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Domingo-Echaburu S, Hernandez-Palacios R, Orive G, Lertxundi U. A proposal to reduce the amount of permethrin entering wastewater resultant from topical use to treat scabies. Sci Total Environ 2024; 925:171787. [PMID: 38499100 DOI: 10.1016/j.scitotenv.2024.171787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
The incidence of scabies is rising in the last years. Subsequently, the use of pharmaceuticals to treat the disease has also increased. Treatment with topical permethrin is usually recommended as a first line agent. This substance is also an aquatic contaminant that is toxic for many non-target organisms, and has been included as a priority substance in the recently published proposal of the European Water Framework Directive. Current guidelines neglect the potential environmental impact of this drug, recommending that the cream should be applied head to toe and "washed off after 8-12 h". Recently, a wiping procedure before hand washing after application of the topical treatment resulted in a 66 % reduction of the amount of diclofenac released in wastewater. The authors suggested that this method could be explored for other topical treatments. In the case of scabiosis, a protocol implicating the whole body needs to be designed. The absorption of topical permethrin is low. Considering the growing incidence of scabies, the amount of the pyrethroid reaching the environment may also be increasing. Therefore, we believe that applying the wiping procedure to the case of topical permethrin deserves consideration. Other measures to minimize the amount of permethrin residues reaching wastewater by washing clothes and bed linen such as wearing single-use pijamas should also be explored. In conclusion, we need to apply a One Health approach in the treatment with scabies, without neglecting the environmental impact of pharmaceuticals. It is not rational to forget drugs once they go down the drain.
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Affiliation(s)
- Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Rafael Hernandez-Palacios
- Internal Medicine Service, Araba Psychiatric Hospital, Araba Mental Health Network, Vitoria-Gasteiz, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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Alzola-Andres M, Cerveny D, Domingo-Echaburu S, Lekube X, Ruiz-Sancho L, Brodin T, Orive G, Lertxundi U. Pharmaceutical residues in stranded dolphins in the Bay of Biscay. Sci Total Environ 2024; 912:168570. [PMID: 37979850 DOI: 10.1016/j.scitotenv.2023.168570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/20/2023]
Abstract
There is a growing concern about the presence of pharmaceuticals on the aquatic environment, while the marine environment has been much less investigated than in freshwater. Marine mammals are suitable sentinel species of the marine environment because they often feed at high trophic levels, have unique fat stores and long lifespan. Some small delphinids in particular serve as excellent sentinel species for contamination in the marine environment worldwide. To the best of our knowledge, no pharmaceuticals have been detected or reported in dolphins so far. In the present study, muscle, liver and blubber samples from three common dolphins (Delphinus delphis) and seven striped dolphins (Stenella coeruleoalba) stranded along the Basque Coast (northern Spain) were collected. A total of 95 pharmaceuticals based on detectability and predicted ability to bioaccumulate in fish were included in the liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. At least one pharmaceutical was found in 70 % of the individuals. Only three of the 95 monitored pharmaceuticals were detected in dolphin's tissues. Very low concentrations (<1 ng/g) of orphenadrine and pizotifen were found in liver and promethazine in blubber. Herein, the gap in the knowledge regarding the study organisms and marine environments with respect to pharmaceutical pollution, which demands further research to understand if pharmaceuticals are a threat for these apex predators, is highlighted and discussed.
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Affiliation(s)
| | - Daniel Cerveny
- Department of Wildlife, Fish and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden; University of South Bohemia in Ceske Budejovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zatisi 728/II, Vodnany, Czech Republic
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Xabier Lekube
- Biscay Bay Environmental Biospecimen Bank (BBEBB), Research Centre for Experimental Marine Biology and Biotechnology (PiE-UPV/EHU), University of the Basque Country (UPV/EHU), Areatza 47, 48620 Plentzia, Basque Country, Spain; CBET+ Research Group, Department of Zoology and Animal Cell Biology, Faculty of Science and Technology, Research Centre for Experimental Marine Biology and Biotechnology PIE, University of the Basque Country UPV/EHU, Sarriena z/g, Leioa, Basque Country, Spain
| | - Leire Ruiz-Sancho
- AMBAR Elkartea Organisation, Ondarreta Ibilbidea z/g, 48620 Plentzia, Bizkaia, Spain
| | - Tomas Brodin
- Department of Wildlife, Fish and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain.
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain.
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García-Blasco C, Domingo-Echaburu S, Orive G, Lertxundi U. Considering environmental impact of medicines in healthcare. Sci Total Environ 2024; 908:168526. [PMID: 37967630 DOI: 10.1016/j.scitotenv.2023.168526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Camino García-Blasco
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Álava, Spain.
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García-Blasco C, Domingo-Echaburu S, Orive G, Lertxundi U. Perfluorohexyloctane: Do we really need a PFAS for the treatment of Dry Eye Disease? Sci Total Environ 2023; 901:165936. [PMID: 37532053 DOI: 10.1016/j.scitotenv.2023.165936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/29/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Camino García-Blasco
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Álava, Spain.
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Alzola-Andrés M, Domingo-Echaburu S, Segura Y, Valcárcel Y, Orive G, Lertxundi U. Pharmaceuticals in hospital wastewaters: an analysis of the UBA's pharmaceutical database. Environ Sci Pollut Res Int 2023; 30:99345-99361. [PMID: 37610546 DOI: 10.1007/s11356-023-29214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
The presence of pharmaceuticals in hospital wastewaters (HWW) has been a focus of interest for researchers in the last decades. Certain therapeutic classes, such as X-ray contrast media, broad-spectrum antimicrobials and cytotoxics among others, are mainly used in hospitals-health care facilities. This study is focused on available studies monitoring the presence of pharmaceuticals in HWW around the world. To that end, the last available version (v3. 2021) of the "Pharmaceuticals in the Environment" database published by the Federal German Environment Agency (Umweltbundesamt) has been used. Almost half of all studies included (107) have been conducted in Europe. Pharmaceuticals have been monitored in HWW in 38 different countries across all five continents. The country with the greatest number of studies is Brazil (11), followed by Spain (8), China (7), and France (6). Our analysis revealed that 271 different pharmaceuticals have been detected at least once in HWW. The five drugs with more studies showing a positive detection are ciprofloxacin (38), sulfamethoxazole (36), diclofenac (34), ibuprofen (29), and trimethoprim (27). A total of 47 out of 271 drugs are considered in the NIOSH "Hazardous drug" list. However, monitoring data for some widely used drugs in hospital settings such as muscle relaxants, anesthetics, and antidotes is lacking. In conclusion, this study provides the first large-scale metadata analysis for the pharmaceuticals in HWW worldwide.
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Affiliation(s)
- Maitane Alzola-Andrés
- School of Pharmacy, NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, 01006, Vitoria-Gasteiz, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500, Arrasate, Gipuzkoa, Spain
| | - Yolanda Segura
- Chemical and Environmental Technology Department, University Rey Juan Carlos, Avenida Tulipan s/n, 28933, Mostoles, Madrid, Spain
| | - Yolanda Valcárcel
- Health and Environment Risk Assessment Group, (RiSAMA), University Rey Juan Carlos, Avda Tulipán sn, Móstoles, Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Avda. Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, 01006, Vitoria-Gasteiz, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
- Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006, Vitoria-Gasteiz, Álava, Spain.
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Egaña I, Domingo-Echaburu S, Orive G, Lertxundi U. Safe levels of pharmaceuticals in groundwater. Sci Total Environ 2023; 886:163990. [PMID: 37164104 DOI: 10.1016/j.scitotenv.2023.163990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/10/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Iker Egaña
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; AMVISA (Aguas Municipales de Vitoria-Gasteiz, S.A.), Water quality and treatment area Pje las Antillas, 3A, 01012 Vitoria-Gasteiz, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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Lertxundi U, Domingo-Echaburu S, Brodin T, Medrano J, Orive G. The future of psychiatry should be One Health. Rev Environ Health 2023; 38:399-400. [PMID: 35254745 DOI: 10.1515/reveh-2022-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/15/2022] [Indexed: 06/02/2023]
Affiliation(s)
- Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Alava, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena-Integrated Health Care Organization, Pharmacy Service, Arrasate, Gipuzkoa, Spain
| | - Tomas Brodin
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, SLU, Umeå, Sweden
| | - Juan Medrano
- Biocruces Bizkaia Health Research Institute, Mental Health Network Research Group, Osakidetza, Bizkaia, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
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Lertxundi U, Domingo-Echaburu S, Barros S, Santos MM, Neuparth T, Quintana JB, Rodil R, Montes R, Orive G. Is the Environmental Risk of Metformin Underestimated? Environ Sci Technol 2023. [PMID: 37256706 DOI: 10.1021/acs.est.3c02468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Susana Barros
- CIIMAR/CIMAR_LA - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto, Avenida General Norton de Matos, S/N, 4450-208 Matosinhos, Portugal
- CITAB - Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, Pavilhão 2, 5000-801 Vila Real, Portugal
| | - Miguel Machado Santos
- CIIMAR/CIMAR_LA - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto, Avenida General Norton de Matos, S/N, 4450-208 Matosinhos, Portugal
- FCUP - Department of Biology, Faculty of Sciences, University of Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal
| | - Teresa Neuparth
- CIIMAR/CIMAR_LA - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto, Avenida General Norton de Matos, S/N, 4450-208 Matosinhos, Portugal
| | - Jose Benito Quintana
- Department of Analytical Chemistry, Nutrition and Food Sciences, IAQBUS - Institute of Research on Chemical and Biological Analysis, Universidade de Santiago de Compostela, Constantino Candeira S/N, 15782 Santiago de Compostela, Spain
| | - Rosario Rodil
- Department of Analytical Chemistry, Nutrition and Food Sciences, IAQBUS - Institute of Research on Chemical and Biological Analysis, Universidade de Santiago de Compostela, Constantino Candeira S/N, 15782 Santiago de Compostela, Spain
| | - Rosa Montes
- Department of Analytical Chemistry, Nutrition and Food Sciences, IAQBUS - Institute of Research on Chemical and Biological Analysis, Universidade de Santiago de Compostela, Constantino Candeira S/N, 15782 Santiago de Compostela, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz 28029, Spain
- Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria 01007, Spain
- Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore 169856
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Abajo Z, Jimenez A, Domingo-Echaburu S, Valcárcel Y, Segura Y, Orive G, Lertxundi U. Analyzing the potential environmental impact of NIOSH list of hazardous drugs (group 2). Sci Total Environ 2023; 873:162280. [PMID: 36822426 DOI: 10.1016/j.scitotenv.2023.162280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/12/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
For the first time, several pharmaceuticals have been defined as priority substances in the new proposal of the revision of the Water Framework Directive (WFD). Consequently, environmental quality standards have been determined for several drugs. This is the case with the antiepileptic carbamazepine, which is considered as hazardous in healthcare settings by The National Institute for Occupational Safety and Health (NIOSH). This organism considers as such drugs that have shown teratogenicity, carcinogenicity, genotoxicity or other developmental, reproductive, or organ toxicity at low doses in studies with animals or humans. This study has been focused on the non-carcinogenic drugs classified in group 2, and their presence in the environment. This group contains many different therapeutic agents such as antineoplastics, psychoactive drugs, immunosuppressants and antivirals, among others. Of the 116 drugs included in the list, 26 have been found in aquatic environmental matrices. Certain drugs have received most attention (e.g., the antiepileptic carbamazepine, progesterone and the antidepressant paroxetine) while others completely lack environmental monitoring. Carbamazepine, fluconazole, paroxetine and warfarin have been found in invertebrates' tissues, whereas carbamazepine, oxazepam and paroxetine have been found in fish tissues. The main aim of the NIOSH's hazardous drug list is to inform healthcare professionals about adequate protection measures to prevent occupational exposure to these pharmaceuticals. However, this list contains useful information for other professionals and researchers such as environmental scientists. The paucity of relevant environmental data of certain hazardous pharmaceuticals might be important to help in the prioritization of compounds that may demand further research.
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Affiliation(s)
- Z Abajo
- Bioaraba Health Research Institute
| | - A Jimenez
- School of Pharmacy, University of the Basque Country
| | - S Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - Y Valcárcel
- Health and Environment Risk Assessment Group, (RiSAMA), University Rey Juan Carlos, Avda Tulipán sn, Móstoles, Madrid, Spain; Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Avda. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Y Segura
- Chemical and Environmental Technology Department, University Rey Juan Carlos, 28933 Madrid, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology-UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain.
| | - U Lertxundi
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain. Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Álava, Spain.
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Domingo-Echaburu S, Abajo Z, Sánchez-Pérez A, Elizondo-Alzola U, de la Casa-Resino I, Lertxundi U, Orive G. Knowledge and attitude about drug pollution in pharmacy students: A questionnaire-based cross sectional study. Curr Pharm Teach Learn 2023:S1877-1297(23)00088-6. [PMID: 37173228 DOI: 10.1016/j.cptl.2023.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/16/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The environmental impact of drugs or pharmaceuticals is an issue of growing concern. Healthcare professionals, and pharmacists in particular, are used to managing medicines, yet aspects about drug pollution are generally neglected in schools of pharmacy worldwide. Formation in this issue is essential to tackle the problem. In this study, we aimed to find out the degree of knowledge about the problem of pharmaceuticals in the environment and the attitude about the matter of pharmacy students at the University of the Basque Country. METHODS We conducted a pilot study (186 students) using an online questionnaire available in two languages (Basque and Spanish). The attitude scale was validated for Spanish. To improve participation, a combination of indirect and direct recruitment was applied in the final study. RESULTS Four hundred eighty-seven students participated in the final study (response rate: 65.8%). The final questionnaire contained a total of 25 questions: 13 (knowledge), eight (attitude), and three (opinion). The results showed that knowledge can be considered relatively poor, whereas attitude was generally positive, and students considered drug pollution to be a relevant issue in general and in pharmacy practice. CONCLUSIONS We believe there is an urgent need to include aspects about pharmaceuticals in the environment in pharmacy studies worldwide.
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Affiliation(s)
- Saioa Domingo-Echaburu
- Pharmacy Service, Debagoiena Integrated Health Organisation, Osakidetza Basque Health Service, Nafarroa Hiribidea, 16, 20500 Arrasate, Gipuzkoa, Spain.
| | - Zuriñe Abajo
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Alvaro Sánchez-Pérez
- Primary Health Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Edificio Biocruces 3, Plaza Cruces 12, 48903 Barakaldo, Spain.
| | - Usue Elizondo-Alzola
- Sciences of Dissemination and Implementation in Health Services research group, Primary Care Research Area - BioCruces Bizkaia Institute, Edificio Biocruces 3, Plaza Cruces 12, 48903 Barakaldo, Spain.
| | - Irene de la Casa-Resino
- Head of Service of Environmental Risk Assessment, Veterinary Medicines Department, Spanish Agency of Medicines and Medical Devices, Calle Campezo 1, 28022 Madrid, Spain.
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Bioaraba Health Research Institute, NanoBioCel Research group, Vitoria-Gasteiz, Spain.
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11
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Arteche-Eguizabal L, Corcuera-Martínez de Tobillas I, Melgosa-Latorre F, Domingo-Echaburu S, Urrutia-Losada A, Eguiluz-Pinedo A, Rodriguez-Piacenza NV, Ibarrondo-Olaguenaga O. Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services. Antibiotics (Basel) 2022; 11:antibiotics11101336. [PMID: 36289994 PMCID: PMC9598292 DOI: 10.3390/antibiotics11101336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pneumonia is a lung parenchyma acute infection usually treated with antibiotics. Increasing bacterial resistances force the review and control of antibiotic use criteria in different health departments. OBJECTIVE Evaluate the adequacy of antibiotic treatment in community-acquired pneumonia in patients initially attended at the emergency department and then admitted to the internal medicine service of the Alto Deba Hospital-Osakidetza Basque Country Health Service (Spain). METHODS Observational, retrospective study, based on the review of medical records of patients with community-acquired pneumonia attended at the hospital between January and May 2021. The review was made considering the following items: antimicrobial treatment indication, choice of antibiotic, time of administration of the first dose, adequacy of the de-escalation-sequential therapy, duration of treatment, monitoring of efficacy and adverse effects, and registry in the medical records. The review was made by the research team (professionals from the emergency department, internal medicine, and pharmacy services). RESULTS Fifty-five medical records were reviewed. The adequacy of the treatments showed that antibiotic indication, time of administration of the first dose, and monitoring of efficacy and adverse effects were the items with the greatest agreement between the three departments. This was not the case with the choice of antibiotic, de-escalation/sequential therapy, duration of treatment, and registration in the medical record, which have been widely discussed. The choice of antibiotic was optimal in 63.64% and might have been better in 25.45%. De-escalation/oral sequencing might have been better in 50.91%. The treatment duration was optimal in 45.45% of the patients and excessive in 45.45%. DISCUSSION The team agreed to disseminate these data among the hospital professionals and to propose audits and feedback through an antibiotic stewardship program. Besides this, implementing the local guideline and defining stability criteria to apply sequential therapy/de-escalation was considered essential.
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Affiliation(s)
- Lorea Arteche-Eguizabal
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
- Correspondence:
| | | | - Federico Melgosa-Latorre
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Emergency Service, 20500 Arrasate/Mondragón, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
| | - Ainhoa Urrutia-Losada
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
| | - Amaia Eguiluz-Pinedo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Internal Medicine Service, 20500 Arrasate/Mondragón, Spain
| | | | - Oliver Ibarrondo-Olaguenaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Research Unit, 20500 Arrasate/Mondragón, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastián, Spain
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12
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Domingo-Echaburu S, Irazola M, Prieto A, Rocano B, Lopez de Torre-Querejazu A, Quintana A, Orive G, Lertxundi U. Drugs used during the COVID-19 first wave in Vitoria-Gasteiz (Spain) and their presence in the environment. Sci Total Environ 2022; 820:153122. [PMID: 35063509 PMCID: PMC8767721 DOI: 10.1016/j.scitotenv.2022.153122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 05/02/2023]
Abstract
The city of Vitoria-Gasteiz was one of the probable first entrances of the SARS-CoV2 in Spain, one of the worst affected countries in the world during the first COVID 19 wave. Driven by the urgency of the situation, multiple drugs with antiviral activity were used off label. Sadly, most of these treatments were of little or no benefit and thus, the number of patients suffering from COVID-19 attended in intensive care units (ICUs) multiplied. After being administered to patients, a variable proportion of these drugs reach the environment where they may have detrimental effects, although this aspect is usually ignored by healthcare professionals. In this study we measured the patterns of hospital drug use in the city of Vitoria-Gasteiz (Spain) during the first COVID-19 wave pandemic, focusing on those with antiviral activity and those used in the ICUs. Subsequently, we measured concentrations of selected drugs in the city's wastewater treatment plant influent and effluent and estimated the potential risk for the environment. The hospital use of certain antivirals and drugs used for sedo-analgesia were dramatically increased during the first wave (cisatracurium was multiplied by 25 and lopinavir/ritonavir by 20). A mean of 1.632 daily defined doses of hydroxychloroquine were used during the period of February-May 2020. In this study we report the first positive detection of hydroxychloroquine ever in the environment. We also show the second positive report of lopinavir. Low risk was estimated for hydroxychloroquine, lopinavir and ritonavir (Risk quotients (RQ) <1), and medium risk for azithromycin (RQ 0f 0.146).
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Affiliation(s)
- S Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea, 16, 20500 Arrasate, Gipuzkoa, Spain
| | - M Irazola
- Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Biscay, Spain; Department of Analytical Chemistry, University of the Basque Country, ES48940 Leioa, Biscay, Spain; Research Centre for Experimental Marine Biology & Biotechnology, ES48620 Plentzia, Biscay, Spain
| | - A Prieto
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country, Bilbao, Spain; Research Centre for Experimental Marine Biology and Biotechnology, University of the Basque Country (PiE-UPV/EHU), Plentzia, Basque Country 48620, Spain
| | - B Rocano
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country, Bilbao, Spain
| | - A Lopez de Torre-Querejazu
- Pharmacy Service, Araba-Integrated Health Care Organization, Santiago Hospital, Vitoria-Gasteiz, Alava, Spain
| | - A Quintana
- Pharmacy Service, Araba Integrated Health Care Organization, Txagorritxu Hospital, Vitoria-Gasteiz, Alava, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain.
| | - U Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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13
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Domingo-Echaburu S, Lopez de Torre-Querejazu A, Valcárcel Y, Orive G, Lertxundi U. Hazardous drugs (NIOSH's list-group 1) in healthcare settings: Also a hazard for the environment? Sci Total Environ 2022; 817:152954. [PMID: 35007598 DOI: 10.1016/j.scitotenv.2022.152954] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
Healthcare workers can be exposed to dangerous drugs during their daily practice. The National Institute for Occupational Safety and Health (NIOSH) considers "hazardous drugs" as those that had shown one or more of the following characteristic in studies with animals, humans or in vitro systems: carcinogenicity, teratogenicity or other toxicity for development, reproductive toxicity, organ toxicity at low doses, or genotoxicity. In the actual list (draft list 2020), drugs classified in group 1 are those with carcinogenic effects. Moreover, the global human and veterinary cancer is expected to grow, so antineoplastic drug consumption may consequently grow, leading to an increase of anticancer pharmaceuticals in the environment. Not all drugs pertaining to group 1 can be classified as "antineoplastic" or "cytostatic". Since most of the research on environment presence and ecotoxicological effects of pharmaceuticals has been focused on this therapeutic class, other carcinogenic drugs belonging to different therapeutic groups may have been omitted in previous studies. In this study we aim to review the presence in the environment of the hazardous drugs (NIOSH group 1) and their possible environmental impact. Of the 90 drugs considered, there is evidence of presence in the environment for 19. Drugs with more studies reporting positive detections are: the antibiotic chloramphenicol (55), the alkylating agents cyclophosphamide (39) and ifosfamide (30), and the estrogen receptor modulator tamoxifen (18). Although the original purpose of the NIOSH list and related documents is to provide guidance to healthcare professionals in order to adequately protect them from the hazards posed by these drugs in healthcare settings, we believe they can be useful for environmentalists too. Absence of data regarding the potential of environmental risk of certain hazardous drugs might tell us which drugs ought to be prioritized in the future.
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Affiliation(s)
- S Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain
| | - A Lopez de Torre-Querejazu
- Pharmacy Service, Araba Integrated Health Care Organization, Vitoria-Gasteiz, Alava, Spain; Bioaraba, Clinical Pharmacy Research Group, Vitoria-Gasteiz, Spain
| | - Y Valcárcel
- Health and Environment Risk Assessment Group, (RiSAMA), University Rey Juan Carlos, Avda Tulipán sn, Móstoles, Madrid, Spain; Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Avda. Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain.
| | - U Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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14
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Lertxundi U, Domingo-Echaburu S, Orive G. Environmental risk of pharmaceuticals: Let us look at the whole package. Br J Clin Pharmacol 2022; 88:3918-3919. [PMID: 35318697 DOI: 10.1111/bcp.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Arrasate, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain.,University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain.,Singapore Eye Research Institute, Singapore.,Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
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15
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Affiliation(s)
- Unax Lertxundi
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain. c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | - Saioa Domingo-Echaburu
- Pharmacy Service, Debagoiena Integrated Health Care Organization.Arrasate, Gipuzkoa 01006, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Vitoria-Gasteiz 01006, Spain
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria 01006, Spain
- Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower 168751, Singapore
- Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz 01006, Spain
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16
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Domingo-Echaburu S, Dávalos LM, Orive G, Lertxundi U. Drug pollution & Sustainable Development Goals. Sci Total Environ 2021; 800:149412. [PMID: 34391154 DOI: 10.1016/j.scitotenv.2021.149412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
The United Nations set "The 2030 Agenda for Sustainable Development," which includes the Sustainable Development Goals (SDGs), a collection of 17 global goals designed to be a "blueprint to achieve a better and more sustainable future for all". Although only mentioned in one of the seventeen goals (goal 3), we argue that drugs in general, and growing drug pollution in particular, affects the SDGs in deeper, not readily apparent ways. So far, the emerging problem of drug pollution has not been sufficiently addressed. Here, we outline and discuss how drug pollution can affect SDGs and even threaten their achievement.
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Affiliation(s)
- S Domingo-Echaburu
- Pharmacy Service, Alto Deba-Integrated Health Care Organization, Arrasate, Gipuzkoa, Spain
| | - L M Dávalos
- Department of Ecology and Evolution, Stony Brook University, 626 Life Sciences Building, Stony Brook, NY 11794, USA; Consortium for Inter-Disciplinary Environmental Research, School of Marine and Atmospheric Sciences, Stony Brook University, 129 Dana Hall, Stony Brook, NY 11794, USA
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - U Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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17
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Lertxundi U, Domingo-Echaburu S, Hernandez R, Medrano J, Orive G. Venlafaxine and desvenlafaxine to be included in the surface water Watch List. Aust N Z J Psychiatry 2021; 55:1112. [PMID: 33636994 DOI: 10.1177/0004867421998787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
| | | | - Rafael Hernandez
- Internal Medicine Service, Araba Psychiatric Hospital, Araba Mental Health Network, Vitoria-Gasteiz, Spain
| | - Juan Medrano
- Mental Health Network Research Group, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country-UPV/EHU, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain.,UPV/EHU-Fundación Eduardo Anitua, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria-Gasteiz, Spain.,The Academia, Singapore Eye Research Institute, Singapore
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18
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Argaluza J, Domingo-Echaburu S, Orive G, Medrano J, Hernandez R, Lertxundi U. Environmental pollution with psychiatric drugs. World J Psychiatry 2021; 11:791-804. [PMID: 34733642 PMCID: PMC8546762 DOI: 10.5498/wjp.v11.i10.791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/25/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Among all contaminants of emerging interest, drugs are the ones that give rise to the greatest concern. Any of the multiple stages of the drug's life cycle (production, consumption and waste management) is a possible entry point to the different environmental matrices. Psychiatric drugs have received special attention because of two reasons. First, their use is increasing. Second, many of them act on phylogenetically highly conserved neuroendocrine systems, so they have the potential to affect many non-target organisms. Currently, wastewater is considered the most important source of drugs to the environment. Furthermore, the currently available wastewater treatment plants are not specifically prepared to remove drugs, so they reach practically all environmental matrices, even tap water. As drugs are designed to produce pharmacological effects at low concentrations, they are capable of producing ecotoxicological effects on microorganisms, flora and fauna, even on human health. It has also been observed that certain antidepressants and antipsychotics can bioaccumulate along the food chain. Drug pollution is a complicated and diffuse problem characterized by scientific uncertainties, a large number of stakeholders with different values and interests, and enormous complexity. Possible solutions consist on acting at source, using medicines more rationally, eco-prescribing or prescribing greener drugs, designing pharmaceuticals that are more readily biodegraded, educating both health professionals and citizens, and improving coordination and collaboration between environmental and healthcare sciences. Besides, end of pipe measures like improving or developing new purification systems (biological, physical, chemical, combination) that eliminate these residues efficiently and at a sustainable cost should be a priority. Here, we describe and discuss the main aspects of drug pollution, highlighting the specific issues of psychiatric drugs.
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Affiliation(s)
- Julene Argaluza
- Department of Epidemiology and Public Health, Bioaraba Health Research Institute, Vitoria-Gasteiz 01002, Spain
| | - Saioa Domingo-Echaburu
- Department of Pharmacy, Alto Deba Integrated Health Care Organization, Arrasate 20500, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz 01006, Spain
- Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz 01006, Spain
- Singapore Eye Research Institute, Discovery Tower, Singapore 168751, Singapore
| | - Juan Medrano
- Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Mental Health Network Research Group, Osakidetza, Portugalete 48920, Spain
| | - Rafael Hernandez
- Department of Internal Medicine, Araba Mental Health Network, Vitoria-Gasteiz 01006, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz 01006, Alava, Spain
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19
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Domingo-Echaburu S, Lertxundi U, Boxall ABA, Orive G. Environmental contamination by pet pharmaceuticals: A hidden problem. Sci Total Environ 2021; 788:147827. [PMID: 34134354 DOI: 10.1016/j.scitotenv.2021.147827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
As the environmental risks of companion animal pharmaceuticals has been assumed to be low, currently, no data on the fate, behaviour or effect is required by the European Medicines Agency. This is in sharp contrast with what happens in farming animals, where ecotoxicological data is a pivotal part on the benefit-risk assessment for the marketing authorization of a new veterinary drug. Recently, concern about the environmental impacts from the indiscriminate prophylactic use of antiparasitic drugs in pets has arisen. Considering the notable increase of companion animals in Europe since 2010, our impression is that, effects and potential deleterious consequences of other therapeutic classes such as antimicrobials and psychotropic drugs are probably underrated. We believe that pets, as animals, should not be excluded from One Health's philosophy, and that authorities should incorporate environmental aspects in the benefit-risk assessment for drugs used in companion animals as well.
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Affiliation(s)
- Saioa Domingo-Echaburu
- Pharmacy Service, Alto Deba Integrated Healthcare Organization, Arrasate, Gipuzkoa, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Spain.
| | - Alistair B A Boxall
- Department of Environment and Geography, University of York, Heslington, York YO10 5NG, UK
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain.
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20
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Lertxundi U, Domingo-Echaburu S, Orive G. Estimation of illicit amphetamine consumption using wastewater based epidemiology: A tiny contribution. Sci Total Environ 2021; 779:146349. [PMID: 33743466 DOI: 10.1016/j.scitotenv.2021.146349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Affiliation(s)
- U Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
| | - S Domingo-Echaburu
- Pharmacy Service, Alto Deba-Integrated Health Care Organization, Arrasate, Gipuzkoa, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
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21
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Domingo-Echaburu S, Orive G, Lertxundi U. Ivermectin & COVID-19: Let's keep a One Health perspective. Sustain Chem Pharm 2021; 21:100438. [PMID: 33898692 PMCID: PMC8053244 DOI: 10.1016/j.scp.2021.100438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 05/08/2023]
Abstract
Despite uncertainty about its clinical benefit, ivermectin has been used for COVID 19, even in prophylaxis. The European Medicines Agency (EMA) has advised against its use for the prevention or treatment of COVID-19 outside randomised clinical trials. Although the potential negative environmental effects of ivermectin have been widely recognised when used in veterinary medicine, scarce attention has been devoted to the potential ecotoxicological impact of human use. We believe is time to include One Health's philosophy in our daily practice. In the specific case of ivermectin & COVID 19, environmental aspects should also be on the table.
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Affiliation(s)
- Saioa Domingo-Echaburu
- Pharmacy Service. Alto Deba-Integrated Health Care Organization, Arrasate, Gipuzkoa, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de La Universidad 7, Vitoria-Gasteiz, 01006, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
- Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore
- Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, C/Alava 43, 01006, Vitoria-Gasteiz, Alava, Spain
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Lertxundi U, Domingo-Echaburu S, Orive G. Rational use of drugs as a source control measure to fight drug pollution. J Hazard Mater 2021; 410:124664. [PMID: 33272727 DOI: 10.1016/j.jhazmat.2020.124664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Unax Lertxundi
- Bioaraba Health Research Institute, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
| | - Saioa Domingo-Echaburu
- Pharmacy Service, Alto Deba Integrated Health Care Organization, Arrasate, Gipuzkoa, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore
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Escudero J, Muñoz JL, Morera-Herreras T, Hernandez R, Medrano J, Domingo-Echaburu S, Barceló D, Orive G, Lertxundi U. Antipsychotics as environmental pollutants: An underrated threat? Sci Total Environ 2021; 769:144634. [PMID: 33485196 DOI: 10.1016/j.scitotenv.2020.144634] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
The heterogeneous class of what we nowadays call antipsychotics was born almost 70 years ago with the serendipitous discovery of chlorpromazine. Their utilization is constantly growing because they are used to treat a diverse group of diseases and patients across all age groups: schizophrenia, bipolar disease, depression, autism, attention deficit hyperactivity disorder, behavioural and psychological symptoms in dementia, among others. They possess a complex pharmacological profile, acting on multiple receptors: dopaminergic, serotoninergic, histaminergic, adrenergic, and cholinergic, leading scientists to call them "agents with rich pharmacology" or "dirty drugs". Serotonin, dopamine, acetylcholine, noradrenaline, histamine and their respective receptors are evolutionary ancient compounds, and as such, are found in many different living beings in the environment. Antipsychotics do not disappear once excreted by patient's urine or faeces and are transported to wastewater treatment plants. But as these plant's technology is not designed to eliminate drugs and their metabolites, a variable proportion of the administered dose ends up in the environment, where they have been found in almost every matrix: municipal wastewater, hospital sewage, rivers, lakes, sea and even drinking water. We believe that reported concentrations found in the environment might be high enough to exert significant effect to aquatic wildlife. Besides, recent studies suggest antipsychotics, among others, are very likely bioaccumulating through the web food. Crucially, psychotropics may provoke behavioural changes affecting populations' dynamics at lower concentrations. We believe that so far, antipsychotics have not received the attention they deserve with regards to drug pollution, and that their role as environmental pollutants has been underrated.
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Affiliation(s)
- J Escudero
- Bioaraba Health Research Institute, Epidemiology and Public Health, Vitoria-Gasteiz, Spain
| | - J L Muñoz
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - T Morera-Herreras
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Neurodegenerative Diseases Group, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - R Hernandez
- Internal Medicine Service, Araba Psychiatric Hospital, Araba Mental Health Network, C/Álava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | - J Medrano
- Biocruces Bizkaia Health Research Institute, Mental Health Network Research Group, Osakidetza, Bizkaia, Spain
| | - S Domingo-Echaburu
- Pharmacy Service, Alto Deba-Integrated Health Care Organization, Arrasate, Gipuzkoa, Spain
| | - D Barceló
- Water and Soil Quality Research Group, Department of Environmental Chemistry, IDAEA-CSIC, C/Jordi Girona 18-26, 08034 Barcelona, Spain; Catalan Institute for Water Research (ICRA), C/Emili Grahit 101, 17003 Girona, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore.; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - U Lertxundi
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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Arteche-Eguizabal L, Domingo-Echaburu S, Urrutia-Losada A, Grau-Cerrato S. Fosfomycin: Salt is what really matters. Enferm Infecc Microbiol Clin 2021; 39:206-207. [DOI: 10.1016/j.eimc.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
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Lertxundi Etxebarria U, Palacios-Zabalza I, Ibarrondo I, Domingo-Echaburu S, Hernandez R, Isla A, Solinis M. Pharmacotherapeutic management of Parkinson's disease inpatients: how about asking hospital pharmacists? Eur J Hosp Pharm 2020; 28:e140-e145. [PMID: 33355236 DOI: 10.1136/ejhpharm-2020-002461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is considered to be the fastest growing neurological disorder in the world. Patients with PD are hospitalised more frequently, have longer admissions and experience more complications during hospitalisation than age-matched control groups. The incorrect timing of levodopa administration and prescription of contraindicated antidopaminergic drugs are the most important risk factors for motor function deterioration during hospital admission, and have been associated with longer hospital stays and even increased mortality. Despite their crucial role in pharmacotherapy, little attention has been paid to the perspective of hospital pharmacists. The objective of this study was to identify key issues in the pharmacotherapeutic management of inpatients with PD by the implementation of a national Spanish survey specifically designed to analyse the perspective of hospital pharmacists. METHODS An internet-based questionnaire covering the following areas was designed: hospital and participant characteristics, drug formulary, medication compliance and reconciliation, protocols and contraindicated drugs and areas for improvement. RESULTS A total of 76 pharmacists from 59 hospitals answered the survey. Some weaknesses were identified in the availability of drugs: (1) pharmacy services closed at certain times (86.4%); (2) low variety of antiparkinsonian drugs (18.4% store >21 different drugs); (3) delay in antiparkinsonian drug administration if unavailable (>12 hours in 39.5% of cases); (4) lack of flexibility in administration times; (5) low availability of transdermal rotigotine and subcutaneous apomorphine (<50%). The participants ranked highly the designing of specific protocols for patients with PD and implementation of concrete actions to optimise PD inpatient pharmacotherapy. CONCLUSIONS The participants detected some improvement opportunities and proposed realistic and applicable recommendations and strategies aiming to enhance the safety of patients with PD. Protocols for antiparkinsonian drug interchange, administration timing and nil by mouth status, medication reconciliation, and handling nausea/vomiting or psychotic symptoms are considered the main improvement areas.
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Affiliation(s)
- Unax Lertxundi Etxebarria
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
| | - Itziar Palacios-Zabalza
- Biocruces Bizkaia Health Research Institute, Pharmacotherapy: Effective, safe and rational use of drugs research group, Osakidetza, Bizkaia, Spain.,Pharmacy Service, Barrualde Integrated Health Organization, Bizkaia, Spain
| | - Itziar Ibarrondo
- Biocruces Bizkaia Health Research Institute, Pharmacotherapy: Effective, safe and rational use of drugs research group, Osakidetza, Bizkaia, Spain.,Pharmacy Service, Barrualde Integrated Health Organization, Bizkaia, Spain
| | | | - Rafael Hernandez
- Internal Medicine Service, Araba Mental Health Network, Vitoria-Gasteiz, Spain
| | - Arantxa Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country (UPV/EHU), Paseo de la Universidad, Vitoria-Gasteiz, Spain
| | - Marian Solinis
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country (UPV/EHU), Paseo de la Universidad, Vitoria-Gasteiz, Spain
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Domingo-Echaburu S, Lertxundi-Etxebarria U, Hernández-Palacios R, Medrano-Albéniz J. Comments on the Anticholinergic Burden Calculator Web Tool. Farm Hosp 2019; 43:168-169. [PMID: 31469631 DOI: 10.7399/fh.11298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
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Lertxundi U, Hernandez R, Medrano J, Domingo-Echaburu S, Garcia M, Aguirre C. Aripiprazole and impulse control disorders: higher risk with the intramuscular depot formulation? Int Clin Psychopharmacol 2018; 33:56-58. [PMID: 28777129 DOI: 10.1097/yic.0000000000000194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dopamine agonists have been associated with an increased risk of developing impulse control disorders (ICDs). The US Food and Drug Administration (FDA) issued a safety warning in 2016 of a possible association between ICDs and aripiprazole. Recently, one large epidemiological study has confirmed this risk. In the present study, we aim to determine whether the safety signal of ICDs associated with aripiprazole detected by the FDA is replicated in the European pharmacovigilance database (EudraVigilance). We searched for all suspected spontaneous cases of ICDs associated with aripiprazole in EudraVigilance up to 23 February 2017. To assess the association between ICD cases and each dopamine agonist drug, we calculated the proportional reporting ratios (PRRs). Among 4 905 110 events of all types recorded in EudraVigilance, we found 160 cases of ICDs associated with aripiprazole. Aripiprazole fulfilled the criteria to generate a safety signal; PRR (95% confidence interval): 16.39 (13.97-19.24). Notably, the association seemed the strongest for the depot formulation of aripiprazole; PRR (95% confidence interval): 27.13 (17.22-42.75). Our analysis of the data contained in EudraVigilance confirms the safety signal detected last year by the FDA. Interestingly, for the first time, we show that the association seems the strongest for the intramuscular depot formulation of aripiprazole.
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Affiliation(s)
| | - Rafael Hernandez
- Internal Medicine Service, Araba Mental Health Network, Vitoria-Gasteiz, Alava Province
| | - Juan Medrano
- Psychiatry Service, Bizkaia Mental Health Network, Portugalete
| | | | - Montserrat Garcia
- Basque Pharmacovigilance Unit, Galdakao-Usánsolo Hospital, Galdakao, Bizkaia Province
| | - Carmelo Aguirre
- Basque Pharmacovigilance Unit, Galdakao-Usánsolo Hospital, Galdakao, Bizkaia Province.,Department of Pharmacology, School of Medicine and Nursing, University of the Basque Country, Leioa, Spain
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Lertxundi U, Domingo-Echaburu S, Corcostegui B, Ibarra O, Mentxaka G, Hernandez R, Medrano J. Adherence to Lipid Lowering Drugs in Patients with Schizophrenia. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lertxundi U, Domingo-Echaburu S, Corcostegui B, Prieto M, Gonzalez U, Arana A, Hernandez R, Medrano J. The Burden of Constipation In Psychiatric Hospitals. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lertxundi U, Marquínez AC, Domingo-Echaburu S, Solinís MÁ, Calvo B, Del Pozo-Rodríguez A, García M, Aguirre C, Isla A. Hiccups in Parkinson's disease: an analysis of cases reported in the European pharmacovigilance database and a review of the literature. Eur J Clin Pharmacol 2017; 73:1159-1164. [PMID: 28600702 DOI: 10.1007/s00228-017-2275-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Some reports have suggested an association between dopamine agonists and hiccups, involuntary contractions that merit full clinical attention because they can be very debilitating. Many drugs frequently used to treat hiccups are formally contraindicated in Parkinson's disease due to their liability to worsen motor symptoms, making the treatment of hiccups problematic in this disease. The objective of the present study was to analyze all spontaneous reports of hiccups from the European Pharmacovigilance Database in patients with Parkinson's disease and/or on dopaminergic drugs. Finally, we sought to identify evidence-based recommendations on the management of hiccups in Parkinson's disease. METHODS We searched for all reports of hiccups in the European Pharmacovigilance Database (EudraVigilance) and calculated proportional reporting ratios for dopamine agonists and hiccups. We reviewed the literature on Parkinson's disease, dopamine agonists, and hiccups, searching for specific treatment recommendations for hiccups in this disease. RESULTS Both rotigotine and pramipexole fulfilled the criteria to generate a safety signal. We found 32 and 13 cases of hiccups associated with dopamine agonists in EudraVigilance and the literature, respectively. There were no specific recommendations for the management of hiccups in Parkinson's disease in the clinical guidelines consulted. CONCLUSIONS We have found evidence that rotigotine and pramipexole are associated with the appearance of hiccups and that this adverse reaction occurs predominantly in males. Given the scarce information available, specific recommendations are needed in clinical guidelines for the adequate management of hiccups in Parkinson's disease.
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Affiliation(s)
- U Lertxundi
- Pharmacy Service, Araba Mental Health Network, C/Alava 43, 01006, Vitoria-Gasteiz, Alava, Spain.
| | - A C Marquínez
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Lascaray Research Center, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006, Vitoria-Gasteiz, Spain
| | - S Domingo-Echaburu
- Pharmacy Service, Alto Deba Integrated Health Organization, Avda. Nafarroa 16, 20500, Arrasate Gipuzkoa, Spain
| | - M Á Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Lascaray Research Center, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006, Vitoria-Gasteiz, Spain
| | - B Calvo
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Lascaray Research Center, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006, Vitoria-Gasteiz, Spain
| | - A Del Pozo-Rodríguez
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Lascaray Research Center, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006, Vitoria-Gasteiz, Spain
| | - M García
- Basque Pharmacovigilance Unit, Hospital de Galdakao-Usansolo, Galdakao, Spain
| | - C Aguirre
- Basque Pharmacovigilance Unit, Hospital de Galdakao-Usansolo, Galdakao, Spain
| | - A Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Lascaray Research Center, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006, Vitoria-Gasteiz, Spain
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Lertxundi U, Hernández R, Medrano J, Domingo-Echaburu S, García M, Aguirre C. Clozapine-Induced Cardiomyopathy in Parkinson's Disease. Mov Disord Clin Pract 2017; 4:643-645. [PMID: 30713978 DOI: 10.1002/mdc3.12477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/01/2017] [Accepted: 01/19/2017] [Indexed: 01/29/2023] Open
Affiliation(s)
- Unax Lertxundi
- Pharmacy Service Araba Mental Health Network Vitoria-Gasteiz Araba Spain
| | - Rafael Hernández
- Internal Medicine Service Araba Mental Health Network Vitoria-Gasteiz Araba Spain
| | - Juan Medrano
- Psychiatry Service Bizkaia Mental Health Network Portugalete Bizkaia Spain
| | | | - Montserrat García
- Basque Pharmacovigilance Unit Hospital Galdakao-Usánsolo Bizkaia Spain
| | - Carmelo Aguirre
- Basque Pharmacovigilance Unit Hospital Galdakao-Usánsolo Bizkaia Spain.,Pharmacology Department School of Medicine and Nursing University of the Basque Country Leioa-Bizkaia Spain
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Lertxundi U, Domingo-Echaburu S, Hernández R, Peral-Aguirregoitia J, Medrano J. Beers 2015 Criteria: Aripiprazole in Parkinson's Disease. J Am Geriatr Soc 2016; 64:920-1. [PMID: 27100608 DOI: 10.1111/jgs.14038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba Mental Health Network, Vitoria-Gasteiz, Araba, Spain
| | | | - Rafael Hernández
- Internal Medicine Service, Araba Mental Health Network, Vitoria-Gasteiz, Araba, Spain
| | | | - Juan Medrano
- Psychiatry Service, Bizkaia Mental Health Network, Portugalete, Bizkaia, Spain
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Lertxundi U, Ruiz AI, Aspiazu MÁS, Domingo-Echaburu S, García M, Aguirre C, García-Moncó JC. Adverse reactions to antipsychotics in Parkinson disease: an analysis of the Spanish pharmacovigilance database. Clin Neuropharmacol 2016; 38:69-84. [PMID: 25970275 DOI: 10.1097/wnf.0000000000000080] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Although antipsychotics are well known for causing a plethora of adverse drug reactions (ADRs), the main concern when used to treat psychosis in Parkinson disease (PD) has traditionally been motor function worsening. The limited number of patients included in clinical trials contributes to underreport less common ADR. The aims of this study were to describe ADR to antipsychotics occurring in patients with PD notified to the Spanish Pharmacovigilance System and to contrast them with published reports. METHODS All notifications from the Spanish Pharmacovigilance System for the last 30 years (1984-2014) where an antipsychotic was considered suspicious of the ADR in patients who were also on dopaminergic therapy were reviewed. In addition, a systematic search of MEDLINE (1966-2014) was conducted with the following Medical Subject Headings (MeSH) terms: "Parkinson disease" and "antipsychotic agents" or "psychotic disorders" and "drug-related side effects" or "adverse reactions." RESULTS Forty-four notifications were selected for evaluation. Quetiapine was the most frequently implicated drug since 2002, and previously clozapine was the drug implied in higher number of notifications. The most severe ADR was neuroleptic malignant syndrome, which was described in 5 patients (3 cases related to quetiapine, one to haloperidol, and another to olanzapine). CONCLUSIONS Some previously unreported ADRs caused by antipsychotic drugs in patients with PD have been described for the first time in this study, although there are in general well-known antipsychotic adverse effects. It is remarkable that some notifications involve the use of drugs not recommended in these patients.
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Affiliation(s)
- Unax Lertxundi
- *Pharmacy Service, Araba's Mental Health Network; †Pharmacokinetics, Nanotechnology, and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, and ‡Centro de Investigación Lascaray Ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Araba/Álava; §Pharmacy Service, Alto Deba Integrated Health Organization, Arrasate, Gipuzkoa; ║Basque Pharmacovigilance Unit, and ¶Department of Neurology, Hospital Galdakao-Usánsolo, Galdakao, Vizcaya, Spain
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Lertxundi U, Isla A, Solinis MA, Domingo-Echaburu S, Hernandez R, Peral-Aguirregoitia J, Medrano J. Anticholinergic burden in Parkinson's disease inpatients. Eur J Clin Pharmacol 2015; 71:1271-7. [PMID: 26254777 DOI: 10.1007/s00228-015-1919-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/28/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Anticholinergic toxicity can arise as a result of the cumulative burden of multiple medications and metabolites rather than be caused by a single compound. In this sense, prescribing drugs with anticholinergic properties to Parkinson's disease (PD) patients could contribute to aggravate some frequent problems of the disease, like dementia, urinary retention, falls, or constipation, among others. The main purpose of this article is to measure the total anticholinergic burden in a group of PD inpatients. METHOD We analyzed information from different administrative Basque Country's healthcare databases using encrypted unique identifiers in order to detect PD patients admitted to public acute care hospital during 2011-2012. Subsequently, anticholinergic burden was measured using Duran et al.'s list. Secondarily, total anticholinergic load was assessed with the Anticholinergic Drug Scale, the Anticholinergic Risk Score, and the Anticholinergic Burden Scale. A logistic regression model was performed to study association of predictive variables with anticholinergic use. RESULTS A high proportion of PD patients were prescribed anticholinergic drugs, with 53.6% of admissions receiving at least one drug from Duran et al.'s "low-risk" and 10% at least "high-risk" drug. Drugs used for non-motor symptoms and other comorbidities other than PD itself contributed significantly to anticholinergic burden, namely antidepressants, antipsychotics, urological drugs, analgesics, and antihistamines, among others. The total number of drugs and cholinesterase inhibitors were independently associated with anticholinergic drug use. CONCLUSIONS Anticholinergic burden in PD patients is significant, and is caused mostly by drugs not used for PD motor symptoms. Polypharmacy and cholinesterase inhibitors were independently associated with anticholinergic drug prescriptions.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba's Mental Health Network, C/alava 43, 01006, Vitoria-Gasteiz, Alava, Spain.
| | - Arantxazu Isla
- Pharmacy and Pharmaceutic Technology Department, Pharmacy Faculty, University of theBasque Country UPV/EHU, Paseo de laUniversidad 7, 01006, Vitoria-Gasteiz, Araba/Álava, Spain.
| | - Maria Angeles Solinis
- Pharmacy and Pharmaceutic Technology Department, Pharmacy Faculty, University of theBasque Country UPV/EHU, Paseo de laUniversidad 7, 01006, Vitoria-Gasteiz, Araba/Álava, Spain.
| | - Saioa Domingo-Echaburu
- Pharmacy Service, Alto Deba Integrated Health Organization, Avda. Nafarroa, 16, 20500, Arrasate, Gipuzkoa, Spain
| | - Rafael Hernandez
- Internal Medicine Service, Araba´s Mental Health Network, C/alava 43, 01006, Vitoria-Gasteiz, Alava, Spain.
| | | | - Juan Medrano
- Psychiatry Service, Bizkaia´s Mental Health Network, Portugalete, Spain.
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Lertxundi U, Domingo-Echaburu S, Hernández R, Peral-Aguirregoitia J, Medrano J. Confusion regarding anticholinergic burden measurement. J Am Geriatr Soc 2015; 63:1054. [PMID: 25989588 DOI: 10.1111/jgs.13411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba's Mental Health Network, Vitoria-Gasteiz, Araba, Spain
| | | | - Rafael Hernández
- Internal Medicine Service, Araba's Mental Health Network, Vitoria-Gasteiz, Araba, Spain
| | | | - Juan Medrano
- Psychiatry Service, Bizkaia's Mental Health Network, Portugalete, Bizkaia, Spain
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Lertxundi U, Isla A, Solinis MA, Domingo-Echaburu S, Hernandez R, García-Moncó JC. A proposal to prevent omissions and delays of antiparkinsonian drug administration in hospitals. Neurohospitalist 2015; 5:53-4. [PMID: 25829983 DOI: 10.1177/1941874414566986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba's Mental Health Network, Vitoria, Spain
| | - Arantxazu Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene). Faculty of Pharmacy. Centro de investigación Lascaray ikergunea. University of the Basque Country UPV/EHU. Paseo de la Universidad, 7. 01006. Vitoria-Gasteiz (Spain)
| | - Ma Angeles Solinis
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene). Faculty of Pharmacy. Centro de investigación Lascaray ikergunea. University of the Basque Country UPV/EHU. Paseo de la Universidad, 7. 01006. Vitoria-Gasteiz (Spain)
| | | | - Rafael Hernandez
- Internal Medicine Service, Araba's Mental Health Network, Vitoria-Gasteiz, Araba, Spain
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Lertxundi U, Domingo-Echaburu S, Irigoyen I, Isla A, Solinís MÁ, García-Moncó JC. [Challenges in the pharmacotherapeutic management of the hospitalised patient with Parkinson's disease]. Rev Neurol 2014; 58:353-364. [PMID: 24723178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients with Parkinson's disease (PD) are admitted to hospital more frequently and for a longer time than other patients from the same age group. The reason they are hospitalised is often different from their underlying baseline disease and they are usually attended in services with little knowledge of the disease. Both the errors made when administering levodopa and the inappropriate use of pharmacological agents with a central antidopaminergic action are relatively common during their stay in hospital. This study reports on an analysis of the literature available on the challenges and complications that patients with PD have to deal with when they are admitted to hospital, especially those that have to do with pharmacotherapy. Likewise, the authors also propose a series of strategies that lead to better care of the patients during the time they are in hospital, including aspects such as controlling the supplies of antiparkinsonian medication and establishing protocols for the therapeutic exchange of antiparkinsonian agents, as well as protocols for a suitable management of comorbidities in this kind of patients. Other strategies involve encouraging self-management of the antiparkinsonian treatment by the hospitalised patients, conducting follow-up studies to monitor inappropriate prescriptions or creating the figure of 'specialist in PD'. To do so, it will be necessary to raise the awareness of the healthcare staff at the hospital, as well as that of both patients and their relatives, about the problems derived from an inappropriate management of pharmacotherapy in PD.
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Lertxundi U, Domingo-Echaburu S, Soraluce A, García M, Ruiz-Osante B, Aguirre C. Domperidone in Parkinson's disease: a perilous arrhythmogenic or the gold standard? Curr Drug Saf 2013; 8:63-8. [PMID: 23656449 DOI: 10.2174/1574886311308010009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 11/22/2022]
Abstract
Domperidone, a dopamine antagonist that does not easily cross the blood-brain barrier, is considered the gold standard for treating gastrointestinal symptoms in patients with Parkinson's disease (PD) because the risk of developing extrapyramidal adverse effects is considered minimal. On the other hand, cardiotoxicity related to domperidone is not a new issue. In fact, arrhythmias, sudden death and cardiac arrest were reported with high intravenous doses in the 80s. Concern about the cardiotoxicity of oral domperidone has arisen more recently after the publication of two case-control studies which have questioned domperidone's safety even further, especially in patients > 60 years and in doses >30 mg/day. Very little is known about domperidone's cardiac effects in patients with PD. In addtion, pharmacoepidemiological data about specific antiemetic use in these patients is scarce, with almost anecdotal reports of inappropriate centrally acting antidopaminergic drugs like metoclopramide in the hospital setting. As a result, and even no cases of serious arrhythmias or sudden cardiac death associated with domperidone concerning patients with PD have been reported, no definitive conclusions can be drawn about its safety. In conclusion, despite domperidone is still recognized as the first choice for treating gastrointestinal symptoms PD, doses above 30 mg/daily should only be considered with special caution taking into account its potential cardiotoxic effects.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Red de Salud Mental de Araba, Vitoria-Gasteiz, Alava, Spain.
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Lertxundi U, Palacios R, Gutierrez F, Domingo-Echaburu S, Garcia M, Gomez C. Levofloxacin-Induced Delirium in a Patient Suffering from Schizoaffective Disorder and Multiple Sclerosis. Curr Drug Saf 2013. [DOI: 10.2174/15748863113089990043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lertxundi U, Palacios RH, Gutierrez FC, Domingo-Echaburu S, García MG, Gomez CA. Levofloxacin-induced delirium in a patient suffering from schizoaffective disorder and multiple sclerosis. Curr Drug Saf 2013; 8:199-200. [PMID: 23914753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 01/29/2013] [Accepted: 02/13/2013] [Indexed: 06/02/2023]
Abstract
Levofloxacin induced psychiatric adverse effects are rare, although they can be serious. There are just five cases of fluoroquinolone-induced delirium published in the medical literature. To our best knowledge, none of them occurred in psychotic patients. We report a case of a 38-year-old Caucasian man diagnosed with schizoaffective disorder and multiple sclerosis who developed delirium and visual hallucinations after initiating levofloxacin therapy. In psychiatric patients, suspecting levofloxacin could be responsible for the symptoms can be a diagnostic challenge, since they could be interpreted like worsening of the mental state as well. Although levofloxacin-induced delirium is a rare adverse event, physicians should be aware of the occurrence of this serious, but potentially reversible CNS complication of levofloxacin, even in psychotic patients.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service. Red de Salud Mental de Araba, C/alava 43, 01006 Vitoria-Gasteiz. Alava. Spain.
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Abstract
BACKGROUND Scoring scales such as the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS), and the Anticholinergic Cognitive Burden Scale (ACB) provide an estimation of total anticholinergic burden. Not all the lists include the same drugs, and the points given for certain drugs differ among them. Whether these discrepancies present important differences in the estimation of anticholinergic burden for an individual patient is unknown. Therefore, the aim of this study is to assess agreement among the three scales. METHOD Anticholinergic burden was measured with the three scales in 83 patients aged ≥65 years in a medium- and long-stay psychiatric hospital. Subsequently, patients were categorized into three risk categories: low risk (0 points), medium risk (1-2 points) or high risk (3 or more points). The chance-corrected measures of agreement for the different scores were determined with the k-statistic (kappa). RESULTS Values for kappa were: 0.19 for Anticholinergic Risk Scale-Anticholinergic Drug Scale, 0.21 for ACB-Anticholinergic Drug Scale and 0.25 for Anticholinergic Risk Scale-ACB. The mean anticholinergic burden measured with ACB was 3.28. CONCLUSIONS There is poor agreement among the three scales. These lists cannot be directly applied to different settings in which drug availability differs substantially, and they require periodic updates. Anticholinergic burden in our setting (psychogeriatric inpatients) was particularly high.
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Domingo-Echaburu S, Lertxundi U, Gonzalo-Olazabal E, Peral-Aguirregoitia J, Pena-Bandres I. Inappropriate Antidopaminergic Drug Use in Parkinson’s Disease Inpatients. CDTH 2012. [DOI: 10.2174/157488512803988067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lertxundi U, Hernandez R, Medrano J, Domingo-Echaburu S, García M, Aguirre C. Antipsychotics and seizures: higher risk with atypicals? Seizure 2012; 22:141-3. [PMID: 23146619 DOI: 10.1016/j.seizure.2012.10.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Almost all antipsychotics have been associated with a risk of epileptic seizure provocation. Among the first-generation antipsychotics (FGA) chlorpromazine appears to be associated with the greatest risk of seizures among the second-generation antipsychotics (SGA) clozapine is thought to be most likely to cause convulsions. This information is largely based on studies that are not sufficiently controlled. Besides, information about the seizure risk associated with newer antipsychotics is scarce. METHOD The Pharmacovigilance Unit of the Basque Country (network of centers of the Spanish Pharmacovigilance System, SEFV) provided reporting data for adverse reactions (AR) from the whole SEFV to estimate the reporting odds ratio (ROR) for antipsychotics and seizures ("convulsions" as Single MedDra Query). Data was obtained from SEFV database from 1984 to the June 2011. RESULTS The total number of convulsions reported for SGA was 169 (total reported AR 3.204). The number of convulsions reported for FGA was 35 (total reported AR 2.051). 94 convulsions were reported in association with clozapine (total AR 1.052). The ROR for SGA versus FGA was 3.2 (CI 95%: 2.21-4.63). The ROR for SGA excluding clozapine versus FGA was 2.08 (CI 95%: 1.39-3.12). CONCLUSION Our results show that SGA may pose a higher risk of seizures than FGA, mainly, but not only due to clozapine. This is line with recent studies suggesting that some SGA carried a higher average risk of electroencephalographic abnormalities than many FGA. Nonetheless, It is well known that spontaneous reports do not allow strong inferences about adverse drug effects, because differences in reporting fractions by time, drug or type of event are difficult or even impossible to distinguish from differences in the occurrence rates of adverse events. Still, we consider that the possibility of SGA carrying a higher risk of seizure induction than FGA warrants further research.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Red de Salud Mental de Araba, C/alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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Lertxundi U, Domingo-Echaburu S, Peral J, García M. Antipsychotic Induced Symptomatic Hyperprolactinemia: Are Dopamine Agonists Safe? Psychopharmacol Bull 2011; 44:66-68. [PMID: 27738363 PMCID: PMC5044550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Published literature shows that dopamine agonists can reverse antipsychotic-induced hyperprolactinemia without worsening psychotic symptoms in the majority of schizophrenic patients. However, psychiatrists have been reluctant to use drugs with dopaminergic properties for fear of exacerbating psychiatric symptoms. There are reported cases of psychosis worsening published for both cabergoline and bromocriptine. Cabergoline has proven to be more effective and safe when used to treat hyperprolactinemia, but whether cabergoline is also safer than bromocriptine in antipsychotic induced hyperprolactinemia remains unproven.
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Affiliation(s)
- Unax Lertxundi
- Dr. Lertxundi, Pharmacy Service, Red de Salud Mental de Araba, C/alava 43, Vitoria-Gasteiz, Araba, Spain. Dr. Domingo-Echaburu, Pharmacy Service, Hospital Alto Deba, Avda, Nafarroa, 16, Arrasate Gipuzkoa, Spain. Dr. Peral, Pharmacy Service, Hospital de Galdakao-Usánsolo, Barrio labeaga s/n, Galdakao, VIzcaya, Spain. Dr. García, Basque Country Pharmacovigilance Unit, Galdakao-Usansolo Hospital, Barrio labeaga s/n, Galdakao, VIzcaya, Spain
| | - Saioa Domingo-Echaburu
- Dr. Lertxundi, Pharmacy Service, Red de Salud Mental de Araba, C/alava 43, Vitoria-Gasteiz, Araba, Spain. Dr. Domingo-Echaburu, Pharmacy Service, Hospital Alto Deba, Avda, Nafarroa, 16, Arrasate Gipuzkoa, Spain. Dr. Peral, Pharmacy Service, Hospital de Galdakao-Usánsolo, Barrio labeaga s/n, Galdakao, VIzcaya, Spain. Dr. García, Basque Country Pharmacovigilance Unit, Galdakao-Usansolo Hospital, Barrio labeaga s/n, Galdakao, VIzcaya, Spain
| | - Javier Peral
- Dr. Lertxundi, Pharmacy Service, Red de Salud Mental de Araba, C/alava 43, Vitoria-Gasteiz, Araba, Spain. Dr. Domingo-Echaburu, Pharmacy Service, Hospital Alto Deba, Avda, Nafarroa, 16, Arrasate Gipuzkoa, Spain. Dr. Peral, Pharmacy Service, Hospital de Galdakao-Usánsolo, Barrio labeaga s/n, Galdakao, VIzcaya, Spain. Dr. García, Basque Country Pharmacovigilance Unit, Galdakao-Usansolo Hospital, Barrio labeaga s/n, Galdakao, VIzcaya, Spain
| | - Montserrat García
- Dr. Lertxundi, Pharmacy Service, Red de Salud Mental de Araba, C/alava 43, Vitoria-Gasteiz, Araba, Spain. Dr. Domingo-Echaburu, Pharmacy Service, Hospital Alto Deba, Avda, Nafarroa, 16, Arrasate Gipuzkoa, Spain. Dr. Peral, Pharmacy Service, Hospital de Galdakao-Usánsolo, Barrio labeaga s/n, Galdakao, VIzcaya, Spain. Dr. García, Basque Country Pharmacovigilance Unit, Galdakao-Usansolo Hospital, Barrio labeaga s/n, Galdakao, VIzcaya, Spain
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Lertxundi U, Peral J, Mora O, Domingo-Echaburu S, Martínez-Bengoechea MJ, García-Moncó JC. Antidopaminergic therapy for managing comorbidities in patients with Parkinson’s disease. Am J Health Syst Pharm 2008; 65:414-9. [DOI: 10.2146/ajhp060624] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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