Drug interactions with oral antineoplastic drugs: The role of the pharmacist

Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards

PURPOSE

To update the ASCO-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location.

METHODS

ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript.

RESULTS

The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification.

STANDARDS

Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.Additional information is available at www.asco.org/standards and www.ons.org/onf.

Assessing the Indicators of Good Pharmacy Practice in Community Pharmacies: A Cross-Sectional Study

To evaluate the extent to which pharmacies in Hetauda Sub-metropolitan City, Nepal adhere to the recommended practices outlined in the good pharmacy practice guidelines formulated by International Pharmaceutical Federation and draft developed by Nepal Pharmacy Council. Good Pharmacy Practice evaluates the safety, effectiveness, availability, and accessibility of medicines, ensuring their correct usage which is essential component of community pharmacies. Data was collected by visiting community pharmacies throughout Hetauda sub-metropolitan city. The questionnaire includes 38 questions under 9 sections: premises, personnel, quality policy, services, documentation, procurement, storage, prescription handling, and dispensing. Frequencies and percentages were used to represent all categorical variables, while mean ± standard deviation (SD) was used to represent continuous variables. To determine relationships between categorical data, the Pearson Chi-square test (χ²) was utilized with a significance level set at P < .05. Using SPSS Version 23, the quantitative data were analyzed. The findings indicated an overall compliance rate of 56.21% with the GPP indicators. The lowest adherence was observed in relation to the quality policy (11.02%), whereas the highest was obtained on the procurement process (86.6%). With regard to the qualifications of the pharmacy in charge, only 16.3% of the pharmacies had a pharmacist holding a bachelor's degree, while 32.6% employed an assistant pharmacist with a diploma degree. A significant association was found between the qualification of pharmacy in charge with availability of computer (P = .010), safe and effective procurement (P = .036), keeping narcotics drugs in lock and key system (P = .002) and maintaining records of narcotics (P = .020). Our findings reveal that community pharmacists in Hetauda Sub-metropolitan city, Nepal do not meet the standards set by International Pharmaceutical Federation and the Good Pharmacy Practice guidelines formulated by the Nepal Pharmacy Council.

Potential Drug Interactions in Hospitalized Hematologic Cancer Patients: New Update with New Chemotherapy Regimens

Objective

This cross-sectional study aimed to assess the frequency of potential drug-drug interactions (DDIs) and demographic correlates of moderate and major DDIs among patients with hematologic cancer at a referral hematology hospital in Iran.

Methods

In this study, for 6 months, all patients suffering from hematologic cancers admitted to the tertiary oncology hospital, Omid, Isfahan, were considered. Data from all medications prescribed to patients during hospitalization were analyzed using the online Lexicomp® drug interaction checker, recording all interactions classified by risk level: C, D, or X.

Findings

A total of 674 DDIs were detected in 109 patients. The prevalence of treatments with at least one clinically relevant interaction was 95%, being 57.9% for those at level C and 31.5% for levels D and X. According to the frequency, the main interaction was between aprepitant and corticosteroids, followed by the interaction between aprepitant and vincristine. The most common interaction between antineoplastic agents was between doxorubicin and cyclophosphamide. In terms of mechanism, most of DDIs (54.9%) were pharmacodynamics. Only the number of administered medications was associated with DDI occurrence.

Conclusion

Potential DDIs of moderate to major severity are common among patients with hematologic malignancies. This underscores the importance of implementing different strategies to mitigate this clinically significant risk.

Combined contributions of cytochrome P450s (CYPs) and non-enzymatic metabolism in the in vitro biotransformation of anaprazole, a novel proton pump inhibitor

Anaprazole, a new proton pump inhibitor (PPI), is designed for the treatment of acid-related diseases, such as gastric ulcers and gastroesophageal reflux. This study explored the in vitro metabolic transformation of anaprazole. The metabolic stabilities of anaprazole in human plasma and human liver microsomes (HLM) were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Then, the contribution (%) of non-enzymatic and cytochrome P450s (CYPs) enzyme-mediated anaprazole metabolism was assessed. To obtain the metabolic pathways of anaprazole, the metabolites generated in HLM, thermal deactivated HLM, and cDNA-expressed recombinant CYPs incubation systems were identified by ultra-performance liquid chromatography/quadrupole-time-of-flight mass spectrometry (UPLC/Q-TOF-MS). Results showed that anaprazole was very stable in human plasma and unstable in HLM. The contribution (%) of non-enzymatic vs. CYPs enzyme-mediated metabolism was 49% vs. 51%. CYP3A4 was the major enzyme (48.3%), followed by CYP2C9 (17.7%) and CYP2C8 (12.3%), in responsible for the metabolism of anaprazole. Specific chemical inhibitors targeting CYP enzymes notably blocked the metabolic transformation of anaprazole. Six metabolites of anaprazole were identified in the non-enzymatic system, whereas 17 metabolites were generated in HLM. The biotransformation reactions mainly included sulfoxide reduction to thioether, sulfoxide oxidation to sulfone, deoxidation, dehydrogenation, O-dealkylation or O-demethylation of thioether, O-demethylation and dehydrogenation of thioether, O-dealkylation and dehydrogenation of thioether, thioether O-dealkylation and dehydrogenation of thioether, and O-dealkylation of sulfone. Both enzymatic and non-enzymatic metabolisms contribute to the clearance of anaprazole in human. Anaprazole is less likely to develop drug-drug interactions in clinical use compared to other PPIs.

Practicing and evaluating clinical pharmacy in oncology: Where are we now? A scoping review

BACKGROUND

Clinical pharmacy is a discipline structured around multiple activities whose objective is to secure patient care. Among all the specialties where it can be applied, oncology is a field of choice. More and more studies are being conducted on the impact of this activity, but their methodology and results seem at first sight very heterogeneous.

OBJECTIVE(S)

The objective of this literature review was to describe the clinical oncology pharmacy activities found in the literature, and analyze the methodology used and the outcomes measured by the authors for their evaluation.

METHODS

This literature review was based on the PRISMA-ScR criteria. The Embase, CINAHL, Google Scholar, and PsycINFO databases were searched. All studies reporting the evaluation of hospital-based clinical pharmacy activity in cancer patients were included based on a previously validated search equation. The search was conducted until the end of 2020. The quality of all studies was assessed using the MMAT.

RESULTS

Of the 2521 results of the initial query, 93 were selected for complete review. The main interventions implemented were pharmaceutical analysis as well as pharmaceutical interviews. The indicators assessed most often were the number of pharmaceutical interventions as well as treatment-related problems. The overall quality assessment score was 55%.

CONCLUSION

Clinical pharmacy activity in oncology still lacks robust studies, whether methodologically or of the measured indicator. Patient-centered impact indicators are still too rare. This area of research should focus on the homogenization of indicators and their relevance.

Pharmacist-led olaparib follow-up service for ambulatory ovarian cancer patients: A prospective study in a tertiary specialized cancer hospital in China

Purpose: To establish a pharmacist-led olaparib follow-up program for ovarian cancer patients, provide patient education, get information on adverse drug reactions (ADRs), and identify and manage drug-related problems. Methods: Ambulatory adult patients with ovarian cancer receiving olaparib were enrolled. At least one follow-up session was conducted by clinical pharmacists. Pharmacists collected data on the type and grade of ADRs, drug adherence, olaparib dosing, concomitant medications, and pharmacists' suggestions. Results: 83 patients were enrolled with the median age of 58. The average number of the follow-up sessions provided to each patient was 1.31, and the average duration of each follow-up was 17.78 min. The olaparib starting dose for most patients (97.59%) was 600 mg/d. 36.14% of the patients had missed olaparib doses and 27.71% of the patients had dose adjustments due to ADRs. The most common ADRs (incidence≥10%) were: fatigue (40.96%), anemia (36.14%), leukopenia (36.14%), nausea (28.92%), thrombocytopenia (16.87%), anorexia (16.87%), dyspepsia (15.66%). The tolerability profiles were generally similar between patients treated for "first-line maintenance" and those treated for "recurrence maintenance" (p > .05). There were 42% of the patients who were concomitantly taking medications without exact chemical contents (such as formulated Chinese medicines and Chinese decoctions), and common types of concomitant medications with exact drug names were antihypertensive, anti-hyperglycemic, and anti-hyperlipidemic medications. The pharmacists identified 4 clinically significant drug-drug interactions (DDIs) in two patients. Pharmacists made 196 suggestions mainly related to rational use of the medications and management of ADRs. Conclusion: The study provides the first report about pharmacist-led follow-up service for olaparib. The types of ADRs were similar to those previously observed in clinical trials, and the profiles of ADRs in different types of patients (first-line maintenance vs. recurrence maintenance) were also similar. Pharmacists identified drug-related problems (such as adherence, DDIs and management of ADRs) and offer suggestions for the patients.

Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

Introduction: Polypharmacy are commonly observed among older adults with cardiovascular disease. However, multiple medications lead to increased risk of drug-drug interactions (DDIs). Therefore, identification and prevention actions related to harmful DDIs are expected in older adults. The study aimed to describe the prevalence of potential DDIs (pDDIs) in discharge prescriptions among older adults with chronic coronary syndrome (CCS).

Methods: A single-center cross-sectional study was performed in a tertiary public hospital in Beijing, China. CCS patients aged 65 years and above who were admitted to cardiology wards over a 3-month period and alive at discharge were included. Electronic medical records and discharge prescriptions were reviewed. pDDIs were evaluated through the Lexi-Interact online.

Results: pDDIs were identified in 72.9% of the 402 individuals (n = 293). A total of 864 pDDIs were obtained. 72.1% of patients were found with C DDIs (n = 290) and 20.3% were categorized in D and X DDIs (n = 82). The only X DDI was between cyclosporine and atorvastatin. Under category D, glycemia alterations within antidiabetics and increased chances of bleeding with antithrombotic were the most common. Concomitant use of clopidogrel and calcium channel blockers was a frequent situation within category C, followed by synergic blood pressure lowering agents and increased rosuvastatin concentration induced by clopidogrel.

Conclusion: DDIs exposure was common in older CCS. DDIs screening tools should be introduced to alert potential adverse effects. Prescribers need to rigorously review or modulate therapies to prevent DDI-related adverse outcomes. Clinical pharmacists should be more involved in complex drug regimen management.

Comparison of different decision support software programs in perspective of potential drug-drug interactions in the oncology clinic

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.

[Hospital - community pharmacy coordination for the dispensing of oral antineoplastic drugs: An observational study in the French county of the Aveyron]

INTRODUCTION

The growing number of oral antineoplastic agents delivered by French community pharmacies has modified the job and roles of community pharmacists. Coordination between hospitals (oncology centers) and community pharmacies has become essential for a quality work in this field. The goal of this work was to obtain information about the feeling of the community pharmacies teams in a French county (Aveyron) regarding the communication tools offered by various hospitals with an oncology service (when receiving a beginning prescription for an oral antineoplastic drug), and to evaluate the impact of these tools on their practice.

METHODS

A declarative survey was submitted to the 109 community pharmacies of this county to evaluate their relationship with their nearest oncology centers (including communication tools) and collect their opinion on the quality of the coordination and their pharmaceutical exercise.

RESULTS

The response rate was of 54% (59 community pharmacies). Communication between the oncology centers and the pharmacies was limited (only 50% of the pharmacies received information complementary to the prescription), the available tools were not used very frequently (44% of pharmacies didn't use shared medical records) and there was a strong feeling of rupture between the pharmacies and the oncology centers, impacting the quality of their work (46% of respondents indicated being little or incapable of correctly validating the indication of the anticancer drug).

DISCUSSION

This study illustrates the under-use of the available hospital-community pharmacy communication tools and the fact that the pharmacies feel difficulties to correctly deliver oral antineoplastic medications due to a lack of information.

Potential drug-drug interactions of immunosuppressants in kidney transplant recipients: comparison of drug interaction resources

Background Drug-drug interactions are frequently observed in kidney transplant recipients due to polypharmacy and use of immunosuppressants. However, there is only one study evaluating clinically relevant potential drug-drug interactions of immunosuppressants specially in kidney transplant recipients by means of online databases and Stockleys Drug Interactions, as a gold standard. Aim This study aimed to compare four online databases used frequently to determined clinically relevant potential drug-drug interactions of immunosuppressants in kidney transplant recipients according to the Renal Drug Handbook. Method This was a descriptive cross-sectional study conducted between October 1, 2019, and March 18, 2020, in the nephrology ward of Ankara University School of the Medicine, Ibn-i Sina Hospital. In total, 52 adult patients' discharge prescriptions were retrieved from their medical records and analyzed retrospectively. Micromedex®, Lexicomp®, Medscape, and Drugs.com databases were used to evaluate drug interactions. The Renal Drug Handbook was used as a gold standard to do specificity and sensitivity analysis. Results A total of 127 potential drug-drug interactions between the immunosuppressants and co-medications were detected by at least one online database. 32 (25.2%) of these were approved as clinically relevant potential drug-drug interactions by the Renal Drug Handbook. Lexicomp® and Drugs.com have exhibited the highest sensitivity (0.72 and 0.75) while Micromedex® has shown the highest specifity (0.83). Furthermore, the highest positive predictive value has been observed in Micromedex® (0.53). Micromedex® and Medscape had the highest negative predictive value (0.83 and 0.82). However, the kappa value of all was low. The values of inter-rater agreement (Kappa index) between online databases and the Renal Drug Handbook were weak (range 0.05-0.36). In addition, only 11 (8.7%) of potential drug-drug interactions were identified by all online databases. Conclusion This study showed that there was a weak compatibility between each database examined and the Renal Drug Handbook to detect clinically relevant potential drug-drug interactions for immunosuppressants in kidney transplant recipients. Therefore, we suggest that although databases might be practical to take a quick glance in detection of potential drug-drug interactions between immunosuppressants and co-medications, the data should be evaluated in detail and interpreted with caution in combination with a reference book like Renal Drug Handbook.

Ceftazidime and cefepime antagonize 5-fluorouracil's effect in colon cancer cells

Background

Drug-drug interaction (DDI), which can occur at the pharmacokinetics and/or the pharmacodynamics (PD) levels, can increase or decrease the therapeutic or adverse response of a drug itself or a combination of drugs. Cancer patients often receive, along their antineoplastic agents, antibiotics such as ß-lactams to treat or prevent infection. Despite the narrow therapeutic indices of antibiotics and antineoplastic agents, data about their potential interaction are insufficient. 5-fluorouracil (5-FU), widely used against colon cancer, is known for its toxicity and large intra- and inter- individual variability. Therefore, knowledge about its interaction with antibiotics is crucial.

Methods

In this study, we evaluated at the PD levels, against HCT-116 colon cancer cells, DDI between 5-FU and several ß-lactams (ampicillin, benzypenicillin, piperacillin, meropenem, flucloxacillin, ceftazidime (CFT), and cefepime (CFP)), widely used in intensive care units. All drugs were tested at clinically achieved concentrations. MTT assay was used to measure the metabolic activity of the cells. Cell cycle profile and apoptosis induction were monitored, in HCT-116 and DLD-1 cells, using propidium iodide staining and Caspase-3/7 activity assay. The uptake of CFT and CFP by the cells was measured using LC-MS/MS method.

Results

Our data indicate that despite their limited uptake by the cells, CFT and CFP (two cephalosporins) antagonized significantly 5-FU-induced S-phase arrest (DLD-1 cells) and apoptosis induction (HCT-116 cells). Remarkably, while CFP did not affect the proliferation of colon cancer cells, CFT inhibited, at clinically relevant concentrations, the proliferation of DLD-1 cells via apoptosis induction, as evidenced by an increase in caspase 3/7 activation. Unexpectedly, 5-FU also antagonized CFT’s induced cell death in DLD-1 cells.

Conclusion

This study shows that CFP and CFT have adverse effects on 5-FU’s action while CFT is a potent anticancer agent that inhibits DLD-1 cells by inducing apoptotic cell death. Further studies are needed to decipher the mechanism(s) responsible for CFT’s effects against colon cancer as well as the observed antagonism between CFT, CFP, and 5-FU with the ultimate aim of translating the findings to the clinical settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-09125-4.

Potential and real drug interactions in patients treated with abiraterone or enzalutamide in clinical practice

BACKGROUND

Abiraterone and enzalutamide, androgen receptor pathway inhibitors (ARPI) for the treatment of metastatic castration-resistant prostate cancer (mCRPC), are at high risk of potential drug interactions (PDIs). We aimed to describe PDIs and their management, and triggered adverse events (AEs) in clinical practice.

METHODS

We conducted a cross-sectional study in mCRPC patients who started treatment with abiraterone or enzalutamide in a university hospital between August 1st, 2016 and July 31st, 2020. Lexicomp® was used to identify and analyze PDIs, and the clinical records to assess their management and the occurrence of AEs.

RESULTS

We included 173 patients: 36.8% and 93.0% of patients treated with abiraterone and enzalutamide, respectively, had at least 1 PDI. Globally, 6.3% of PDIs had X-risk (contraindication due to high probability of AE). Treatment was modified in 9.2% of patients and 9.8% suffered AEs due to PDIs. Factors associated with a higher risk of PDIs were polypharmacy (OR=41.0, p=0.003) and treatment with enzalutamide (OR=128.26, p< 0.001).

CONCLUSIONS

At least two-thirds of patients treated with ARPI suffered a PDI. Overall, abiraterone would have a more favorable PDI profile. Knowing these interaction profiles may be helpful to develop a more efficient therapeutic follow-up and to select the safest treatment.

Medication Errors During Treatment with New Oral Anticancer Agents: Consequences for Clinical Practice Based on the AMBORA Study

Patients treated with oral anticancer agents (e.g., kinase inhibitors) are a high-risk population for medication errors due to, for example, polymedication, age, and limited adherence. Systematic evaluations regarding frequencies and causes of medication errors and resulting harm are lacking. Our previously published multicenter randomized AMBORA trial revealed that an intensified support by clinical pharmacologists/pharmacists for patients and the treatment team considerably reduced drug-related problems and improved patient-reported outcomes. Using this database, we performed a comprehensive, additional analysis focusing on medication errors related to the patients' complete medication with consideration of the antitumor agents, concomitantly administered drugs, and herb/food intake. Two hundred two patients starting a new oral anticancer drug regardless of the tumor entity were included. Clinical pharmacologists/pharmacists performed advanced medication reviews for 12 weeks. Medication errors were characterized regarding type, cause, patient harm, and the involved medicines. We detected 1.7 medication errors per patient (335/202). Of the medication errors (216/335), 64.5% occurred within the concomitant medication. Patients caused 28.4% of the medication errors. There were 67.8% detected immediately after the start of the new oral regimen, and 14.9% resulted in temporary harm. Drug-drug or drug-food interactions accounted for 24.8% of the medication errors. Patients and physicians need to be addressed in strategies for systematic reduction of medication errors during treatment with new oral antitumor drugs. Clinical decision support systems focusing on drug-drug interactions capture only a minority of the medication errors. Specialists with expertise in clinical pharmacology/pharmacy should support both the treating physicians as well as the patients for improved patient safety.

Pharmacists' knowledge, attitudes, beliefs, and barriers toward breast cancer health promotion: a cross-sectional study in the Palestinian territories

BACKGROUND

Among all cancers, breast cancer is the most prevalent cancer and the leading cause of mortality among women in developing countries including Palestine. Community pharmacists are trusted and easily accessible healthcare providers who could be engaged in breast cancer health promotion. This study was conducted with the aim of exploring knowledge, attitudes, beliefs, and barriers toward breast cancer health promotion among community pharmacists in the Palestinian territories.

METHODS

This study was conducted in a cross-sectional design using a questionnaire among community pharmacists. Knowledge of community pharmacists of breast cancer was tested using a 26-item knowledge test. Attitudes and beliefs of the community pharmacists with regard to breast cancer promotion were explored using 14 items. Barrier to breast cancer health promotion were explored using 9 items.

RESULTS

Data were collected from 200 community pharmacists. The median knowledge score was 69.2 % with and IQR of 15.2 %. Of the community pharmacists, 67.5 % scored 50 % and above in the knowledge test. Multivariate logistic regression showed that community pharmacists who were female in gender were more likely to score 50 % and above in the knowledge test compared to the community pharmacists who were male in gender (OR = 4.73, 95 % CI of 2.26-9.89). The community pharmacists had positive attitudes toward breast cancer health promotion. There was a significant moderate positive correlation between knowledge and attitudes scores (Spearman's rho = 0.37, p-value < 0.001). Lack of reimbursement, lack of enough personnel, lack of time, and fear of offending the patients were the main barriers to breast cancer health promotion (percentage of agreement > 60.0 %).

CONCLUSIONS

This study shed light on the role of community pharmacists in breast cancer health promotion. Pharmacists had good knowledge of breast cancer and positive attitudes toward promoting the health of patients with breast cancer. Further studies are still needed to determine how to integrate community pharmacists in the team of healthcare providers caring for patients with breast cancer.

Real-life drug-drug and herb-drug interactions in outpatients taking oral anticancer drugs: comparison with databases

PURPOSE

Due to polypharmacy and the rising popularity of complementary and alternative medicines (CAM), oncology patients are particularly at risk of drug-drug interactions (DDI) or herb-drug interactions (HDI). The aims of this study were to assess DDI and HDI in outpatients taking oral anticancer drug.

METHOD

All prescribed and non-prescribed medications, including CAM, were prospectively collected by hospital pharmacists during a structured interview with the patient. DDI and HDI were analyzed using four interaction software programs: Thériaque^®, Drugs.com^®, Hédrine, and Memorial Sloan Kettering Cancer Center (MSKCC) database. All detected interactions were characterized by severity, risk and action mechanism. The need for pharmaceutical intervention to modify drug use was determined on a case-by-case basis.

RESULTS

294 patients were included, with a mean age of 67 years [55-79]. The median number of chronic drugs per patient was 8 [1-29] and 55% of patients used at least one CAM. At least 1 interaction was found for 267 patients (90.8%): 263 (89.4%) with DDI, 68 (23.1%) with HDI, and 64 (21.7%) with both DDI and HDI. Only 13% of the DDI were found in Thériaque^® and Drugs.com^® databases, and 125 (2.5%) were reported with similar level of risk on both databases. 104 HDI were identified with only 9.5% of the interactions found in both databases. 103 pharmaceutical interventions were performed, involving 61 patients (20.7%).

CONCLUSION

Potentially clinically relevant drug interaction were frequently identified in this study, showing that several databases and structured screening are required to detect more interactions and optimize medication safety.

Medication errors in hematology-oncology ward by consultation: The role of the clinical pharmacologist

Background

The aim was to describe, evaluate and document the prevention of medication errors by clinical pharmacologist consultations in patients with cancer.

Methods

We assessed the effect of clinical pharmacologist consultation by the acceptance of interventions recommended due to dosage, frequency, duration of therapy errors and drug-drug interactions (DDIs). All medication errors detected by clinical pharmacologist were reported in the format of medical consultation. A documentation template was designed to collect the patient's data (sex, age, and diagnosis), prescriptions written, and drug-specific recommendations. For the descriptive analysis of medication errors, the unit of analysis was the number and percentage of errors.

Results

A total of 296 patients included in this study with a median age of 48.67±19.76 years of which 47.30% were females. 936 prescribing errors were detected and recommended for their correction. The specialist physicians accepted 897 of prescribed errors. DDIs that were detected in 66.22% of patients, were the most errors in this group of errors (47%). Improper dose (17.41%) wrong frequency (16.67%) and drug-food interaction (10.26%) were after that.

Conclusion

Pharmacological consultation in the hematology-oncology ward revealed many medication errors. The trust of physicians in the views of the clinical pharmacologist led to a large part of these errors being accepted and resolved.

Potential drug interactions between targeted oral antineoplastic agents and concomitant medication in clinical practice

OBJECTIVES

Our objective was to analyze potential drug interactions (PDIs) between targeted OAAs and concomitant therapy in clinical practice.

METHODS

A cross-sectional observational study was performed in cancer outpatients who started treatment with a targeted OAA between 1 December 2015 and 31 May 2019. PDIs were analyzed using the Lexicomp® and the database About Herbs®. PDIs were classified according to severity, risk, and reliability ratings and their underlying mechanism. Univariate and multivariate analysis were performed to identify risk factors associated with PDIs.

RESULTS

A total of 881 patients were included, of whom 50.9% had at least 1 PDI between the OAA and the concomitant medication. The factors associated with a higher risk of PDIs were polypharmacy (≥5 concomitant medicines) (OR = 3.64 (2.54-5.20), p < 0.001), type of tumor (prostate cancer [OR = not available, p < 0.001], chronic myelogenous leukemia [OR = 5.10 (1.08-24.05), p = 0.040], sarcoma [OR = 4.97 (1.05-23.55), p = 0.043]), and treatment with hormone therapies (OR = not available, p < 0.001).

CONCLUSION

A search of PDIs should be prioritized, especially in patients receiving targeted OAAs with risk factors, such as polymedication, prostate cancer, chronic myelogenous leukemia, sarcoma, and treatment with hormone therapies.

[Feedback on clinical oncology pharmacy]

The rising of oral anticancer therapies let more and more patients to be cared at home and improve their quality of life. However the toxicities of these drugs and the distance with health professionals imply that the patient needs to be more autonomous with respect to his treatment. Patients through therapeutic education programs allows them to manage side effects, to be more observant and then to subsequently benefit from the treatment. We report here, oncology clinical pharmacists experiences in some health facilities in France, presented at the 1st day of clinical oncology pharmacy (December 2017, Marseille).