Multiple Drug Interactions Research Articles

Multiple drug interactions

Multiple drug interactions

Glibenclamide and multiple drug interactions

Glibenclamide and multiple drug interactions

Traitement de la douleur du sujet âgé

The elderly patient's pain is undervalued and difficult to manage because of the multiple co-morbidities and drug interactions specific. While several international recommendations exist for the management of pain management in the elderly patient, a French multidisciplinary consensus of experts in pain and geriatrics was published in 2017. Analgesics can be used in elderly patients by following certain precautions. It will mainly be necessary to introduce the treatments one by one in order to monitor their own efficacy and their tolerance, it will be necessary to adapt the dosages to: the age, hepatic or renal failure and especially the co-prescriptions. In order to optimize the treatment, the combination of non-pharmacological therapies must be considered and proposed. Finally, to promote adherence, it will be important to explain to the patient and his entourage the treatment put in place, its expected benefit, and its potential adverse effects.

Direct Oral Anticoagulants in Octogenarians With Atrial Fibrillation: It Is Never Too Late.

Atrial fibrillation is the most common arrhythmia in clinical practice, and age is one of the strongest predictors/risk factors for ischemic stroke in patients with atrial fibrillation. Elderly patients, in particular patients aged 80 years and older, are at higher risk of both ischemic and bleeding events compared with younger patients. Vitamin K antagonists (VKAs) reduce the risk of ischemic stroke, especially in the elderly, but increase the bleeding risk. In addition, frequent international normalized ratio monitoring is needed to ensure the optimal level of anticoagulation. Furthermore, VKAs have multiple drug and food interactions. Direct oral anticoagulants (DOACs) have recently emerged as alternatives to VKAs and are gradually increasing their popularity mainly because of their fewer drug and food interactions and ease of use. Their effectiveness and safety have been well-established in the general population, but the benefit in the very elderly (≥80 years old) is still unclear. Data about the safety and the effectiveness of DOACs in patients older than 75 years are available in literature, but the evidences of the use of DOACs in patients aged 80 years and older are lacking. This review aims to give light to the differences, in terms of benefits and safety, of the DOACs in this subset of patients.

Previously published drug interaction models predict loss of response for transoesophageal echocardiography sedation well but not response to oesophageal instrumentation

Response surface models (RSMs) were used to predict effects of multiple drugs interactions. Our study was aimed to validate accuracy of the previous published volunteer models during transoesophageal echocardiography (TEE). This is a cross-sectional study with 20 patients scheduled for transesophageal echocardiography in Taipei Veterans General Hospital, Taiwan. Effect-site concentration pairs of alfentanil and propofol were recorded and converted to equivalent remifentanil and propofol effect-site concentrations. Observer’s Assessment of Alertness/Sedation (OAA/S) scores were assessed every 2 minutes. Using these data, previous published models of loss of response (LOR), intolerable ventilatory depression (IVD), and loss of response to esophageal instrumentation (LREI) were then estimated. Accuracy of prediction is assessed by calculating the difference between the true response and the model-predicted probability. Clinical events such as interruption of TEE were recorded. The average procedure time was 11 minutes. Accuracy for prediction of LOR and LREI is 63.6% and 38.5%, respectively. There were four patients experienced desaturation for less than 1 minute, which were not predicted by IVD model, and one interruption of TEE due to involuntary movement. The previous published drug-interaction RSMs predict LOR well but not LREI for TEE sedation. Further studies using response surface methodology are needed to improve quality for TEE sedation and clinical implementation.

Multiple drugs interaction

Multiple drugs interaction

Multiple drug interaction

Multiple drug interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Outcomes Following Macrolide Use in Kidney Transplant Recipients.

Background:Calcineurin inhibitors (CNI; cyclosporine, tacrolimus) are critical for kidney transplant immunosuppression, but have multiple potential drug interactions, such as with macrolide antibiotics. Macrolide antibiotics (clarithromycin, erythromycin, and azithromycin) are often used to treat atypical infections. Clarithromycin and erythromycin inhibit CNI metabolism and increase the risk of CNI nephrotoxicity, while azithromycin does not.Objective:To determine the frequency of CNI-macrolide co-prescriptions, the proportion who receive post-prescription monitoring, and the risk of adverse drug events in kidney transplant recipients.Design:Retrospective cohort study.Setting:We used linked health care databases in Alberta, Canada.Patients:We included 293 adult kidney transplant recipients from 2008-2015 who were co-prescribed a CNI and macrolide.Measurements:The primary outcome was a composite of all-cause hospitalization, acute kidney injury (creatinine increase ≥0.3 mg/dL or 1.5 times baseline), or death within 30 days of the macrolide prescription.Methods:We identified CNI-macrolide co-prescriptions and compared outcomes in those who received clarithromycin/erythromycin versus azithromycin. We used a linear mixed-effects model to examine the mean change in serum creatinine and estimated glomerular filtration rate (eGFR).Results:Of the 293 recipients who were co-prescribed a CNI and a macrolide, 38% (n = 112) were prescribed clarithromycin/erythromycin while 62% (n = 181) were prescribed azithromycin. Compared with azithromycin users, clarithromycin/erythromycin users were less likely to have outpatient serum creatinine monitoring post-prescription (56% vs 69%, P = .03). There was no significant difference in the primary outcome between the 2 groups (17% vs 11%, P = .11); however, the risk of all-cause hospitalization was higher in the clarithromycin/erythromycin group (10% vs 3%, P = .02). The mean decrement in eGFR was significantly greater in the clarithromycin/erythromycin versus azithromycin group (−5.4 vs −1.9 mL/min/1.73 m2, P < .05).Limitations:We did not have CNI levels to correlate with the timing of CNI-macrolide co-prescriptions. We also did not have information regarding the indications for macrolide prescriptions.Conclusion:Clarithromycin and erythromycin were frequently co-prescribed in kidney transplant recipients on CNIs despite known drug interactions. Clarithromycin/erythromycin use was associated with a higher risk of hospitalization compared with azithromycin users. Safer prescribing practices in kidney transplant recipients are warranted.

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Pharmacogenetics of Warfarin Therapy.

A substantial burden of cardiovascular disease results from thrombosis that manifests clinically as acute coronary syndrome, stroke, and venous thromboembolism. Although antithrombotic drugs have been shown to reduce thrombotic events, there exists considerable variability in response to many of these drugs that affects the relative efficacy and safety in individual patients. Clinical, environmental, and genetic factors contribute to variability in drug response. A recent trial (1) has provided important insights into how pharmacogenomics offers an opportunity for personalized medicine through the identification of medically actionable variants to help determine an optimal dosing regimen for warfarin. Vitamin K antagonists, such as warfarin, are the most frequently prescribed oral anticoagulants used worldwide and are indicated for patients across the spectrum of cardiovascular disease, including those with or at risk for venous thromboembolism (deep venous thrombosis and pulmonary embolism), atrial fibrillation (AF),2 and mechanical heart valves. Warfarin's mechanism of action is the prevention of γ-carboxylation of the vitamin K-dependent coagulation factors prothrombin (factor II), factor VII, factor IX, and factor X. Although warfarin and other vitamin K antagonists are highly effective in reducing thromboembolism, their use is limited by multiple genetic, food, and drug interactions, as well as a narrow therapeutic index that necessitates frequent monitoring and dose adjustments, resulting in considerable bleeding risk and inconvenience. Even with frequent monitoring and dose adjustments, patients taking vitamin K antagonists spend about a third of the time outside the standard target therapeutic range [international normalized ratio (INR), 2.0–3.0]. A substantial portion of interindividual variability in the metabolism and response to warfarin is explained by genetic polymorphisms in cytochrome P450 family 2 subfamily C member 9 ( CYP2C9 ) …

Multiple drugs interactions

Multiple drugs interactions

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction

Multiple drugs interaction