors deciding which drug to prescribe to patients who are poor compilers.
This is a preview of subscription content, log in to check access
This work was supported by APRET (Agence Pour la Recherche et l’Evaluation Thérapeutique), the Luennec Medical School and Lyon Teaching Hospital.
Haynes RB, Taylor DW, Sackett DL, editors. Compliance in health care. Baltimore (MD): Johns Hopkins University Press, 1979: 1Google Scholar
Peyrieux JC, Boissel JP, Leizorovicz A. Relationship between plasma mexiletine levels at steady-state. Presence of ventricular arrhythmias and side effects. Fundam Clin Pharmacol 1987; 1: 45–57PubMedCrossRefGoogle Scholar
Boissel JP, Collet JP, Moleur P, et al. Surrogate endpoints: a basis for a rational approach. Eur J Clin Pharmacol 1992; 43: 235–44PubMedCrossRefGoogle Scholar