Background Drug compliance is a cause for concern in every medical speciality. Particularly in Psychiatry, the adherence rate to pharmacological treatment seems to be lower than in other areas. This may be due to the length and complexity of treatments and the adverse reactions they may trigger. Modified-Release Oral Psychotropic Drugs (MROPD) are helpful tools as they allow both treatment simplification and reduction in the incidence and severity of adverse drug reactions, hence easing drug compliance. Purpose The aim of this study is to analyse the prescription of MROPD and compare their posologies with the approved ones on the Summaries of Product Characteristics (SPC). Materials and methods 1 month observational, retrospective study on the prescription of MROPD used on the acute Psychiatric ward in a third level hospital. Results 411 prescriptions for MROPD were included. The distribution was as follows: 38% (155) venlafaxine, 19% (78) valproate, 17% (71) alprazolam, 10% (41) quetiapine, 9% (37) lithium and 7% (29) biperiden. 33% (134) prescriptions were not correct according to the SPCs. Long-acting venlafaxine accounted for 68% (105) of these prescriptions, just in one case the posology was corrected from 75 mg 1-0-1 to 150 mg 1-0-0. Retard alprazolam was prescribed incorrectly in 25% (18) of the occasions, quetiapine in 15% (8) and lithium in the 35% (13) of the instances. Valproate and biperiden posologies were correct 100% of the times these drugs were prescribed. Conclusions Discrepancies between SPC recommendations and real use of MROPD commonly occur, which means added risk for the patients. Pharmacists may make interventions such as suggesting simplification of treatments to improve compliance and educating clinicians on different prolonged-release preparations to promote the safer use of psychotropic drugs. No conflict of interest.
Background Pancreatic cancer is one of the most deadly forms of cancer. Standard treatment in metastatic disease is the quemotherapy with gemcitabine, but there is not a standard therapy for gemcitabine-refractory patients. Purpose Assess the off-label efficacy of nab-paclitaxel, in patients who progressed on gemcitabine-based therapy, in our hospital. Materials and Methods Observational retrospective study of pancreatic cancer patients treated with nab-paclitaxel who progressed on gemcitabine-based therapy from June 2011 to April 2012. Data were collected from clinical history, Oncofarm® and Omega3MIL® programmes. We determined: Progression free survival (PFS) and Overall Survival (OS). 12 patients (100% male) were treated with nab-paclitaxel. Eleven of them presented metastatic desease. The patients were treated with two therapies: nab-paclitaxel 100 mg/m2 (1.8,15/28d). 5 patients received this treatment. Median age was 79.4 years (sd = 4.2 years) Gemcitabine 1000 mg/m2 plus nab-paclitaxel 100 mg/m2 (1.8,15/28d): 7 patients received this treatment; Median age was 65.5 years (sd = 6.9 years). Results Median PFS was 2,8 months (95% CI, 1.5 to 4.1 months) with single agent, and 5.3 months (95% CI, 4.0 to 6.5 months) with gemcitabine plus nab-paclitaxel. The PFS in the study was 20% and 83% respectively. The OS couldn’t be determine in the nab-paclitaxel group, because there wasn’t any event during the study period. The OS with gemcitabine plus nab-paclitaxel was 66.7%. Conclusions It showed better clinical outcomes in the gemcitabine plus nab-paclitaxel group in PFS. The nab-paclitaxel can be an effective second-line chemotherapy in gemcitabine resistant patients. No conflict of interest.
BackgroundLinezolid is an antibiotic which has been reported to possess monoamine oxidase (MAO) inhibitory effects. According to the prescribing information, it should not be used with MAO inhibitors, considering that such drugs may enhance its toxic effects, including side effects such as hypertension and serotonin syndrome (SS). SS is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It may include mental status changes, autonomic dysfunction and neuromuscular abnormalities.Although this interaction is well reported, the MAOI properties of linezolid are not very well known.PurposeTo detect interactions between linezolid and serotonergic modulators (X risk according to the Lexi Comp classification) and the appearance of SS.Material and methodsAn observational retrospective study of patients treated with linezolid was made over two months (January–February 2014). The clinical history of every patient was checked, looking for associated prescriptions with serotonergic agonists in order to detect symptoms related to the SS. The possibility of other drug interactions was ruled out.ResultsIn two months 90 patients received antimicrobial treatment with linezolid (aged 15 to 89 years, 63.3% were male).18.8% of the patients were also taking serotonergic psychiatric drugs such as clomipramine, trazodone, citalopram, escitalopram, venlafaxine and aripiprazole.Looking over the clinical history in these patients, it was found that four of them met clinical criteria for SS (confusional states, agitation and high heart rate). None of the symptoms were referred as having an iatrogenic cause.ConclusionAlthough an interaction was detected that can lead to symptoms related to SS, neither of the drugs were referred to as possible sources of an interaction in the clinical history.We strongly recommend a pharmacist check of the whole treatment with the purpose of informing the physician about any interactions of this type. Moreover, some patients will continue the treatment with oral linezolid at home, and they should be made aware of any possible symptoms.References and/or acknowledgementsNo conflict of interest.
BackgroundEribulin is a chemotherapy agent approved for metastatic breast cancer treatment after at least one regimen including an anthracycline and a taxane.There is no standard treatment for heavily pretreated patients but there are other available options, such as capecitabine, vinorelbine and gemcitabine. Eribulin is the only one which has significantly increased overall survival (OS).PurposeTo evaluate the safety and efficacy of eribulin in a third level hospital.Material and methodsAn observational retrospective study was done with the archives of patients treated with eribulin from August 2012 to August 2015. We collected age, oestrogen and HER-2 receptor status, sites of metastasis, tolerance to eribulin, lines and cycles of treatment, progression free survival (PFS) and OS of 25 patients.ResultsMedian age was 59 years (range 33–81). 84% were oestrogen receptor positive, 8% HER-2 positive and 12% triple negative.Median lines of treatment was 4 (range 3–8), and median number of cycles received was 4 (range 2–13).Only 32% could tolerate the full dosage; 52% had 80% dose reduction and 16% had 60% does reduction due to side effects, the most common being fatigue (72%) and neutrophenia (24%, 4 patients suffered from grades 3–4).72% of patients had taken capecitabine before, 56% gemcitabine and 36% vinorelbine.At the time of the report only 2 patients were still in treatment with a follow-up of 7.9 and 1.7 months. Median PFS was 2.6 months (0.3–10.3) and the OS of the 15 patients who had died was 7.7 months (0.7–16.7).ConclusionIn our case, PFS and OS were lower than in the clinical trial EMBRACE: 3.6 and 13.2 months, respectively. The reason could be that our patients received more lines of treatment before eribulin compared with the trial (maximum 5), and our sample size was smaller.Choice of suitable treatment should be adapted to each patient regarding their quality of life. Because of its easy administration and manageable toxicity, eribulin is a good option in sequential monotherapy, but with regard to cost effectiveness, capecitabine should be consider first, according to published studies.No conflict of interest.
BackgroundThe use of protease inhibitors in the treatment of hepatitis C virus (HCV) infection has significantly increased the recovery rate.PurposeTo analyse the efficacy of triple therapy – telaprevir (TVP), peginterferon (P-IFN) and ribavirin (RBV) – as treatment for HCV genotype 1.Material and methodsRetrospective and observational study of patients who finished the triple therapy from September 2012 to January 2014.The following data was gathered: age, sex, genotype, stage of hepatic fibrosis (FibroScan), frequencies of IL28B polymorphisms, response in case of pre-treatment, viral levels before starting treatment and 4, 12, 24 and 48 weeks afterwards (RT-PCR), as well as sustained virological response (SVR).Data was obtained from the Electronic Clinical History (Jimena), Outcome Patients Program (Farmatools) and the laboratory program (Omega 3000 and 4000).ResultsOf the 24 patients studied – 19 of whom were men – 2 were co-infected with HIV and another one with HBV. 33.33% of them were treatment-naïve, 25% null responders, 20.83% partial responders, 16.67% relapsers and 4.17% unknown. Genotypes 1a, 1b, 1c corresponded to 8, 9 and 1 patients respectively, 6 unknown. Hepatic fibrosis stage F4/F3/F2/F0–1 corresponded to 54.16%, 37.5%, 4.17% and 4.17% respectively. Two patients started the treatment with F < 3 because of several extrahepatic symptoms (MALT lymphoma and Porphyria Cutanea Tarda). IL28B polymorphisms were 50% CT, 33.33% CC, 12.5% TT and 4.16% not specified. The average viral load pre-treatment was 3,496,125 IU/ml (log = 6.54).83.33% of patients achieved an undetectable viral load after 4 weeks, maintained after 12, 24 and 48 weeks, except for one patient. Two patients achieved viral suppression in the 12th week. The load did not decrease for the other two patients, therefore it was stopped. All of them improved, by at least one fibrosis stage.ConclusionThe introduction of TVP in HCV genotype 1 treatment increased the SVR rate for all patients, and was effective for 87.5% of them. There is a relationship between SVR and IL28B polymorphism, being 100% effective for CC patients and 80% for T allele carriers (CT and TT)References and/or AcknowledgementsNo conflict of interest.
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