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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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2
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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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Urien L, Jauregizar N, Lertxundi U, Fernández U, Morera-Herreras T. Medication impact on oral health in schizophrenia. Med Oral Patol Oral Cir Bucal 2024; 29:e51-e57. [PMID: 37992139 PMCID: PMC10765325 DOI: 10.4317/medoral.26061] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Patients with schizophrenia constitute a particularly vulnerable group for oral diseases. Among the different factors involved, we aimed to examine the evidence of how drugs could contribute to the poorer oral health of this population. MATERIAL AND METHODS An overview of the potential impact of medication on dental/oral health among people with schizophrenia was proposed focusing on selected literature. RESULTS Studies show a higher dental caries and degree of periodontal diseases in this population and point to drug-induced xerostomia as an important risk factor for oral health deterioration. The risk of dry mouth depends on not only antipsychotics, but also drugs with anticholinergic activity. We hypothesize that antipsychotic induced glycaemic alterations might contribute to reduced oral health, and that the antimicrobial activity of certain antipsychotics could have an impact on oral microbiota affecting oral condition. Pharmacovigilance data show that involuntary movements are caused by typical and some atypical antipsychotics. Dry mouth is most frequently reported for quetiapine and olanzapine, while clozapine is more frequently associated with sialorrhea. CONCLUSIONS Literature clearly shows higher caries and periodontal disease in schizophrenic patients. However, overall, there is scarce literature about the potential influence of drugs in these disorders. Health professionals should be aware of this issue in order to implement adequate preventive measures in this vulnerable population.
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Affiliation(s)
- L Urien
- Dept. Pharmacology, Faculty of Medicine and Nursing University of the Basque Country (UPV/EHU) Barrio Sarriena s/n, 48940-Leioa, 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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Mozas-Blanco S, Rodríguez-Gil JL, Kalman J, Quintana G, Díaz-Cruz MS, Rico A, López-Heras I, Martínez-Morcillo S, Motas M, Lertxundi U, Orive G, Santos O, Valcárcel Y. Occurrence and ecological risk assessment of organic UV filters in coastal waters of the Iberian Peninsula. Mar Pollut Bull 2023; 196:115644. [PMID: 37922592 DOI: 10.1016/j.marpolbul.2023.115644] [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: 06/23/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
This study aimed to assess the presence of 21 UVFs and metabolites in coastal regions of the Iberian Peninsula, to evaluate their environmental risk, and identify possible influential factors affecting their measured concentrations. Sampling was carried out in spring and summer to assess possible seasonal variations. UVFs were detected in 43 of the 46 sampling sites. Only 5 were found above LOD: BP4, OC, BP3 and metabolites BP1 and BP8. Samples collected in Mar Menor had the greatest variety of compounds per sample and the highest cumulative concentrations. The risk was characterized using Risk Quotients (RQ). BP1 showed a Low environmental Risk in 2 sites while for OC the RQ indicated a Moderate Risk in 22 points. The variables that contribute most to the variation are population density, sampling season, whether it was an open bay or not, and level of urbanization. The presence of WWTPs had a lower influence.
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Affiliation(s)
- Sandra Mozas-Blanco
- Research Group on Human and Environmental Risk (RISAMA), Rey Juan Carlos University, 28933 Móstoles, Madrid, Spain; Department of Medical Specialties and Public Health, 28922 Alcorcón, Madrid, Spain
| | - José Luis Rodríguez-Gil
- Research Group on Human and Environmental Risk (RISAMA), Rey Juan Carlos University, 28933 Móstoles, Madrid, Spain; IISD - Experimental Lakes Area, Winnipeg, MB R3B 0T4, Canada; Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2M6, Canada.
| | - Judit Kalman
- Research Group on Human and Environmental Risk (RISAMA), Rey Juan Carlos University, 28933 Móstoles, Madrid, Spain; Department of Medical Specialties and Public Health, 28922 Alcorcón, Madrid, Spain
| | - Gerard Quintana
- Institute of Environmental Assessment and Water Research, Severo Ochoa Excellence Center, Spanish National Research Council (IDAEA-CSIC). Jordi Girona 18-26, 08034 Barcelona, Spain
| | - M Silvia Díaz-Cruz
- Institute of Environmental Assessment and Water Research, Severo Ochoa Excellence Center, Spanish National Research Council (IDAEA-CSIC). Jordi Girona 18-26, 08034 Barcelona, Spain
| | - Andreu Rico
- IMDEA Water Institute, Science and Technology Campus of the University of Alcalá, Avenida Punto Com 2, 28805 Alcalá de Henares, Madrid, Spain; Cavanilles Institute of Biodiversity and Evolutionary Biology, University of Valencia, c/Catedrático José Beltrán 2, 46980 Paterna, Valencia, Spain
| | - Isabel López-Heras
- IMDEA Water Institute, Science and Technology Campus of the University of Alcalá, Avenida Punto Com 2, 28805 Alcalá de Henares, Madrid, Spain
| | - Salomé Martínez-Morcillo
- Toxicology Unit, Veterinary School, University of Extremadura, Avda. de la Universidad s/n, 10003 Caceres, Spain
| | - Miguel Motas
- Department of Toxicology, Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Veterinary, Campus of Espinardo, University of Murcia, 30100 Murcia, Spain.
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, 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; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain; Singapore Eye Research Institute, The Academy, 20 College Road, Discovery Tower, Singapore, Singapore
| | - Osvaldo Santos
- Environmental Health Institute, Faculty of Medicine, University of Lisbon, Portugal
| | - Yolanda Valcárcel
- Research Group on Human and Environmental Risk (RISAMA), Rey Juan Carlos University, 28933 Móstoles, Madrid, Spain; Department of Medical Specialties and Public Health, 28922 Alcorcón, Madrid, 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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10
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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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11
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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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12
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Lopez-Herguedas N, Irazola M, Alvarez-Mora I, Orive G, Lertxundi U, Olivares M, Zuloaga O, Prieto A. Comprehensive micropollutant characterization of wastewater during Covid-19 crisis in 2020: Suspect screening and environmental risk prioritization strategy. Sci Total Environ 2023; 873:162281. [PMID: 36822422 PMCID: PMC9943555 DOI: 10.1016/j.scitotenv.2023.162281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 06/04/2023]
Abstract
Micropollutants monitoring in wastewater can serve as a picture of what is consuming society and how it can impact the aquatic environment. In this work, a suspect screening approach was used to detect the known and unknown contaminants in wastewater samples collected from two wastewater treatment plants (WWTPs) located in the Basque Country (Crispijana in Alava, and Galindo in Vizcaya) during two weekly sampling campaigns, which included the months from April to July 2020, part of the confinement period caused by COVID-19. To that aim, high-resolution mass spectrometry was used to collect full-scan data-dependent tandem mass spectra from the water samples using a suspect database containing >40,000 chemical substances. The presence of > 80 contaminants was confirmed (level 1) and quantified in both WWTP samples, while at least 47 compounds were tentatively identified (2a). Among the contaminants of concern, an increase in the occurrence of some compounds used for COVID-19 disease treatment, such as lopinavir and hydroxychloroquine, was observed during the lockdown. A prioritization strategy for environmental risk assessment was carried out considering only the compounds quantified in the effluents of Crispijana and Galindo WWTPs. The compounds were scored based on the removal efficiency, estimated persistency, bioconcentration factor, mobility, toxicity potential and frequency of detection in the samples. With this approach, 33 compounds (e.g. amantadine, clozapine or lopinavir) were found to be considered key contaminants in the analyzed samples based on their concentration, occurrence and potential toxicity. Additionally, antimicrobial (RQ-AR) and antiviral (EDRP) risk of certain compounds was evaluated, where ciprofloxacin and fluconazole represented medium risk for antibiotic resistance (1 > RQ-AR > 0.1) in the aquatic ecosystems. Regarding mixture toxicity, the computed sum of toxic unit values of the different effluents (> 1) suggest that interactions between the compounds need to be considered for future environmental risk assessments.
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Affiliation(s)
- N Lopez-Herguedas
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain; Research Centre for Experimental Marine Biology and Biotechnology (PIE), University of the Basque Country (UPV/EHU), Plentzia, Basque Country, Spain.
| | - M Irazola
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain; Research Centre for Experimental Marine Biology and Biotechnology (PIE), University of the Basque Country (UPV/EHU), Plentzia, Basque Country, Spain
| | - I Alvarez-Mora
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain; Research Centre for Experimental Marine Biology and Biotechnology (PIE), University of the Basque Country (UPV/EHU), Plentzia, Basque Country, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Bioaraba, NanoBioCel Research Group, 01009 Vitoria-Gasteiz, Spain
| | - U Lertxundi
- Bioaraba, NanoBioCel Research Group, 01009 Vitoria-Gasteiz, Spain; 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
| | - M Olivares
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain; Research Centre for Experimental Marine Biology and Biotechnology (PIE), University of the Basque Country (UPV/EHU), Plentzia, Basque Country, Spain
| | - O Zuloaga
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain; Research Centre for Experimental Marine Biology and Biotechnology (PIE), University of the Basque Country (UPV/EHU), Plentzia, Basque Country, Spain
| | - A Prieto
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain; Research Centre for Experimental Marine Biology and Biotechnology (PIE), University of the Basque Country (UPV/EHU), Plentzia, Basque Country, Spain
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13
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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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14
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Gamboa L, Lafuente AS, Morera-Herreras T, Garcia M, Aguirre C, Lertxundi U. Analysis of heat stroke and heat exhaustion cases in EudraVigilance pharmacovigilance database. Eur J Clin Pharmacol 2023; 79:679-685. [PMID: 37009927 PMCID: PMC10068193 DOI: 10.1007/s00228-023-03487-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/26/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The frequency and intensity of heat waves have increased and will keep increasing. This meteorological phenomenon, which is considered one of the most dangerous, can affect the entire population, but certain populations are at greater risk. Concretely, elderly people are more prompt to suffer from chronic diseases and therefore to be on medication that can interact with the different temperature-regulating systems of the body. So far, there are no published studies that have analyzed pharmacovigilance databases to characterize the association between specific pharmaceuticals and heat-related adverse reactions. OBJECTIVE Therefore, in this study, we aimed to investigate the reported cases of heat exhaustion or heat stroke, associated with any drug notified to the European pharmacovigilance database (EudraVigilance). METHOD The Basque Country Pharmacovigilance Unit selected spontaneous reports recorded in EudraVigilance from January 1, 1995, to January 10, 2022. "Heat Stroke" and "Heat Exhaustion" preferred terms were selected. Non-cases, used as controls, were all the other adverse drug reaction reports recorded in EudraVigilance for the same time period. RESULTS In total, 469 cases were obtained. Mean age: 49.74 ± 8 years, 62.5% were male, and the majority (94.7%) were considered serious by EU criteria. Fifty-one active substances fulfilled the criteria to generate a signal of disproportionate reporting. CONCLUSIONS The majority of implicated drugs belong to therapeutic groups that are already mentioned in different heat-illness prevention plans. But we also show that drugs aimed to treat multiple sclerosis and several cytokines were also associated with heat-related adverse effects.
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Affiliation(s)
- Lorea Gamboa
- Department of Pharmacology, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | | | - Teresa Morera-Herreras
- Department of Pharmacology, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Neurodegenerative Diseases Group, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Montserrat Garcia
- Biocruces Bizkaia Health Research Institute, Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, Spain
| | - Carmelo Aguirre
- Department of Pharmacology, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, 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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15
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Lertxundi U, Orive G. [Translated article] A more sustainable pharmacy. Farm Hosp 2023; 47:T53-T54. [PMID: 36963995 DOI: 10.1016/j.farma.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/02/2023] [Accepted: 01/17/2023] [Indexed: 03/26/2023] Open
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, Álava, 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
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16
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Lertxundi U, Orive G. Por una farmacia más sostenible. Farm Hosp 2023; 47:53-54. [PMID: 36801093 DOI: 10.1016/j.farma.2023.01.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/02/2023] [Accepted: 01/17/2023] [Indexed: 05/19/2023] Open
Affiliation(s)
- Unax Lertxundi
- Instituto de Investigación Sanitaria Bioaraba, Osakidetza-Servicio Vasco de Salud, Red Araba de Salud Mental, Servicio de Farmacia, Hospital Psiquiátrico Araba, Vitoria-Gasteiz, España.
| | - Gorka Orive
- Grupo NanoBioCel, Laboratorio de Farmacia, Facultad de Farmacia, Universidad del País Vasco, Vitoria-Gasteiz, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina Nanomedicina (CIBER-BBN), Vitoria-Gasteiz, España; Instituto Universitario de Medicina Regenerativa e Implantología Oral, Vitoria-Gasteiz, España; Instituto de Investigación Ocular de Singapur, Singapur; Grupo de Investigación NanoBioCel, Bioaraba, Vitoria-Gasteiz, España
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17
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Li X, Zhang S, Sherchan S, Orive G, Lertxundi U, Haramoto E, Honda R, Kumar M, Arora S, Kitajima M, Jiang G. Correlation between SARS-CoV-2 RNA concentration in wastewater and COVID-19 cases in community: A systematic review and meta-analysis. J Hazard Mater 2023; 441:129848. [PMID: 36067562 PMCID: PMC9420035 DOI: 10.1016/j.jhazmat.2022.129848] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 05/26/2023]
Abstract
Wastewater-based epidemiology (WBE) has been considered as a promising approach for population-wide surveillance of coronavirus disease 2019 (COVID-19). Many studies have successfully quantified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentration in wastewater (CRNA). However, the correlation between the CRNA and the COVID-19 clinically confirmed cases in the corresponding wastewater catchments varies and the impacts of environmental and other factors remain unclear. A systematic review and meta-analysis were conducted to identify the correlation between CRNA and various types of clinically confirmed case numbers, including prevalence and incidence rates. The impacts of environmental factors, WBE sampling design, and epidemiological conditions on the correlation were assessed for the same datasets. The systematic review identified 133 correlation coefficients, ranging from -0.38 to 0.99. The correlation between CRNA and new cases (either daily new, weekly new, or future cases) was stronger than that of active cases and cumulative cases. These correlation coefficients were potentially affected by environmental and epidemiological conditions and WBE sampling design. Larger variations of air temperature and clinical testing coverage, and the increase of catchment size showed strong negative impacts on the correlation between CRNA and COVID-19 case numbers. Interestingly, the sampling technique had negligible impact although increasing the sampling frequency improved the correlation. These findings highlight the importance of viral shedding dynamics, in-sewer decay, WBE sampling design and clinical testing on the accurate back-estimation of COVID-19 case numbers through the WBE approach.
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Affiliation(s)
- Xuan Li
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Wollongong, Australia; Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Shuxin Zhang
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Wollongong, Australia
| | - Samendrdra Sherchan
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA 70112, USA
| | - 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
| | - Unax Lertxundi
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, Kofu, Japan
| | - Ryo Honda
- Faculty of Geosciences and Civil Engineering, Kanazawa University, Kanazawa, Japan
| | - Manish Kumar
- Sustainability Cluster, School of Engineering, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Sudipti Arora
- Dr. B. Lal Institute of Biotechnology, Jaipur, India
| | - Masaaki Kitajima
- Division of Environmental Engineering, Faculty of Engineering, Hokkaido University, Hokkaido, Japan
| | - Guangming Jiang
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, Australia.
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Abstract
PURPOSE Some case reports have suggested a possible association between COVID-19 vaccines and subacute thyroiditis (SAT), however, to our knowledge, no study has analyzed this possible relationship. This study aimed to analyze whether a disproportionate number of cases of SAT were reported in the EudraVigilance database for four COVID-19 vaccines (BNT162b2, mRNA-1273 ChAdOx1-S or Ad26.COV2.S). METHODS A case/non-case study was conducted to assess the association between SAT and COVID-19 vaccines, calculating the reporting odds ratios (RORs) up to December 2, 2021. Cases were selected using the preferred term 'subacute thyroiditis'. First, cases involving COVID-19 vaccines were compared with those involving all other drugs. Secondly, the RORs for COVID-19 vaccines compared with other viral vaccines (overall and influenza vaccines only) were obtained. RESULTS Until December 2, 2021, of 1,221,582 spontaneous cases of adverse reactions with the four vaccines, we found 162 SAT cases: BNT162b2 (n = 103), mRNA-1273 (n = 27), ChAdOx1-S (n = 31) and Ad26.COV2.S (n = 1). SAT cases were found to be reported more frequently in association with BNT162b2, mRNA-1273, and ChAdOx1-S vaccines than with other drugs. Moreover, we found a signal of disproportionate reporting for SAT with BNT162b2 and mRNA-1273 vaccines comparing with other viral vaccines (BNT162b2 ROR 3.58, 95% CI 1.92-6.66; mRNA-1273 ROR 3.44, 95% CI 1.71-6.94). However, this association was absent when these COVID-19 vaccines were compared with influenza vaccines. CONCLUSIONS In EudraVigilance, SAT is relatively more frequently reported in association with mRNA COVID-19 vaccines than with other viral vaccines. Well designed observational studies are needed to confirm these results.
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Affiliation(s)
- Montserrat García
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Barrio Labeaga 46 A, Galdakao, 48960, Spain.
| | - Itziar Albizua-Madariaga
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, Bizkaia, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Gasteiz, Alava, Spain
| | - Carmelo Aguirre
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Barrio Labeaga 46 A, Galdakao, 48960, Spain
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Spain
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19
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Estévez-Danta A, Bijlsma L, Capela R, Cela R, Celma A, Hernández F, Lertxundi U, Matias J, Montes R, Orive G, Prieto A, Santos MM, Rodil R, Quintana JB. Use of illicit drugs, alcohol and tobacco in Spain and Portugal during the COVID-19 crisis in 2020 as measured by wastewater-based epidemiology. Sci Total Environ 2022; 836:155697. [PMID: 35523346 PMCID: PMC9065690 DOI: 10.1016/j.scitotenv.2022.155697] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 02/23/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 05/11/2023]
Abstract
The COVID-19 pandemic spread rapidly worldwide in the year 2020, which was initially restrained by drastic mobility restrictions. In this work, we investigated the use of illicit drugs (amphetamine, methamphetamine, ecstasy, cocaine and cannabis), and licit substances of abuse (alcohol and tobacco) during the earlier months (March-July 2020) of the pandemic restrictions in four Spanish (Bilbao and its metropolitan area, Vitoria-Gasteiz, Castellón and Santiago de Compostela) and two Portuguese (Porto and Vila do Conde) locations by wastewater-based epidemiology (WBE). The results show that no methamphetamine was detected in any of the locations monitored, while amphetamine use was only detectable in the two locations from the Basque Country (Bilbao and its metropolitan area and Vitoria-Gasteiz), with high estimated average usage rates (700-930 mg day-1 1000 inhabitant-1). The remaining substances were detected in all the investigated catchment areas. In general, no remarkable changes were found in population normalized loads compared to former years, except for cocaine (i.e. its main metabolite, benzoylecgonine). For this drug, a notable decrease in use was discernible in Castellón, while its usage in Porto and Santiago de Compostela seemed to continue in a rising trend, already initiated in former years. Furthermore, two events of ecstasy (3,4-methylenedioxymethamphetamine, MDMA) dumping in the sewage network were confirmed by enantiomeric analysis, one in Santiago de Compostela just prior the lockdown and the second one in the Bilbao and its metropolitan area in July after relieving the more stringent measures. The latter could also be associated with a police intervention. The comparison of WBE with (web) survey data, which do not provide information at a local level, points towards contradictory conclusions for some of the substances, thereby highlighting the need for stable WBE networks capable of near real-time monitoring drug use.
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Affiliation(s)
- Andrea Estévez-Danta
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, 15782 Santiago de Compostela, Spain
| | - Lubertus Bijlsma
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Avda Sos Baynat s/n, 12071 Castellón, Spain
| | - Ricardo Capela
- CIMAR/CIIMAR, Interdisciplinary Centre of Marine and Environmental Research, Group of Endocrine Disrupter and Emerging Contaminants, 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, 4169-007 Porto, Portugal
| | - Rafael Cela
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, 15782 Santiago de Compostela, Spain
| | - Alberto Celma
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Avda Sos Baynat s/n, 12071 Castellón, Spain
| | - Félix Hernández
- Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Avda Sos Baynat s/n, 12071 Castellón, 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
| | - João Matias
- European Monitoring Centre for Drugs and Drug Addiction, 1249-289 Lisbon, Portugal
| | - Rosa Montes
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), 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, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - Ailette Prieto
- Department of Analytical Chemistry, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain; Research Centre for Experimental Marine Biology and Biotechnology (PIE), University of the Basque Country (UPV/EHU), Plentzia, Basque Country, Spain
| | - Miguel M Santos
- CIMAR/CIIMAR, Interdisciplinary Centre of Marine and Environmental Research, Group of Endocrine Disrupter and Emerging Contaminants, 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, 4169-007 Porto, Portugal
| | - Rosario Rodil
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, 15782 Santiago de Compostela, Spain.
| | - José Benito Quintana
- Department of Analytical Chemistry, Nutrition and Food Sciences, Institute of Research on Chemical and Biological Analysis (IAQBUS), Universidade de Santiago de Compostela, Constantino Candeira S/N, 15782 Santiago de Compostela, Spain.
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20
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Abstract
New measures and research are needed to limit the ecological impact of pharmaceuticals
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Affiliation(s)
- Gorka Orive
- 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, Vitoria-Gasteiz, Spain
- Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
- Singapore Eye Research Institute, Singapore
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
| | - Tomas Brodin
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden
| | - Peter Manning
- Senckenberg Biodiversity and Climate Research Centre, Frankfurt am Main, Germany
- Department of Biological Sciences, University of Bergen, Bergen, Norway
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21
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Jiang G, Wu J, Weidhaas J, Li X, Chen Y, Mueller J, Li J, Kumar M, Zhou X, Arora S, Haramoto E, Sherchan S, Orive G, Lertxundi U, Honda R, Kitajima M, Jackson G. Artificial neural network-based estimation of COVID-19 case numbers and effective reproduction rate using wastewater-based epidemiology. Water Res 2022; 218:118451. [PMID: 35447417 PMCID: PMC9006161 DOI: 10.1016/j.watres.2022.118451] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 02/02/2022] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 05/06/2023]
Abstract
As a cost-effective and objective population-wide surveillance tool, wastewater-based epidemiology (WBE) has been widely implemented worldwide to monitor the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentration in wastewater. However, viral concentrations or loads in wastewater often correlate poorly with clinical case numbers. To date, there is no reliable method to back-estimate the coronavirus disease 2019 (COVID-19) case numbers from SARS-CoV-2 concentrations in wastewater. This greatly limits WBE in achieving its full potential in monitoring the unfolding pandemic. The exponentially growing SARS-CoV-2 WBE dataset, on the other hand, offers an opportunity to develop data-driven models for the estimation of COVID-19 case numbers (both incidence and prevalence) and transmission dynamics (effective reproduction rate). This study developed artificial neural network (ANN) models by innovatively expanding a conventional WBE dataset to include catchment, weather, clinical testing coverage and vaccination rate. The ANN models were trained and evaluated with a comprehensive state-wide wastewater monitoring dataset from Utah, USA during May 2020 to December 2021. In diverse sewer catchments, ANN models were found to accurately estimate the COVID-19 prevalence and incidence rates, with excellent precision for prevalence rates. Also, an ANN model was developed to estimate the effective reproduction number from both wastewater data and other pertinent factors affecting viral transmission and pandemic dynamics. The established ANN model was successfully validated for its transferability to other states or countries using the WBE dataset from Wisconsin, USA.
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Affiliation(s)
- Guangming Jiang
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, Australia.
| | - Jiangping Wu
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia
| | - Jennifer Weidhaas
- University of Utah, Civil and Environmental Engineering, 110 Central Campus Drive, Suite 2000, Salt Lake City, UT, USA
| | - Xuan Li
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia
| | - Yan Chen
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia
| | - Jochen Mueller
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Australia
| | - Jiaying Li
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Australia
| | - Manish Kumar
- Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
| | - Xu Zhou
- Shenzhen Engineering Laboratory of Microalgal Bioenergy, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China; State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Sudipti Arora
- Dr. B. Lal Institute of Biotechnology, Jaipur, India
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, Kofu, Japan
| | - Samendra Sherchan
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA, USA
| | - 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
| | - Unax Lertxundi
- 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
| | - Ryo Honda
- Faculty of Geosciences and Civil Engineering, Kanazawa University, Kanazawa 920-1192, Japan
| | - Masaaki Kitajima
- Division of Environmental Engineering, Hokkaido University, Hokkaido 060-8628, Japan
| | - Greg Jackson
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 4102, Brisbane, Australia
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22
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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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23
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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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24
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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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25
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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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26
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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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27
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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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28
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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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29
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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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Zazu L, Morera-Herreras T, Garcia M, Aguirre C, Lertxundi U. Do cariprazine and brexpiprazole cause impulse control symptoms? A case/non-case study. Eur Neuropsychopharmacol 2021; 50:107-111. [PMID: 34082277 DOI: 10.1016/j.euroneuro.2021.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
Aripiprazole has been associated with impulse control symptoms (ICS). Recently, two drugs with similar pharmacological features have become available: cariprazine and brexpiprazole. All of them interact with the D3 receptor, which plays a role in cerebral circuits involved in reward pathways. The objective of this study was to analyze whether a disproportionate number of cases of ICS are reported for cariprazine or brexpiprazole in EudraVigilance. A case/non-case study was conducted to assess the association between ICS and these antipsychotics, calculating reporting odds ratios (RORs) from their respective approval date to Nov 17, 2020. First, cases involving cariprazine or brexpiprazole were compared with those involving all other drugs. Second, to reduce the risk of confounding by indication, the RORs for cariprazine and brexpiprazole were compared with other antipsychotics. Besides, to evaluate a possible notoriety bias, a sensitivity analysis excluding aripiprazole was performed. Seven cases of ICS were reported for cariprazine and another seven for brexpiprazole. The ROR for cariprazine was 28.3 (95% confidence interval [CI], 13.4-59.8) and 33.4 (15.8-70.1) in the case of brexpiprazole. Nonetheless, this association disappeared for cariprazine when compared with other antipsychotics drugs. However, when excluding aripiprazole from the analysis, a safety signal emerged. Although our study is the first to suggest an association between cariprazine, brexpiprazole and ICS, these results should only be considered as exploratory in the context of safety signal detection. Further, well designed observational analytical studies will be needed to confirm these results.
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Affiliation(s)
- Leire Zazu
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Teresa 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.
| | - Montserrat Garcia
- Biocruces Bizkaia Health Research Institute,Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, Spain
| | - Carmelo Aguirre
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Biocruces Bizkaia Health Research Institute,Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, 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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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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García M, Lertxundi U, Aguirre C. Tramadol-induced hiccups: a case-noncase study in the European pharmacovigilance database. Ther Adv Drug Saf 2021; 12:20420986211021230. [PMID: 34211690 PMCID: PMC8216342 DOI: 10.1177/20420986211021230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/09/2020] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hiccups are usually benign and self-limiting, but can sometimes be persistent. If left untreated, they can provoke severe discomfort, and even death. Hiccups can be idiopathic, organic, psychogenic, and caused by drugs. Although some case reports have suggested a possible association between tramadol and hiccups, to our knowledge, no study has analyzed this possible relationship. The aim of this study was to analyze whether a disproportionate number of cases of hiccups are reported for tramadol in the EudraVigilance database. Methods A case-noncase study was conducted to assess the association between hiccups and tramadol, calculating reporting odds ratios (RORs) from 1 January 1995 to 11 September 2020. Cases were selected using the preferred term 'Hiccups'. The noncases used as controls were all other adverse drug reaction reports recorded in EudraVigilance during the same period. Exposure was defined as exposure to tramadol among cases and noncases. To reduce the risk of confounding by indication, the RORs for tramadol compared with other opioids were obtained. Additionally, we performed a confirmatory analysis in the World Health Organization pharmacovigilance database, VigiBase®. Results There were 3089 cases of hiccups in the 7,213,623 reports. Tramadol was involved in 50 cases. The ROR for tramadol exposure was 3.35 [95% confidence interval (CI) 2.53-4.43]. This association persisted when comparing tramadol with other opioids; ROR: 2.13 (95% CI 1.52-2.99). Disproportionality was also observed in VigiBase®: ROR 1.69 (95% CI 1.47-1.93). Conclusion Our study confirms, for the first time, a possible signal for a tramadol-hiccups association. Nevertheless, observational analytical studies are needed to confirm these results. Plain Language Summary Evaluation of the relationship between the tramadol and the risk of hiccupsIntroduction: Hiccups are sudden involuntary contractions of the diaphragm. This involuntary contraction causes the vocal cords to close very briefly, which produces the characteristic sound of a hiccup. Hiccups are usually benign and self-limiting, but can sometimes be persistent. If left untreated, they can provoke severe discomfort, depression, disability, and in the most extreme cases, even death. Drugs are a rare cause of hiccups.Methods: This study investigated the possible association between tramadol and hiccups (an unmentioned adverse drug reaction in the Summary of Product Characteristics) in the European pharmacovigilance database (EudraVigilance) and a confirming analysis in the World Health Organization pharmacovigilance database (VigiBase).Results: Our analysis shows that hiccups is relatively more frequently reported in association with tramadol than with other medicinal products, with EudraVigilance and VigiBase confirming this association.Conclusion: Tramadol is an opioid analgesic indicated, alone or in combination with dexketoprofen or paracetamol for pain with various causes, so healthcare professionals and patients should be aware of this possible association.
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Affiliation(s)
- Montserrat García
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Barrio Labeaga 46A, Galdakao, 48960, Spain
| | - Unax Lertxundi
- Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Bioaraba Health Research Institute, Osakidetza Basque Health Service, Vitoria-Gasteiz, Araba, Spain
| | - Carmelo Aguirre
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Galdakao, Spain
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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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35
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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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Abstract
Apart from SARS-Co-V-2 coronavirus, bats also host many highly virulent zoonotic pathogens. A matter of rising concern is the detrimental impact of pharmaceuticals in the environment, as they can have major impact at low concentrations. Insectivorous bats are among the wildlife animals likely to be exposed due to the bioaccumulation through the food web. Bat's behaviour might be deeply affected by human psychoactive drugs. Current massive antiviral use activity will increase environmental concentrations of these pharmaceuticals, for whose potential eco-toxicological consequences are scarce. We need to study the complex interrelation between people, bats, drugs, viruses, and their shared environment.
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Affiliation(s)
- 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
- Basque Sustainable Pharmacy Association, Vitoria-Gasteiz, Spain
| | - Unax Lertxundi
- Basque Sustainable Pharmacy Association, Vitoria-Gasteiz, Spain
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Orive G, Lertxundi U, Barcelo D. Early SARS-CoV-2 outbreak detection by sewage-based epidemiology. Sci Total Environ 2020; 732:139298. [PMID: 32417555 PMCID: PMC7207139 DOI: 10.1016/j.scitotenv.2020.139298] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 04/22/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 04/14/2023]
Abstract
Sewage can be used to determine the scale of COVID-19 outbreak. Sewage Epidemiology or Waste Based Epidemiology (WBE) approach has been successfully used to track and provide early warnings of outbreaks of pathogenic viruses such as Hepatitis A, Poliovirus and Norovirus. In untreated wastewater COVID-19 (excreted via faeces then introduced to wastewater) can survive from hours to days. Detection of COVID-19 can be carried out with nucleic acid-based polymerase chain reaction (PCR) assay, used for confirmation of COVID-19 patients around the globe. New cheaper and faster monitoring tools are being developed to detect Covid-19 in wastewater by biosensors, ELISA, or paper-based indicator methods. This will allow to reveal true scale of Covid-19 outbreak associated with population link to a specific wastewater treatment plant.
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Affiliation(s)
- 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.
| | - Unax Lertxundi
- Pharmacy Service, Araba Psychiatric Hospital, Araba Mental Health Network, Spain; 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
| | - Damia Barcelo
- 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
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García M, Arteche-Martinez U, Lertxundi U, Aguirre C. SGLT2 Inhibitors and Bladder Cancer: Analysis of Cases Reported in the European Pharmacovigilance Database. J Clin Pharmacol 2020; 61:187-192. [PMID: 32827151 DOI: 10.1002/jcph.1722] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/28/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023]
Abstract
The association between sodium-glucose cotransporter 2 inhibitors (SGLT2is) and cancer risk is unclear. The objective of this study was to analyze whether a disproportionate number of cases of bladder cancer are reported for SGLT2is in EudraVigilance. A case/noncase study was conducted to assess the association between bladder cancer and SGLT2is, calculating reporting odds ratios (RORs) from November 11, 2012 (approval date for the first SGLT2i, dapagliflozin) to May 19, 2020. First, cases involving SGLT2is were compared with those involving all other drugs; and similar analysis was performed for each SGLT2i. Second, to reduce the risk of confounding by indication, the RORs for SGLT2is compared with other antidiabetics were obtained. Besides, 2 measures were taken to evaluate a possible notoriety bias: a sensitivity analysis excluding pioglitazone was performed and the evolution of the ROR over time for SGLT2is was measured. There were 6602 cases of bladder cancer in the 4,213,637 reports during the study period. SGLT2is were involved in 155 cases. The ROR for pooled SGLT2is was 3.97 (95% confidence interval [CI], 3.39-4.66), disproportionality also being observed for each SGLT2i separately. The association was strongest for dapagliflozin (ROR, 7.02; 95%CI, 5.69-8.66). Nonetheless, this association disappeared when comparing SGLT2is with other antidiabetic drugs (ROR, 0.20; 95%CI, 0.17-0.24). But when excluding pioglitazone from the analysis, a safety signal for SGLT2is compared with other antidiabetics emerged (ROR, 6.84; 95%CI 5.41-8.65). Our study found a disproportionately high number of cases of bladder cancer among users of SGLT2is. However, observational analytical studies will be needed to confirm these results.
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Affiliation(s)
- Montserrat García
- Biocruces Bizkaia Health Research Institute, Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, Spain
| | - Unai Arteche-Martinez
- Osakidetza Basque Health Service, Primary Health Centre Lakua-Arriaga, 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
| | - Carmelo Aguirre
- Biocruces Bizkaia Health Research Institute, Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, Spain.,Department of Pharmacology, School of Medicine and Nursing, University of the Basque Country, Leioa, Spain
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39
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Affiliation(s)
- Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine, Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology, Eduardo Anitua Foundation, Vitoria-Gasteiz, Spain; Singapore Eye Research Institute, Singapore, Singapore.
| | - 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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Abstract
Preoccupation about potential deleterious effects of pharmaceuticals in the environment is growing fast. Psychiatric pharmaceuticals have received particular attention because of their increasing use and their potential impacts on many living beings due to their effects on phylogenetically highly conserved neuroendocrine systems. Recent studies that have shown that many pharmaceuticals (including psychotropics) bioaccumulate through the web food have raised this concern into new heights. As professionals working in the field of psychiatry and academia, we believe we are about to enter a new era with regard to pharmacotherapy. We estimate drug pollution will have a major impact on our daily practice in a way we are just starting to imagine. So far, this problem has largely been ignored by healthcare professionals, who are the ones prescribing and dispensing pharmaceuticals. We are convinced that increasing awareness among these professionals will be a key element to effectively fight against drug pollution.
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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, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | - Rafael Hernández
- Internal Medicine Service, Araba Psychiatric Hospital, Araba Mental Health Network, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | - Juan Medrano
- Psychiatry Service, Bizkaia Mental Health Network, Vitoria-Gasteiz, Spain.,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, Paseo de la Universidad 7, Vitoria-Gasteiz01006, 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, Singapore
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Lertxundi U, Hernandez R, Medrano J. The impact of the ambiguous definition of "month" on pharmacotherapy. Med Hypotheses 2019; 129:109258. [PMID: 31371075 DOI: 10.1016/j.mehy.2019.109258] [Citation(s) in RCA: 2] [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: 04/01/2019] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
Abstract
AIM The Gregorian calendar divides a common year into 12 months of irregular length. As a result, whenever time is measured in months, an unavoidable degree of inaccuracy exists. We hypothesize that the use of this unprecise measure of time has profound implications for the field of pharmacotherapy from practical and drug safety issues, to variations in drug budgets, and pharmacoepidemiological, industrial and drug regulatory considerations, such as price-fixing policies. In this paper, we have tried to gather evidence in favor of our hypothesis, focusing on the particular case of antipsychotics. METHODS First, we examined all monthly prescriptions of long acting injectable aripiprazole or paliperidone in the Basque Country from January 1st to December 31st, 2017. Second, we investigated how the WHO Collaborating Centre for Drug Statistics defines the defined daily dose (DDD) for these drugs. Third, we analyzed the pack size of oral solid formulations of antipsychotics on the market in Spain. Finally, we explored how evidence from clinical trials is transferred to clinical practice and how it may affect drug fixing-policies. RESULTS We found that "monthly" and "every 4 week" injections were prescribed for approximately half of patients. We estimated that an extra cost of almost half a million euros (€495,420) would have been incurred if all prescriptions had been every 4 weeks. We also found that 21 additional adverse site reactions per year could be expected for aripiprazole. Besides, the WHO Collaborating Centre for Drug Statistics calculates the defined daily dose using a 30-day interval for these drugs. In addition, we found that pack sizes for currently available solid oral antipsychotic formulations are inconsistent, with 53% being sold as 28-day multiples and 46% as 30-day multiples. Finally, we found out that although the vast majority of clinical trials are performed in weeks, drug regulatory agencies frequently use the term "month" or "monthly" in the summary of product characteristics of marketed antipsychotics. CONCLUSION This study shows that the inconsistent definition of month has deep implications on various aspects of pharmacotherapy. Considering all the data given above, we urge drug regulatory agencies to specifically avoid the term "month" in the summary of product characteristics and adopt 4-week intervals instead. We also suggest that the WHO Collaborating Centre for Drug Statistics establishes a new 28-day based DDD for "monthly" antipsychotics. Finally, healthcare providers worldwide should abstain from using "monthly" frequencies in drug prescription software tools.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba Psychiatric Hospital, Araba Mental Health Network, Spain; Biocruces Bizkaia Health Research Institute, Pharmacotherapy: Effective, safe and rational use of drugs reserach group, Osakidetza, Portugalete, Bizkaia, Spain.
| | - Rafael Hernandez
- Internal Medicine Service, Araba Psychiatric Hospital, Araba Mental Health Network, Spain
| | - Juan Medrano
- Psychiatry Service, Bizkaia Health Research Institute, Mental Health Network Research Group, Bizkaia Mental Health Network, Osakidetza, Portugalete, Bizkaia, Spain
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Lertxundi U, Hernandez R, Corcóstegui B, Ibarra O, Mentxaka G, Medrano J. Influence of an inconsistent appearance of antipsychotics on drug adherence in patients with schizophrenia. Medicine (Baltimore) 2018; 97:e12990. [PMID: 30383653 PMCID: PMC6221711 DOI: 10.1097/md.0000000000012990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, we aimed to determine whether an inconsistent appearance of antipsychotic drugs dispensed was associated with poorer adherence in patients with schizophrenia.To conduct this study, we linked information from different administrative healthcare databases from the Basque Country. Patients with a medication possession ratio (<80%) were considered to be nonadherent.More than a quarter of the study population (26.9%, 1294/4810) was nonadherent to antipsychotics. Different brands of the same antipsychotic were dispensed to 8.5% of the patients. Inconsistent appearance was not associated with nonadherence to antipsychotics. Lower adherence to antipsychotics was associated with several other factors: age ≥65 or <30 years, prescription of typical antipsychotics or of long-acting injectable compounds, and nonadherence to antihypertensive and lipid-lowering drugs.Contrary to our expectations, we did not find a significant association between inconsistent appearance of prescribed antipsychotics and poorer adherence. The percentage of patients who were dispensed different brands of the same antipsychotics was also lower than expected.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba Psychiatric Hospital, Internal Medicine Service, Araba Mental Health Network, Vitoria-Gasteiz, Alava
| | - Rafael Hernandez
- Pharmacy Service, Araba Psychiatric Hospital, Internal Medicine Service, Araba Mental Health Network, Vitoria-Gasteiz, Alava
| | - Beatriz Corcóstegui
- Pharmacy Service, Bermeo Psychiatric Hospital, Bizkaia Mental Health Network, Bermeo
| | - Olatz Ibarra
- Pharmacy Service, Uribe Kosta Integrated Healthcare Organization, Goieta Kalea, Urduliz, Bizkaia
| | - Gorka Mentxaka
- Informatics service, Central Informatics Department, Osakidetza, Vitoria, Araba
| | - Juan Medrano
- Psychiatry Service, Bizkaia Mental Health Network, Portugalete, Bizkaia, Spain
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Lertxundi U, Hernandez R, San Miguel S, Corcostegui B, Prieto M, Gonzalez U, Arana A, Medrano J. The burden of constipation in psychiatric hospitals. Int J Psychiatry Clin Pract 2018; 22:143-150. [PMID: 28982280 DOI: 10.1080/13651501.2017.1384023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In this study, we aimed to explore the total burden of constipation in our setting by measuring aggregate laxative consumption data and hospital admissions potentially associated with complications of chronic constipation. In addition, we aimed to determine point prevalence of individual laxative use. METHODS This study was carried out across all public psychiatric hospitals in the Basque Country. First, laxative consumption data was obtained for the period from January 2008 to October 2016. Total laxative use was then calculated as the total number of individual daily defined doses (DDD). Second, we analyzed the number of admissions to any public acute health-care hospitals for constipation complications. Third, a cross prevalence study was performed to estimate the point constipation prevalence on December 2016. RESULTS A mean consumption of oral laxatives around 1 DDD per stay and 1 enema per 100 stays was found. A total of 192 admissions potentially associated with constipation complications were recorded. At the time of the study, approximately half of admitted patients had at least one laxative prescribed. CONCLUSIONS Our study highlights the important burden constipation represents in psychiatric inpatients. Although frequently neglected, it can lead to serious adverse clinical consequences.
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Affiliation(s)
- Unax Lertxundi
- a Pharmacy Service , Araba Mental Health Network , Vitoria-Gasteiz , Spain
| | - Rafael Hernandez
- b Internal Medicine Service , Araba Mental Health Network , Vitoria-Gasteiz , Spain
| | - Sonia San Miguel
- c Internal Medicine Service , Zaldibar Psychiatric Hospital, Bizkaia Mental Health Network , Zaldibar , Spain
| | - Beatriz Corcostegui
- d Pharmacy Service , Bermeo Psychiatric Hospital, Bizkaia Mental Health Network , Bermeo , Spain
| | - Marta Prieto
- e Pharmacy Service , Zaldibar Psychiatric Hospital, Bizkaia Mental Health Network , Zaldibar , Spain
| | - Unai Gonzalez
- f Pharmacy Service , Zamudio Psychiatric Hospital, Bizkaia Mental Health Network , Zamudio , Spain
| | - Anunciacion Arana
- f Pharmacy Service , Zamudio Psychiatric Hospital, Bizkaia Mental Health Network , Zamudio , Spain
| | - Juan Medrano
- g Psychiatry Service , Bizkaia Mental Health Network , Portugalete , Spain
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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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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service; Alava´s Psychiatric Hospital; Arabas´s Mental Health Network; Vitoria-Gasteiz Araba, Spain
| | - Beatriz Corcóstegui
- Pharmacy Service; Bermeo´s Psychiatric Hospital; Bizkaia´s Mental Health Network; Bermeo Bizkaia Spain
| | - Marta Prieto
- Pharmacy Service; Zaldibar´s Psychiatric Hospital; Bizkaia´s Mental Health Network; Zaldibar Bizkaia Spain
| | - Unai Gonzalez
- Pharmacy Service; Zamudio´s Psychiatric Hospital; Bizkaia´s Mental Health Network; Zamudio Bizkaia, Spain
| | - Anunciación Arana
- Pharmacy Service; Zamudio´s Psychiatric Hospital; Bizkaia´s Mental Health Network; Zamudio Bizkaia, Spain
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Lertxundi U, Isla A, Solinís MÁ, Echaburu SD, Hernandez R, Peral-Aguirregoitia J, Medrano J, García-Moncó JC. Medication errors in Parkinson's disease inpatients in the Basque Country. Parkinsonism Relat Disord 2017; 36:57-62. [PMID: 28065403 DOI: 10.1016/j.parkreldis.2016.12.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) medication errors, including both missing dopaminergic drug doses and antidopaminergic usage, have been suggested as risk factors for prolonged hospital stays. The objective of this study was to evaluate the prevalence of such errors in PD patients admitted to public acute-care hospitals in the Basque Country over a two year period and their association with clinically relevant adverse health outcomes, such as length of hospital stay and mortality. METHODS All PD patients admitted to any of the 11 public acute-care hospitals in the Basque Country in 2011-2012 were included. Medication errors involved incorrect timing or the complete omission of administration for dopaminergic drugs, and the administration of centrally acting antidopaminergics. A logistic regression and a competing risk analysis were applied to verify whether those errors affected intrahospital mortality and length of stay. RESULTS The study included 1628 patients admitted 2546 times. Medication errors, affecting almost one third of admissions and half of patients, were associated with higher mortality: inappropriately omitted dopaminergic drug doses OR = 1.92 CI 95% (1.34-2.76); inappropriate antiemetic administration OR = 2.15 CI 95% (1.36-3.39); and inappropriate antipsychotic administration OR = 1.91 CI 95% (1.33-1.73). Inappropriately omitted doses and both inappropriate antipsychotic and antiemetic administration were associated with a significant 4-day increase in median hospital stay. CONCLUSION Medication errors (missing dopaminergic drug doses and centrally acting antidopaminergic use) are not only associated with increased length of hospital stays in PD patients, but also with a higher mortality rate.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba Mental Health Network, C/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
| | - Arantxa 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
| | - María Ángeles 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
| | - Saioa Domingo- Echaburu
- Pharmacy Service, Alto Deba Integrated Health Organization, Avda. Nafarroa 16, 20500 Arrasate Gipuzkoa, Spain
| | - Rafael Hernandez
- Internal Medicine Service, Araba Mental Health Network, C/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | | | - Juan Medrano
- Psychiatry Service, Bizkaia Mental Health Network, Portugalete, Bizkaia, Spain
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