In this study, nearly half of the geriatric outpatients attending a diagnostic day clinic who were taking more than one drug were candidates for DDIs. One-quarter of these patients were found to have possible adverse events or diminished treatment effectiveness that may have been at least partly caused by these DDIs. These potential interactions can be identified through clinical evaluation. In the majority of patients (99 of 172) the potential interactions resulting in possible ADRs or diminished effectiveness were not present in the 'Top Ten' interactions described by a national database of public pharmacies, a finding that emphasizes that the particular characteristics of geriatric patients (e.g. frequent psychiatric co-morbidities) need to be considered when evaluating their drug use. At least 7% of all patients taking more than one drug, and 80% of those with possible drug interactions whose drug regimen was adjusted, benefited from changes made to their drug regimens.
Aims To study the effect of fluconazole on the steady‐state pharmacokinetics of the protease inhibitors ritonavir and saquinavir in HIV‐1‐infected patients.
Methods Five subjects treated with saquinavir and three with ritonavir received the protease inhibitor alone (saquinavir 1200 mg three times daily, ritonavir 600 mg twice daily) on day 1, and the same protease inhibitor in combination with fluconazole (400 mg on day 2 and 200 mg on days 3 to 8). Pharmacokinetic parameters were determined on days 1 and 8.
Results In the saquinavir group, the median increase in the area under the plasma concentration vs time curve was 50% from 1800 µg l−1 h to 2700 µg l−1 h (P = 0.04, median increase: 900 µg l−1 h; 2.5 and 97.5 percentile: 500–1300), and 56% for the peak concentration in plasma (from 550 to 870 µg l−1, P = 0.04; median increase: 320 µg l−1 h, 2.5 and 97.5 percentile: 60–450 µg l−1). In the ritonavir group, there were no detectable changes in the pharmacokinetic parameters on addition of fluconazole.
Conclusions Because of the favourable safety profile of saquinavir, dose adjustments are probably not necessary with concomitant use of fluconazole, as is the case for ritonavir.
The authors describe the development of a population pharmacokinetic model using NONMEM for itraconazole and its active metabolite hydroxyitraconazole in a Thai cohort of HIV-infected patients who were using itraconazole as an addition to their antiretroviral therapy. The data were best described with an open two-compartment model for both itraconazole and hydroxyitraconazole. The model adequately described the data and provided population pharmacokinetic parameters which were not different from those described for other populations. The authors found that concomitant use of co-trimoxazole leads to a reduced formation rate (-51%) of hydroxyitraconazole.
With the commercial availability of a cream (EMLA) containing a eutectic mixture of local anaesthetics, 2.5% (w/w) lidocaine and 2.5% (w/w) prilocaine, effective topical anaesthesia of the intact skin is possible without the need for subcutaneous injections or exposure to high concentrations of local anaesthetics. In our hospital a topical anaesthetic product was designed for the same purpose. The home-made product contains a eutectic mixture of a local anaesthetic (5% w/w) and l-menthol (1% w/w). Prilocaine was used as the local anaesthetic because it is known for its safety and its well investigated analgesic effects. The eutectic mixture of prilocaine and l-menthol was mixed with a carbopol hydrogel (1% w/w). Preliminary testing of this anaesthetic hydrogel in our hospital has yielded satisfactory results. The anaesthetic hydrogel was found to be stable after at least 3 months' storage at ambient temperature.
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