Legemiddelrotasjon

Legemiddelrotasjon refers to a systematic strategy of regularly switching patients from one medication within a therapeutic class to another similar drug. The aim is to minimize cumulative adverse effects, reduce the development of tolerance or dependence, and lower the risk of harmful drug interactions. It is commonly applied with agents that have narrow therapeutic indices or are associated with long‑term side effects, such as anticonvulsants, neuroleptics, anticonvulsants, antidiabetics, and certain immunosuppressants.

In clinical practice legemiddelrotasjon is most frequently used in long‑term care facilities, psychiatric wards and chronic disease management programs. For example, patients receiving a benzodiazepine for anxiety may be transitioned to a short‑acting hypnotic on a schedule that allows clinicians to assess efficacy and tolerability while preserving the overall pharmacologic benefit. When applied to antiepileptic drugs, the rotation can help preserve seizure control while potentially offsetting dose‑related hepatic enzyme induction.

Guidelines for implementing rotation usually include a thorough medication history, identification of therapeutic endpoints, and a schedule that balances pharmacokinetic considerations with patient preferences. Clinicians typically monitor plasma drug concentrations, clinical response, and adverse event profiles before, during, and after the transition. Documentation of the rationale, timing, and outcome is essential for continuity of care and legal compliance.

Research evidence for legemiddelrotasjon is mixed. Some studies suggest reduced side‑effect burden and improved adherence, especially in populations with polypharmacy. Other investigations highlight challenges such as the complexity of switching protocols and potential transient loss of therapeutic effect during the transition window. Consequently, many professional bodies recommend a shared decision‑making process, incorporating patient values and evidence‑based risk–benefit analysis, to determine when a rotation is appropriate.