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Ramos KA, de Oliveira Duarte YA, Freitas RL, Boing AC, Santos JLF, Bof de Andrade F. Effect of the use of potentially inappropriate medications on the mortality of Brazilian older adults: SABE cohort study. Geriatr Nurs 2024; 59:256-260. [PMID: 39089144 DOI: 10.1016/j.gerinurse.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/24/2024] [Accepted: 07/13/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVE Investigate the association between potentially inappropriate medication (PIM) use and the risk of death among community-dwelling older Brazilian adults. METHODS Participants from the Health, Well-Being, and Aging Cohort Study (SABE) in São Paulo, Brazil, between 2000 and 2016 were included. The dependent variable was all-cause mortality, measured as the time elapsed until death. The exposure of interest was the use of PIM according to the Beers Criteria 2019 version. All covariates, except for sex and education, were considered time-varying. RESULTS PIM use was not associated with mortality after adjusting for covariates (HR = 0.99; 95 % CI: 0.88-1.12). There was a significant interaction between PIM use and age (HR = 0.98; 95 % CI: 0.96-0.99). CONCLUSION The association between PIM use and the risk of death was moderated by age. Future studies should consider the impact of necessary medication omissions when assessing the mortality risk associated with PIM use.
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Affiliation(s)
- Karina Alves Ramos
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30.190-002, Brazil
| | | | - Renata Lara Freitas
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30.190-002, Brazil
| | | | | | - Fabíola Bof de Andrade
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30.190-002, Brazil.
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Dil-Nahlieli D, Ben-Yehuda A, Souroujon D, Hyam E, Shafran-Tikvah S. Validation of a novel Artificial Pharmacology Intelligence (API) system for the management of patients with polypharmacy. Res Social Adm Pharm 2024; 20:633-639. [PMID: 38637208 DOI: 10.1016/j.sapharm.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Medication management of patients with polypharmacy is highly complex. We aimed to validate a novel Artificial Pharmacology Intelligence (API) algorithm to optimize the medication review process in a comprehensive, personalized, and scalable way. MATERIALS AND METHODS The study was conducted on anonymized retrospective electronic health records (EHR) of 49 patients. Each patient's file was reviewed by the API system, a clinical pharmacist, and a judging committee. Validation was assessed by comparing the overall agreement of the judging committee (as the gold standard, blinded to the identity of the analyzer) to both the API system and clinical pharmacists' conclusions. Five medication-related problem (MRP) categories were assessed: duplication of therapy, age-related issues, incorrect dose, current side effects and future side effects' risk. For each category the overall validity parameters, agreement, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were analyzed. RESULTS The agreement between the API system and the judging committee was 93.5 % (95 % CI 92.7-94.4), while the agreement between the clinical pharmacists and the judging committee was 73.9 % (95 % CI 72.5-75.3). The PPV was 92.2 % (90.9-93.5) and NPV was 94.2 % (93.1-95.2) for the API system and 76.3 % (69.8-82.8) and 73.5 % (72.3-74.8) respectively for the clinical pharmacists. DISCUSSION AI systems can equip clinicians with sophisticated tools and scale manual processes such as comprehensive medication reviews, thus reducing MRPs and drug-related hospitalizations related to multidrug treatments. The API system validated in this study provided comprehensive, multidrug, multilayered analysis intended to bridge the innate complexity of personalized polypharmacy treatment. CONCLUSIONS The API system was validated as a tool for providing actionable clinical insights non-inferior to a manual clinical review of a clinical pharmacist. The API system showed promising results in reducing MRPs.
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Affiliation(s)
- Dorit Dil-Nahlieli
- Department of Research and Development, MDI Health Technologies, Ramat Gan, Israel.
| | - Arie Ben-Yehuda
- Department of Medicine, Hadassah Medical Center Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Eytan Hyam
- Department of Research and Development, MDI Health Technologies, Ramat Gan, Israel
| | - Sigal Shafran-Tikvah
- Nursing Division, Hadassah University Medical Center & Jerusalem College of Technology, Jerusalem, Israel
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Liu S, Zhao Y, Tang X, Yang J, Pan C, Liu C, Han J, Li C, Yi Y, Li Y, Cheng J, Zhang Y, Wang L, Tian J, Wang Y, Wang L, Liang A. In vitro inhibition of six active sesquiterpenoids in zedoary turmeric oil on human liver cytochrome P450 enzymes. JOURNAL OF ETHNOPHARMACOLOGY 2024; 322:117588. [PMID: 38104879 DOI: 10.1016/j.jep.2023.117588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Suyan Liu
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yong Zhao
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Xuan Tang
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Junling Yang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, PR China
| | - Chen Pan
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Chenyue Liu
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Jiayin Han
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Chunying Li
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yan Yi
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yingfei Li
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Jintang Cheng
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yushi Zhang
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Lianmei Wang
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Jingzhuo Tian
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yuan Wang
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Liping Wang
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Aihua Liang
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China.
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Li S, Zheng Y, Long Q, Nong J, Shao H, Liang G, Wu F. Drug-drug interactions between propofol and ART drugs: Inhibiting neuronal activity by affecting glucose metabolism. CNS Neurosci Ther 2024; 30:e14437. [PMID: 37650345 PMCID: PMC10916437 DOI: 10.1111/cns.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The use of two or more drugs carries the potential risk of drug-drug interactions (DDIs), which may result in adverse reactions. Some human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) may require general anesthesia with propofol (PRL) before undergoing surgical treatment. Both PRL and ART drugs may lead to neuronal dysfunction, which can be accompanied by energy metabolism disorders. Neurons take in glucose mainly through glucose transporter 3 (Glut3) which is specifically expressed on the cell membranes of neurons. However, to date, no study has examined whether the DDIs of PRL and ART drugs interfere with glucose metabolism and Glut3 expression in neurons. METHODS An in vitro model was constructed using the primary cultures of neurons. PRL and ART drugs (EFV, AZT, and 3TC), were added at different concentrations (low, medium, and high). The neurons were exposed to the drugs for 1, 4, 8, and 12 h. The optimal drug concentration and exposure time were selected. The cellular survival rate, glucose concentration, electrophysiology, and the expression of Glut3 were detected. RESULTS There were no significant changes in the cellular survival rates of the neurons that were exposed to both PRL and ART drugs at low concentrations for 1 h. However, the survival rates of the neurons decreased significantly as the drug concentrations and durations increased. The glucose concentration of the neurons that were exposed to both PRL and the ART drugs was significantly decreased. The glucose concentration of the neurons was not affected by any individual drug. The amplitude of the action potential and the expression of Glut3 were decreased in the neurons that were exposed to both PRL and ART drugs. CONCLUSIONS The main adverse reactions induced by the DDIs between PRL and the ART drugs were decreased glucose metabolism and neuronal damage, which were caused by inhibiting the expression of Glut3. More importantly, we found that decreases in glucose metabolism predated neuronal damage.
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Affiliation(s)
- Sijun Li
- Department of Internal MedicineThe Fourth People's Hospital of NanningNanningChina
- Infectious Disease LaboratoryThe Fourth People's Hospital of NanningNanningChina
| | - Yanqing Zheng
- Infectious Disease LaboratoryThe Fourth People's Hospital of NanningNanningChina
| | - Qian Long
- Department of Clinical LaboratoryThe Fourth People's Hospital of NanningNanningChina
| | - Jianhong Nong
- Department of AnesthesiologyThe Fourth People's Hospital of NanningNanningChina
| | - Honghua Shao
- Department of Internal MedicineThe Fourth People's Hospital of NanningNanningChina
| | - Gang Liang
- Infectious Disease LaboratoryThe Fourth People's Hospital of NanningNanningChina
| | - Fengyao Wu
- Department of AnesthesiologyThe Fourth People's Hospital of NanningNanningChina
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Dash S, Singh PA, Bajwa N, Choudhury A, Bisht P, Sharma R. Why Pharmacovigilance of Non-steroidal Anti-inflammatory Drugs is Important in India? Endocr Metab Immune Disord Drug Targets 2024; 24:731-748. [PMID: 37855282 DOI: 10.2174/0118715303247469230926092404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/15/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are among the drugs that are most regularly administered to manage inflammation and pain. Over-the-Counter (OTC) NSAIDs are widely accessible, particularly in developing countries like India. This casual approach to using NSAIDs may operate as a magnet for NSAID-related adverse drug reactions (ADRs) among patients. OBJECTIVES As patients in India are less informed about the appropriate use of NSAIDs and consumption patttern, adverse drug reactions, and the importance of reporting ADRs, the current study's objective is to promote patient safety by using pharmacovigilance as a tool to educate patients. METHODS A targeted literature methodology was utilized to gather the data pertaining to NSAIDs, their ADRs and their pharmacovigilance. Different scientific databases, such as Science Direct, PubMed, Wiley Online Library, Springer, and Google Scholar, along with authentic textbooks, were explored as reference literature. RESULTS In general, NSAIDs consumption pattern depends upon the different age groups. Around 1.6 billion tablets of NSAIDs are consumed in India for ailments, such as headaches, arthritis, menstrual cramps, osteoarthritis, back pain, rheumatoid arthritis, gout, osteoporosis, tendinitis, cancer pain and chronic pain. Common ADRs of NSAIDs include nausea, vomiting, headache, gastritis, abdominal pain, and diarrhoea. Also, they can cause renal damage and cardiovascular problems if not consumed in a dose-dependent manner. However, Diclofenac and Ibuprofen have both been linked to depression and dementia. There have been reports of aplastic anaemia, agranulocytosis linked to phenylbutazone, Stevens-Johnson, and Lyell's syndrome linked to isoxicam and piroxicam, as well as the vulnerability of new-borns to Reye's syndrome after aspirin use. Lack of awareness, time constraints and unpredictability, poor training in ADRs identification, etc., are some of the reasons for the under-reporting of ADR of NSAIDs in India. CONCLUSION In order to rationally prescribe NSAIDs, it is essential to be aware of probable ADR's and establish prescription guidelines. Prescribers' behaviour can be changed toward excellent prescribing practices by conducting routine prescription assessments dealing with NSAIDs and providing feedback. In the near future, it will be critical to strengthen ADR data management and expand the reach of pharmacovigilance programs, ADR monitoring centers, and healthcare professionals' especially pharmacists' training in rural locations.
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Affiliation(s)
- Subhransu Dash
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Abinash Choudhury
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preeti Bisht
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Rajiv Sharma
- College of Pharmacy, Desh Bhagat University, Mandi Gobindgarh, Punjab, India
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Yehualaw A, Tafere C, Demsie DG, Feyisa K, Bahiru B, Kefale B, Berihun M, Yilma Z. Determinants t of patient satisfaction with pharmacy services at Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia. Ann Med Surg (Lond) 2023; 85:5885-5891. [PMID: 38098594 PMCID: PMC10718396 DOI: 10.1097/ms9.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/02/2023] [Indexed: 12/17/2023] Open
Abstract
Background Patients have explicit desire for quality services when they visit health institutions. Patient satisfaction is a primary means of measuring the effectiveness of healthcare delivery. However, inadequate discovery of their needs may result in patient dissatisfaction. Patients who are satisfied with pharmaceutical care are likely to adherence, seeking for medical attentions and take medications properly. Providing better access to quality pharmacies is a way to improve patient satisfaction with healthcare services. Study objective The study was aimed to assess patient satisfaction with pharmacy services at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). Methods and materials An institution-based cross-sectional study design was conducted at FHCSH from 1 May 2021 to 30 October 2021. Data were collected by interview with structured questionnaires. Then the data were coded, entered, and then analyzed by SPSS version 23. The association between predictors and outcome was measured using bivariate logistic regression. Result In this study, 384 study participants were included. Majority of the participants were males (55.37%, N=227). The overall satisfaction score of the participants of this study was 65.37%. In our study, clients showed greater satisfaction towards pharmacists' commitment to correct myths (92%), pharmacist availability (88.78), and cleanliness (87.8%). Multivariate analysis indicated physical restriction [adjusted odds ratio (AOR)=6:95%; 95% CI (2.98, 25.9)] and rural residence [AOR=2.43; 95% CI (1.71, 9.6)] had significant association with pharmacy service dissatisfaction. Among the quality pharmacy service indicators, counselling on how medications work [AOR=9; 95% CI (1.48, 8.85)], keeping to dosage regimen [AOR=7.3; 95% CI (5.49, 11.06)], and advice on the current medical condition had greater odds of client dissatisfaction. Conclusion The findings of the current study showed that patients' satisfaction towards outpatient pharmacy services provided by FHCSH is very low as it is indicated in their perception towards revealing written information about medication use, medication availability, medication storage, and instructions about medication side effects.
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Affiliation(s)
| | - Chernet Tafere
- Department of Pharmacy, Bahir Dar University, College of Medicine and Health Sciences, Bahir Dar, Ethiopia
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Alhubail SA, Alharthi MM, Alsayyah FF, Younis NS. Healthcare Professionals and Undergraduate Students' Knowledge Toward Drug-Food Interactions in the Eastern Region of Saudi Arabia. J Multidiscip Healthc 2023; 16:2883-2892. [PMID: 37790990 PMCID: PMC10543414 DOI: 10.2147/jmdh.s419544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Drug and Food Interactions (DFI) arise when particular nutrients in food interact with drugs when consumed concurrently, consequently resulting in alterations in the pharmacokinetics, pharmacodynamics, and therapeutic effectiveness of the drug. This study aimed to evaluate the information and understanding of healthcare providers (HCPs) about common DFI. Methods A cross-sectional study was achieved by a self-administered online-based questionnaire to gather data from HCPs in eastern region of Saudi Arabia between Sep. to Oct. 2022. The questionnaire integrated questions related to HCP demographic features and knowledge of DFI. The DFI section included questions that assessed the general knowledge of DFI and knowledge of specific food and drug interactions. Results A total of 401 participants completed the study questionnaire; 41.4% were undergraduate students, 37.2% were pharmacists, 10.5% were nurses, and 9.5% were doctors. Unfortunately, HCPs are unable to recognize several food types that may interact with medications, which may lead to undesirable consequences associated with an enormous financial burden. For instance, only 27.9% of the HCPs stated that patients on monoamine oxidase inhibitors should avoid cheese. In addition, only approximately 11% of HCPs knew that patients on levothyroxine should avoid cauliflower, those taking digoxin should avoid wheat bran, those taking lithium should avoid cola, and those on heparin should avoid calcium-rich food. Overall knowledge was significantly higher among pharmacists and others HCPs with more than 5 years of experience. Discussion and Conclusion This study demonstrated a low level of knowledge regarding specific food and drug interactions among healthcare providers in the eastern region of Saudi Arabia.
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Affiliation(s)
- Sarah Abdullah Alhubail
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
| | - Mayar Mohammed Alharthi
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
| | - Fadiyah Faisal Alsayyah
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
| | - Nancy S Younis
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
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Dong JY, Ju JH, Yang YM. Analysis of the prescription trends of potentially inappropriate medications in Korean older outpatients by sex: A retrospective study using data from the health insurance review and assessment service. Medicine (Baltimore) 2023; 102:e34818. [PMID: 37653764 PMCID: PMC10470708 DOI: 10.1097/md.0000000000034818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This study aimed to determine the policy implications for drug management by identifying the prescription trends of potentially inappropriate medications (PIMs) in older outpatients. Considering the Drug Utilization Review and Korean version of the standards for PIMs based on the Beers Criteria, 141 ingredients were selected that spanned over 7 years of health insurance claims data analysis. During the study period, the number of patients and claims related to PIMs increased. Although the number of health insurance claims decreased in 2020 owing to coronavirus disease (COVID-19), it increased again in 2021. Tamsulosin was the most frequently prescribed drug for male patients, followed by alprazolam and zolpidem. For female patients, eperisone was the most frequently prescribed drug, followed by alprazolam, zolpidem, and etizolam. In Korea, health insurance claims for PIMs decreased in 2020 owing to the COVID-19 pandemic. However, an overall increasing trend was observed from 2015 to 2021. Moreover, during this period, the prescription trend of benzodiazepine-type drugs and zolpidem increased in both male and female patients. Therefore, management policies regarding PIMs and drug ingredients, such as benzodiazepines and zolpidem, are required.
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Affiliation(s)
- Jae-Yong Dong
- Department of Digital Medical Technology listing, Health Insurance Review and Assessment Service, Wonju, Gangwon-do, Republic of Korea
| | - Jin-Han Ju
- Department of Healthcare System Policy, Health Insurance Review and Assessment Service, Wonju, Gangwon-do, Republic of Korea
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, Republic of Korea
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Bektay MY, Seker Z, Eke HK, Turk HM, Izzettin FV. Comparison of different decision support software programs in perspective of potential drug-drug interactions in the oncology clinic. J Oncol Pharm Pract 2022:10781552221104814. [PMID: 35642275 DOI: 10.1177/10781552221104814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION One of the most intriguing situations for healthcare providers is cancer therapy. Drug-drug interactions (DDIs) account for 20-30% of all adverse effects. Cancer patients are more likely to have potential-DDIs since they are taking other drugs with anticancer treatments to prevent the side effects of chemotherapeutic agents. The purpose of this research is to compare various decision support software (CDSS) programs in terms of potential DDIs. METHODS A cross-sectional study was carried out. A clinical pharmacist assessed the treatment regimens of 231 cancer patients. pDDIs were evaluated using three sources: Lexicomp®, Medscape®, and Micromedex®. The ethical approval was given in November 2017 with decision number 21/286. RESULTS A total of 231 participants who were receiving therapy and had a median age of 61.5 ± 9.18 years were assessed. Almost half of the patients (49%) were female, and 155 had at least one comorbidity in addition to cancer. Medscape had a substantial pDDI ratio of 7.09%, Micromedex had a ratio of 11.15%, and Lexicomp had a ratio of 19.50%. The total number of pDDIs for major/X/contraindicated were 363-2716 (1.56-11.7 pDDI/patient) for Medscape®, 60-1723 (0.26-7.4 pDDI/patient) for Micromedex, and 145-984 (0.62-2.24 pDDI/patient) for Lexicomp®. One of the most common pDDI found was diclofenac and dexamethasone. Interactions between escitalopram and granisetron were also common, and different CDSSs made different recommendations. CONCLUSIONS In this study, significant disparities in the quantity and severity of CDSS across distinct CDSS were discovered. One of the major finding of our study was suboptimal prescribing. To address this issue, regulatory organizations should establish and verify validation and reporting mechanisms.
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Affiliation(s)
- Muhammed Yunus Bektay
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey.,Department of Clinical Pharmacy, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Zehra Seker
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
| | - Hatice Kubra Eke
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Haci Mehmet Turk
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fikret Vehbi Izzettin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
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Goncuoglu C, Guven GS, Sener B, Demirkan K. Effect of gastric acid suppression on Clostridioides difficile-induced diarrhea and appropriateness of gastric acid suppressors in hospitalized patients: A matched case-control study. Arab J Gastroenterol 2021; 22:292-296. [PMID: 34531136 DOI: 10.1016/j.ajg.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/05/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND STUDY AIMS The effects of gastric acid suppressors (GASs) on Clostridioides difficile infection remain controversial. Moreover, studies have shown that GASs are overused. This study was designed to evaluate the effects of GAS use on the risk of C. difficile-induced diarrhea (CDID) development and to investigate the appropriate use of GASs. PATIENTS AND METHODS In this observational case-control study, patients hospitalized between January 2010 and December 2016 who had diarrhea after 3 days of hospitalization were included. The study (n = 122) and control (n = 122) groups were matched according to the patients' hospitalization dates and departments. RESULTS No significant difference in CDID development was observed between the study and control groups. However, GAS use was excessive in the study and control groups (usage rates were 90.2% and 91.8%, respectively) (p > 0.05). Most proton pump inhibitors and histamine-2 receptor antagonists were used without an appropriate indication. Surprisingly, the use of nonsteroidal anti-inflammatory drugs for 7 days and longer showed a significant difference between the study and control groups (p < 0.05). Additionally, significant differences in enteral feeding, oral nutritional support products, carbapenem, penicillin, glycopeptide antibiotics, antifungals, hypoalbuminemia, and increased leukocyte levels were observed between the study and control groups (p < 0.05). CONCLUSION A significant difference in CDID development was not detected. The use of non-steroidal anti-inflammatory drugs for 7 days and longer was a risk factor for CDID development. Additionally, an excessive inappropriate use of GASs was observed. Clinicians should be cautious of all these factors, which may increase the risk of CDID development.
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Affiliation(s)
- Cansu Goncuoglu
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, P.O. Box 06100, Sıhhiye, Ankara, Turkey.
| | - Gulay Sain Guven
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, P.O. Box 06100, Sıhhiye, Ankara, Turkey
| | - Burcin Sener
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, P.O. Box 06100, Sıhhiye, Ankara, Turkey
| | - Kutay Demirkan
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, P.O. Box 06100, Sıhhiye, Ankara, Turkey
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Hernández-Rodríguez MÁ, Sempere-Verdú E, Vicens-Caldentey C, González-Rubio F, Miguel-García F, Palop-Larrea V, Orueta-Sánchez R, Esteban-Jiménez Ó, Sempere-Manuel M, Arroyo-Aniés MP, Fernández-San José B, de Juan-Roldán JI, Ioakeim-Skoufa I. Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094754. [PMID: 33946914 PMCID: PMC8125508 DOI: 10.3390/ijerph18094754] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
We aimed to identify and compare medication profiles in populations with polypharmacy between 2005 and 2015. We conducted a cross-sectional study using information from the Computerized Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP, Spain). We estimated the prevalence of therapeutic subgroups in all individuals 15 years of age and older with polypharmacy (≥5 drugs during ≥6 months) using the Anatomical Therapeutic Chemical classification system level 4, by sex and age group, for both calendar years. The most prescribed drugs were proton-pump inhibitors (PPIs), statins, antiplatelet agents, benzodiazepine derivatives, and angiotensin-converting enzyme inhibitors. The greatest increases between 2005 and 2015 were observed in PPIs, statins, other antidepressants, and β-blockers, while the prevalence of antiepileptics was almost tripled. We observed increases in psychotropic drugs in women and cardiovascular medications in men. By patient´s age groups, there were notable increases in antipsychotics, antidepressants, and antiepileptics (15–44 years); antidepressants, PPIs, and selective β-blockers (45–64 years); selective β-blockers, biguanides, PPIs, and statins (65–79 years); and in statins, selective β-blockers, and PPIs (80 years and older). Our results revealed important increases in the use of specific therapeutic subgroups, like PPIs, statins, and psychotropic drugs, highlighting opportunities to design and implement strategies to analyze such prescriptions’ appropriateness.
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Affiliation(s)
- Miguel Ángel Hernández-Rodríguez
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Dirección del Servicio Canario de la Salud, Plan de Salud de Canarias, ES-38004 Santa Cruz de Tenerife, Spain
- Correspondence: (M.Á.H.-R.); (I.I.-S.)
| | - Ermengol Sempere-Verdú
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud de Paterna, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, ES-46980 Valencia, Spain
| | - Caterina Vicens-Caldentey
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud Son Serra-La Vileta, Servicio de Salud de las Islas Baleares Ib-salut, ES-07013 Palma, Spain
- Institut d’Investigació Sanitaria Illes Balears (IDISBA), Servicio de Salud de las Islas Baleares Ib-salut, ES-07120 Palma de Mallorca, Spain
| | - Francisca González-Rubio
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud Delicias Sur, Servicio Aragonés de Salud, ES-50009 Zaragoza, Spain
- EpiChron Research Group on Chronic Diseases, Aragon Health Research Institute (IIS Aragón), ES-50009 Zaragoza, Spain
| | - Félix Miguel-García
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Ministerio de Sanidad, Consumo y Bienestar Social, ES-28014 Madrid, Spain
| | - Vicente Palop-Larrea
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Hospital de Denia. Marina Salud, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, ES-03700 Alicante, Spain
| | - Ramón Orueta-Sánchez
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud de Sillería, Servicio de Salud de Castilla-La Mancha, ES-45001 Toledo, Spain
| | - Óscar Esteban-Jiménez
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud de Sádaba, Servicio Aragonés de Salud, ES-50670 Zaragoza, Spain
| | - Mara Sempere-Manuel
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud de Sueca, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, ES-46410 Valencia, Spain
| | - María Pilar Arroyo-Aniés
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud de Huarte, Servicio Navarro de Salud, ES-31620 Pamplona, Spain
| | - Buenaventura Fernández-San José
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Centro de Salud de Canalejas, Servicio Canario de la Salud, ES-35004 Las Palmas de Gran Canaria, Spain
| | - José Ignacio de Juan-Roldán
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, ES-29010 Málaga, Spain
| | - Ignatios Ioakeim-Skoufa
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain; (E.S.-V.); (C.V.-C.); (F.G.-R.); (F.M.-G.); (V.P.-L.); (R.O.-S.); (Ó.E.-J.); (M.S.-M.); (M.P.A.-A.); (B.F.-S.J.); (J.I.d.J.-R.)
- EpiChron Research Group on Chronic Diseases, Aragon Health Research Institute (IIS Aragón), ES-50009 Zaragoza, Spain
- Vaksinasjonssenter BSN, Bydel Søndre Nordstrand, Oslo kommune, NO-1252 Oslo, Norway
- Correspondence: (M.Á.H.-R.); (I.I.-S.)
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Drug-Drug Interactions and Prescription Appropriateness in Patients with COVID-19: A Retrospective Analysis from a Reference Hospital in Northern Italy. Drugs Aging 2020; 37:925-933. [PMID: 33150470 PMCID: PMC7641655 DOI: 10.1007/s40266-020-00812-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
Background Patients hospitalised with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2; coronavirus 2019 disease (COVID-19)] infection are frequently older with co-morbidities and receiving polypharmacy, all of which are known risk factors for drug–drug interactions (DDIs). The pharmacological burden may be further aggravated by the addition of treatments for COVID-19. Objective The aim of this study was to assess the risk of potential DDIs upon admission and during hospitalisation in patients with COVID-19 treated at our hospital. Methods We retrospectively analysed 502 patients with COVID-19 (mean age 61 ± 16 years, range 15–99) treated at our hospital with a proven diagnosis of SARS-CoV-2 infection hospitalised between 21 February and 30 April 2020 and treated with at least two drugs. Results Overall, 68% of our patients with COVID-19 were exposed to at least one potential DDI, and 55% were exposed to at least one potentially severe DDI. The proportion of patients experiencing potentially severe DDIs increased from 22% upon admission to 80% during hospitalisation. Furosemide, amiodarone and quetiapine were the main drivers of potentially severe DDIs upon admission, and hydroxychloroquine and particularly lopinavir/ritonavir were the main drivers during hospitalisation. The majority of potentially severe DDIs carried an increased risk of cardiotoxicity. No potentially severe DDIs were identified in relation to tocilizumab and remdesivir. Conclusions Among hospitalised patients with COVID-19, concomitant treatment with lopinavir/ritonavir and hydroxychloroquine led to a dramatic increase in the number of potentially severe DDIs. Given the high risk of cardiotoxicity and the scant and conflicting data concerning their efficacy in treating SARS-CoV-2 infection, the use of lopinavir/ritonavir and hydroxychloroquine in patients with COVID-19 with polypharmacy needs to be carefully considered.
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Martocchia A, Spuntarelli V, Aiello F, Meccariello AL, Proietta M, Del Porto F, Di Rosa R, Salemi S, Rocchietti March M, Laganà B, Martelletti P, Sesti G. Using INTERCheck ® to Evaluate the Incidence of Adverse Events and Drug-Drug Interactions in Out- and Inpatients Exposed to Polypharmacy. Drugs Real World Outcomes 2020; 7:243-249. [PMID: 32346839 PMCID: PMC7392968 DOI: 10.1007/s40801-020-00193-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Polypharmacy exposes patients with comorbidities (particularly elderly patients) to an increased risk of drug-specific adverse events and drug–drug interactions. These adverse events could be avoided with the use of a computerized prescription support system in the primary care setting. The INTERCheck® software is a prescription support system developed with the aim of balancing the risks and benefits of polytherapy and examining drug–drug interactions. Objectives This observational study used the INTERCheck® software to evaluate the incidence of adverse events and of drug–drug interactions in outpatients and inpatients receiving multiple medications. Methods Patients were randomly enrolled from the outpatient department (n = 98) and internal medicine ward (n = 46) of S. Andrea Hospital of Rome. Polypharmacological treatment was analyzed using INTERCheck® software, and the prevalence of risk indicators and adverse events was compared between the two groups. Results Polypharmacy (use of five or more drugs) applied to all except three cases among outpatients and one case among inpatients. A significant positive correlation was found between the number of medications and the INTERCheck® score (ρ = 0.67; p < 0.000001), and a significant negative correlation was found between the drug-related anticholinergic burden and cognitive impairment (r = − 0.30 p = 0.01). Based on the INTERCheck® analysis, inpatients had a higher score for class D (contraindicated drug combination should be avoided) than did outpatients (p = 0.01). The potential class D drug–drug interactions were associated with adverse events that caused hospitalization (χ2 = 7.428, p = 0.01). Conclusions INTERCheck® analysis indicated that inpatients had a high risk of drug–drug interactions and a high percentage of related adverse drug events. Further prospective studies are necessary to evaluate whether the INTERCheck® software may help reduce polypharmacy-related adverse events when used in a primary care setting and thus potentially avoid related hospitalization and severe complications such as physical and cognitive decline.
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Affiliation(s)
- Antonio Martocchia
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Valerio Spuntarelli
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Francesco Aiello
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Anna Laura Meccariello
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Maria Proietta
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Flavia Del Porto
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Roberta Di Rosa
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Simonetta Salemi
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | | | - Bruno Laganà
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Paolo Martelletti
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Giorgio Sesti
- Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
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Ribaldone DG, Astegiano M, Actis GC, Pellicano R. Management of inflammatory bowel disease during COVID-19 pandemic. MINERVA GASTROENTERO 2020; 66:184-186. [PMID: 32327626 DOI: 10.23736/s1121-421x.20.02707-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Davide G Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Marco Astegiano
- Unit of Gastroenterology, Molinette-SGAS Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette-SGAS Hospital, Città della Salute e della Scienza, Turin, Italy
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Stillhart C, Vučićević K, Augustijns P, Basit AW, Batchelor H, Flanagan TR, Gesquiere I, Greupink R, Keszthelyi D, Koskinen M, Madla CM, Matthys C, Miljuš G, Mooij MG, Parrott N, Ungell AL, de Wildt SN, Orlu M, Klein S, Müllertz A. Impact of gastrointestinal physiology on drug absorption in special populations––An UNGAP review. Eur J Pharm Sci 2020; 147:105280. [DOI: 10.1016/j.ejps.2020.105280] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
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