1
|
Lule AP, Delic OB, Katunguka K, Muwonge F, Yadesa TM. Prevalence and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city, southwestern Uganda. BMC Pharmacol Toxicol 2024; 25:2. [PMID: 38167526 PMCID: PMC10763418 DOI: 10.1186/s40360-023-00719-1] [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: 03/28/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Drug-drug interactions (DDIs) influence the effectiveness of medication and thus determine the treatment outcomes of diseases managed with pharmacotherapy. This study aimed to determine the prevalence, severity, and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city. METHODS DDIs were identified and classified basing on risk and severity using Lexicomp drug interaction database. STATA version 13 was used to analyze the collected data. Descriptive statistics were used to summarize the severity of potential DDIs identified. Bivariate and multivariate logistic regression was employed to identify different factors associated with the presence of potential DDIs. RESULTS A total of 295 prescriptions from 18 private pharmacies were studied and the prevalence of clinically significant potential DDIs was 37.6%. About half (149, 50.5%) of the patients were females, the majority (199, 67.5%) were adults 18-59 years of age whereas most (208, 70.5%) had a comorbid condition. Over one half (162, 54.9%) of the prescriptions were received from hospitals and majority of the prescriptions had 4 drugs prescribed (n = 175, 59.32%). Having one or more comorbidities and prescribing of therapeutic drug categories including anti-fungal, antihypertensives, analgesics, or corticosteroids were significantly associated with potential DDIs. CONCLUSIONS The prevalence of potential drug-drug interactions in outpatient setting in Mbarara city was high and majority of the potential DDIs were of moderate severity. Having 1 or more comorbidities and prescribing of therapeutic drug categories including antifungals, antihypertensives, analgesics, or corticosteroids were significantly associated with potential DDIs.
Collapse
Affiliation(s)
- Allan Phillip Lule
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda.
| | - Ogwal Basil Delic
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
| | - Keneth Katunguka
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
| | - Francis Muwonge
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
- Department of Clinical Pharmacy and Pharmacy Practice, Kampala International University, Ishaka, Uganda
| |
Collapse
|
2
|
Chisholm BS, Swart AM, Blockman M. South African healthcare workers' knowledge of dolutegravir's drug-drug interactions in the first year of its rollout: a cross-sectional online survey. J Int AIDS Soc 2022; 25:e25885. [PMID: 35255196 PMCID: PMC8901146 DOI: 10.1002/jia2.25885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction In December 2019, dolutegravir‐based treatment was recommended as first‐line antiretroviral therapy (ART) in South Africa. Dolutegravir has clinically significant interactions with several commonly used drugs, such as rifampicin, metformin and cation‐containing medicines. National guidelines detail these interactions and how to manage them. While previous international studies have shown low healthcare worker knowledge of drug–drug interactions, there is a paucity of information on antiretroviral interaction knowledge in the South African setting, where much ART is nurse‐led. The study aimed to determine this knowledge and to describe which variables were associated with gaps in knowledge. Methods An anonymous online survey of healthcare workers in the field of HIV was conducted in August/September 2020. The survey was designed, tested and piloted, and included sections on demographics, guideline access and training, interaction knowledge, counselling and the effect of COVID‐19. Dissemination was via e‐mail and social media (convenience sampling). Descriptive and inferential analysis was done using proportions and the 95% confidence interval to determine relationships between independent and dependent variables. Research ethics approval was obtained from the University of Cape Town's Human Research Ethics Committee (HREC Ref: 357/2020). Results and discussion In total, 1950 survey responses were included in the analysis – 47.1% nurses, 35.8% doctors and 8.9% pharmacists. When asked whether they were aware that dolutegravir has interactions, 70% said yes, 13.9% said no and 16.1% did not answer. Knowledge of specific interactions and the dosing changes needed was low with a wide range between different drugs: 79.7% knew to double the dolutegravir dose with rifampicin, but with calcium, 5.1% picked both correct dosing options and 33.7% picked one of the two correct options. Access to guidelines and training were positively associated with drug interaction knowledge. Conclusions There are gaps in the awareness and knowledge of dolutegravir interactions and how to adjust dosing among South African healthcare workers.
Collapse
Affiliation(s)
- Briony S Chisholm
- Division of Clinical Pharmacology, National HIV and TB Healthcare Worker Hotline, Medicines Information Centre, University of Cape Town, Cape Town, South Africa
| | - Annoesjka M Swart
- Division of Clinical Pharmacology, National HIV and TB Healthcare Worker Hotline, Medicines Information Centre, University of Cape Town, Cape Town, South Africa
| | - Marc Blockman
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
3
|
Yeşilbağ Z, Şengül Eİ, Şenoğlu S, Aydın ÖA, Karaosmanoğlu HK. Co-medications and Drug-Drug Interactions in People Living with HIV in Turkey in the Era of Integrase Inhibitors. Curr HIV Res 2020; 18:415-425. [PMID: 32787762 DOI: 10.2174/1574885515666200812215140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Long life expectancy in people living with human immunodeficiency virus (PLWH) caused an increase in comorbidities and co-medications. We aimed to analyse comedications and drug-drug interactions (DDIs) in antiretroviral therapy (ART)-naive PLWH in the era of integrase inhibitors. METHODS A retrospective observational study was conducted between January 2016-August 2019. Patients' characteristics and chronic co-medications were recorded. The University of Liverpool HIV drug interaction database was used for DDIs. RESULTS Among 745 patients, the chronic co-medication rate was 30.9%. Older age (p<0.001, OR:6.66, 95% CI: 3.86-11.49) and female gender (p=002, OR:2.25, 95%:1.14-4.44) were independently associated with co-medication. Cardiovascular system (CVS) and central nervous system (CNS) drugs were the most common co-medications. Older age patients (p<0.001, OR:12.04, 95% CI:4.63-36.71), having heterosexual (HS) contact (p=0.003, OR:3.8, 95% CI:1.57-9.22) were independently associated with CVS drugs use, while being men who have sex with men (MSM) (p=0.03, OR:2.59, 95% CI:1.11-6.03) were associated with CNS drugs use. DDIs were seen in 37.4% of patients with co-medications. Antidiabetics (23.3%), CNS (22.1%) and CVS drugs (19.8%) most commonly had DDIs. Contraindication was most commonly seen between inhaled corticosteroids and elvitegravir/cobicistat. A number of non-ART drugs, elvitegravir/cobicistat, antidiabetics, vitamins were independently associated with the presence of DDIs. CONCLUSION Results suggested the need for attention about co-medication in PLWH regardless of whether they are young or older. CNS drugs should be questioned more detailed in MSM, as well as CVS drugs in older HS patients. Elvitegravir/cobicistat is significantly associated with DDIs and switching to an unboosted INSTI should be considered in patients with multiple comorbidities.
Collapse
Affiliation(s)
- Zuhal Yeşilbağ
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Emine İlay Şengül
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sevtap Şenoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Özlem Altuntaş Aydın
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Eneh PC, Hullsiek KH, Kiiza D, Rhein J, Meya DB, Boulware DR, Nicol MR. Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda. BMC Infect Dis 2020; 20:572. [PMID: 32758158 PMCID: PMC7405463 DOI: 10.1186/s12879-020-05296-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of potential DDIs (pDDIs) in hospitalized HIV patients presenting with suspected cryptococcal or tuberculous meningitis. Methods In a retrospective review of three cryptococcal meningitis trials between 2010 and 2017 in Kampala, Uganda, medications received over hospitalization were documented and pDDI events were assessed. IBM Micromedex DRUGDEX® online drug reference system was used to identify and describe potential interactions as either contraindicated, major, moderate or minor. For antiretroviral DDIs, the Liverpool Drug Interactions Checker from the University of Liverpool was also used to further describe interactions observed. Results In 1074 patients with suspected meningitis, pDDIs were present in 959 (overall prevalence = 89.3%) during the analyzed 30 day window. In total, 278 unique interacting drug pairs were identified resulting in 4582 pDDI events. Of all patients included in this study there was a mean frequency of 4.27 pDDIs per patient. Of the 4582 pDDI events, 11.3% contraindicated, 66.4% major, 17.4% moderate and 5% minor pDDIs were observed. Among all pDDIs identified, the most prevalent drugs implicated were fluconazole (58.4%), co-trimoxazole (25.7%), efavirenz (15.6%) and rifampin (10.2%). Twenty-one percent of the contraindicated pDDIs and 27% of the major ones involved an antiretroviral drug. Increased likelihood of QT interval prolongation was the most frequent potential clinical outcome. Dissonance in drug interaction checkers was noted requiring clinicians to consult more than one database in making clinical decisions about drug combinations. Conclusions The overall prevalence of pDDIs in this population is high. An understanding of drug combinations likely to result in undesired clinical outcomes, such as QT interval prolongation, is paramount. This is especially important in resource limited settings where availability of therapeutic drug monitoring and laboratory follow-up are inconsistent. Adequate quantification of the increased likelihood of adverse clinical outcomes from multiple drug-drug interactions of the same kind in a single patient is needed to aid clinical decisions in this setting.
Collapse
Affiliation(s)
- Prosperity C Eneh
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | | | - Daniel Kiiza
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Joshua Rhein
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - David B Meya
- Infectious Disease Institute, Makerere University, Kampala, Uganda.,Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - David R Boulware
- Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Melanie R Nicol
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
5
|
Xia H, Gao L, Gong X, Zaongo SD, Zhang T, Wu H, Ma P, Huang X. The Challenge of Potential Drug-Drug Interactions Among People Living With HIV on Antiretroviral Therapy: A Cross-Sectional Study in Selected Provinces in China. Front Pharmacol 2020; 11:800. [PMID: 32536872 PMCID: PMC7266979 DOI: 10.3389/fphar.2020.00800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Potential drug–drug interactions (DDIs) are a significant therapeutic threat among human immunodeficiency virus (HIV)-positive individuals on antiretroviral (ARV) medications. DDIs involving ARV drugs in mainland China are unknown and insufficiently described. Herein, we investigated the prevalence and frequencies of potential ARV DDIs in Chinese people living with HIV (PLWH), then we assessed the risk factors associated with potential DDIs. Methods This study was conducted with HIV-positive adults undergoing ARV medications from multiple centers across China. The latest prescription of each participant was evaluated for potential DDIs using the Liverpool HIV drug interaction database. Multivariable logistic regressions were used to evaluate the factors associated with DDIs. Results Among 600 PLWH recruited, at least one non-HIV co-medication was observed in 511 (85.2%) individuals. A total of 2566 DDIs were identified, of which 11 (0.43%) and 311 (12.89%) were of contraindicated (red-flags) and dosage/timing adjustment required (orange-flags), respectively. Multivariate regression analysis revealed a higher risk of clinically significant DDIs (red- and orange-flagged comedication) associated with: the use of boosted protease inhibitors (p < 0.0001), boosted integrase strand transfer inhibitors (p < 0.0001), and non-nucleoside reverse transcriptase inhibitors-based ARV regimen (p < 0.0001); or the use of antiinfectives for systemic use (p < 0.0001), cardiovascular system drugs (p < 0.0001), nervous system drugs (p < 0.0001), fungal infection (p = 0.0071), and Herpes simplex virus infection (p = 0.0231). Conclusions Potential DDIs and inappropriate medications constitute a burden for people living with HIV in China. The knowledge of DDIs patterns and the scan for DDIs is crucial. Indeed, they can help to prevent drug-related adverse outcomes in such immunodeficient population.
Collapse
Affiliation(s)
- Huan Xia
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Liying Gao
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Xiaowen Gong
- Department of Biostatistics, Tianjin Medical University, Tianjin, China
| | - Silvere D Zaongo
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China.,International School of Medicine, Tianjin Medical University, Tianjin, China
| | - Tong Zhang
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ping Ma
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Xiaojie Huang
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Schlaeppi C, Vanobberghen F, Sikalengo G, Glass TR, Ndege RC, Foe G, Kuemmerle A, Paris DH, Battegay M, Marzolini C, Weisser M. Prevalence and management of drug-drug interactions with antiretroviral treatment in 2069 people living with HIV in rural Tanzania: a prospective cohort study. HIV Med 2020; 21:53-63. [PMID: 31532898 PMCID: PMC6916175 DOI: 10.1111/hiv.12801] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Widespread access to antiretroviral therapy (ART) has substantially increased life expectancy in sub-Saharan African countries. As a result, the rates of comorbidities and use of co-medications among people living with HIV are increasing, necessitating a sound understanding of drug-drug interactions (DDIs). We aimed to assess the prevalence and management of DDIs with ART in a rural Tanzanian setting. METHODS We included consenting HIV-positive adults initiating ART in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) between January 2013 and December 2016. DDIs were classified using www.hiv-druginteractions.org as red (contra-indicated), amber (potential clinical relevance requiring dosage adjustment/monitoring), yellow (weak clinical significance unlikely to require further management) or green (no interaction). We assessed management of amber DDIs by evaluating monitoring of laboratory or clinical parameters, or changes in drug dosages. RESULTS Of 2069 participants, 1945 (94%) were prescribed at least one co-medication during a median follow-up of 1.8 years. Of these, 645 (33%) had at least one potentially clinically relevant DDI, with the highest grade being red in nine (< 1%) and amber in 636 (33%) participants. Of the 23 283 prescriptions, 19 (< 1%) and 1745 (7%) were classified as red and amber DDIs, respectively. Overall, 351 (2%) prescriptions were red DDIs or not appropriately managed amber DDIs. CONCLUSIONS Co-medication use was common in this rural sub-Saharan cohort. A third of participants had DDIs requiring further management. Of the 9% of participants with not appropriately managed DDIs, most were with cardiovascular and analgesic drugs. This highlights the importance of physicians' awareness of DDIs for their recognition and management.
Collapse
Affiliation(s)
- C Schlaeppi
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - F Vanobberghen
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - G Sikalengo
- Ifakara Health InstituteIfakaraTanzania
- St Francis Referral HospitalIfakaraTanzania
| | - TR Glass
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - RC Ndege
- Ifakara Health InstituteIfakaraTanzania
- St Francis Referral HospitalIfakaraTanzania
| | - G Foe
- St Francis Referral HospitalIfakaraTanzania
| | - A Kuemmerle
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - DH Paris
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - M Battegay
- University of BaselBaselSwitzerland
- Division of Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| | - C Marzolini
- University of BaselBaselSwitzerland
- Division of Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
- Department of Molecular and Clinical PharmacologyInstitute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | - M Weisser
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
- Ifakara Health InstituteIfakaraTanzania
- Division of Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| |
Collapse
|
7
|
Marzolini C, Rajoli R, Battegay M, Elzi L, Back D, Siccardi M. Physiologically Based Pharmacokinetic Modeling to Predict Drug-Drug Interactions with Efavirenz Involving Simultaneous Inducing and Inhibitory Effects on Cytochromes. Clin Pharmacokinet 2017; 56:409-420. [PMID: 27599706 DOI: 10.1007/s40262-016-0447-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antiretroviral drugs are among the therapeutic agents with the highest potential for drug-drug interactions (DDIs). In the absence of clinical data, DDIs are mainly predicted based on preclinical data and knowledge of the disposition of individual drugs. Predictions can be challenging, especially when antiretroviral drugs induce and inhibit multiple cytochrome P450 (CYP) isoenzymes simultaneously. METHODS This study predicted the magnitude of the DDI between efavirenz, an inducer of CYP3A4 and inhibitor of CYP2C8, and dual CYP3A4/CYP2C8 substrates (repaglinide, montelukast, pioglitazone, paclitaxel) using a physiologically based pharmacokinetic (PBPK) modeling approach integrating concurrent effects on CYPs. In vitro data describing the physicochemical properties, absorption, distribution, metabolism, and elimination of efavirenz and CYP3A4/CYP2C8 substrates as well as the CYP-inducing and -inhibitory potential of efavirenz were obtained from published literature. The data were integrated in a PBPK model developed using mathematical descriptions of molecular, physiological, and anatomical processes defining pharmacokinetics. Plasma drug-concentration profiles were simulated at steady state in virtual individuals for each drug given alone or in combination with efavirenz. The simulated pharmacokinetic parameters of drugs given alone were compared against existing clinical data. The effect of efavirenz on CYP was compared with published DDI data. RESULTS The predictions indicate that the overall effect of efavirenz on dual CYP3A4/CYP2C8 substrates is induction of metabolism. The magnitude of induction tends to be less pronounced for dual CYP3A4/CYP2C8 substrates with predominant CYP2C8 metabolism. CONCLUSION PBPK modeling constitutes a useful mechanistic approach for the quantitative prediction of DDI involving simultaneous inducing or inhibitory effects on multiple CYPs as often encountered with antiretroviral drugs.
Collapse
Affiliation(s)
- Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Division of Infectious Diseases and Hospital Epidemiology, Department of Clinical Research, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Rajith Rajoli
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Department of Clinical Research, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Luigia Elzi
- Division of Infectious Diseases, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - David Back
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Marco Siccardi
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
8
|
Reeves D, Lovering A, Thomson A. Therapeutic drug monitoring in the past 40 years of the Journal of Antimicrobial Chemotherapy. J Antimicrob Chemother 2017; 71:3330-3332. [PMID: 27856702 DOI: 10.1093/jac/dkw408] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Since the Journal of Antimicrobial Chemotherapy was first published in 1975, papers addressing therapeutic drug monitoring (TDM) have been a regular feature. Initially they focused on laboratory aspects of drug concentration measurement then they changed more to the application of TDM in a clinical setting. Over its history, the Journal has provided its readership with the latest technological and scientific advances in TDM and has helped to drive changes in TDM that have directly impacted on patient care. These have varied from improvement in the quality of antimicrobial measurements through better identification of dosage regimens and TDM targets that help predict outcome and adverse events. Despite these advances in our understanding of the science and practice of TDM, there remain many areas of uncertainty. As we move into the next 40 years, it is clear that the Journal will continue to provide the readership with the latest science and opinion in this important area.
Collapse
Affiliation(s)
- David Reeves
- Antimicrobial Reference Laboratory, Severn Infection Sciences Partnership, Southmead Hospital, Bristol BS10 5NB, UK
| | - Andrew Lovering
- Antimicrobial Reference Laboratory, Severn Infection Sciences Partnership, Southmead Hospital, Bristol BS10 5NB, UK
| | - Alison Thomson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| |
Collapse
|
9
|
Seden K, Gibbons S, Marzolini C, Schapiro JM, Burger DM, Back DJ, Khoo SH. Development of an evidence evaluation and synthesis system for drug-drug interactions, and its application to a systematic review of HIV and malaria co-infection. PLoS One 2017; 12:e0173509. [PMID: 28334018 PMCID: PMC5363796 DOI: 10.1371/journal.pone.0173509] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/21/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In all settings, there are challenges associated with safely treating patients with multimorbidity and polypharmacy. The need to characterise, understand and limit harms resulting from medication use is therefore increasingly important. Drug-drug interactions (DDIs) are prevalent in patients taking antiretrovirals (ARVs) and if unmanaged, may pose considerable risk to treatment outcome. One of the biggest challenges in preventing DDIs is the substantial gap between theory and clinical practice. There are no robust methods published for formally assessing quality of evidence relating to DDIs, despite the diverse sources of information. We defined a transparent, structured process for developing evidence quality summaries in order to guide therapeutic decision making. This was applied to a systematic review of DDI data with considerable public health significance: HIV and malaria. METHODS AND FINDINGS This was a systematic review of DDI data between antiretrovirals and drugs used in prophylaxis and treatment of malaria. The data comprised all original research in humans that evaluated pharmacokinetic data and/or related adverse events when antiretroviral agents were combined with antimalarial agents, including healthy volunteers, patients with HIV and/or malaria, observational studies, and case reports. The data synthesis included 36 articles and conference presentations published via PubMed and conference websites/abstract books between 1987-August 2016. There is significant risk of DDIs between HIV protease inhibitors, or NNRTIs and artemesinin-containing antimalarial regimens. For many antiretrovirals, DDI studies with antimalarials were lacking, and the majority were of moderate to very low quality. Quality of evidence and strength of recommendation categories were defined and developed specifically for recommendations concerning DDIs. CONCLUSIONS There is significant potential for DDIs between antiretrovirals and antimalarials. The application of quality of evidence and strength of recommendation criteria to DDI data is feasible, and allows the assessment of DDIs to be robust, consistent, transparent and evidence-based.
Collapse
Affiliation(s)
- Kay Seden
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Sara Gibbons
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | | | - David M. Burger
- Department of Pharmacy & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David J. Back
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Saye H. Khoo
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
10
|
Hahn M, Roll SC. Dosing Recommendations of Aripiprazole Depot with Strong Cytochrome P450 3A4 Inhibitors: A Relapse Risk. DRUG SAFETY - CASE REPORTS 2016; 3:5. [PMID: 27747685 PMCID: PMC5005780 DOI: 10.1007/s40800-016-0027-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 50-year-old male patient with comorbid human immunodeficiency virus developed a relapse of bipolar disorder after a switch from oral aripiprazole 10 mg/day to intramuscular aripiprazole depot 200 mg every 28 days plus oral aripiprazole 5 mg/day. The patient was concomitantly taking lopinavir, saquinavir, ritonavir, silybum marianum extract, and omeprazole. Only 1 week after the switch, the patient developed mood swings, irritability, depressive mood, and lack of drive. The oral aripiprazole was increased again to stabilize the patient. The measured trough drug concentration of aripiprazole was low and may be correlated to the relapse. When oral aripiprazole was increased back to 10 mg again, the depressive symptoms subsided. The dose of the next depot injection was increased to 300 mg and that of oral aripiprazole decreased back to 5 mg/day. Because trough drug concentrations were still low after 28 days, the depot dose was increased to 400 mg every 28 days, which is double that recommended in the prescriber’s information. Two months after the initial switch from oral to intramuscular aripiprazole, the patient’s mood stabilized on aripiprazole depot 400 mg every 28 days. More clinical data, especially regarding the pharmacokinetic drug interactions of aripiprazole depot are needed to improve dosing recommendations, and prevent relapses or adverse drug events. Genetic polymorphisms may play an important role in the clinical relevance of drug interactions concerning aripiprazole depot.
Collapse
Affiliation(s)
- Martina Hahn
- Vitos Klinik Eichberg, Kloster-Eberbach-Str. 4, Eltville, 65346, Germany.
| | - Sibylle C Roll
- Vitos Klinik Eichberg, Kloster-Eberbach-Str. 4, Eltville, 65346, Germany
| |
Collapse
|