IntroductionAlthough combination therapies are generally used to achieve better therapeutic results, drug-drug interactions (DDIs) can lead to life-threatening adverse reactions (ADRs) or therapeutic failure by changing the therapeutic efficacy of drugs. DDIs have been reported to cause 4% of drug-related emergency visits (1). Changes in the pharmacokinetic properties of drugs may produce adverse drug reactions or therapeutic failure. The pharmacodynamics of DDIs can produce additive, synergistic, or antagonistic pharmacological effects (2).ADRs can be considered an important public health problem, particularly in the elderly patients (3). Polypharmacy and DDIs play critical roles in the production of ADRs and are related to an increased risk of mortality (4,5). Among identified adverse drug events, preventable adverse drug events have been reported to be 27% in primary care and 42% in long-term care, where prescribing and monitoring stages of pharmaceutical care were emphasized for prevention of adverse drug events (6,7). Potentially inappropriate medications have been identified in Beers Criteria (8), which aimed to prevent poor outcomes in elderly patients such as ADRs, hospitalization, morbidity, or mortality (8). In the elderly population DDIs can be diagnosed as severe adverse outcomes (9). Increased sensitivity to DDIs in elderly patients and the most frequent ADRs experienced by this age group have been shown in many studies (10-12). Elderly patients exposed to polypharmacy are at high risk of DDIs that depend on agerelated changes in pharmacokinetics or pharmacodynamics of drugs, and multiple co-morbidities.Another important factor for the increased vulnerability of elderly patients to DDIs can be poor compliance, underuse, overuse, or misuse of the medications (13). Moreover, elderly patients who will undergo surgical treatment or treatment in an intensive care unit have been reported to have a high risk for the occurrence of DDIs ( 14). Although there are publications investigating the use of inappropriate drugs in Turkish elderly patients (15,16), there are no data evaluating potential DDIs in Turkish elderly patients.Background/aim: Elderly patients are at high risk from drug-drug interactions (DDIs). This study evaluates the potential DDIs in Turkish elderly patients at a primary health care outpatient clinic. Materials and methods:Online database systems were used to examine DDIs on the prescriptions of patients (n = 1206). The clinical severity of DDIs was classified by the Lexi-Interact Online database.Results: Of the 5059 prescriptions, 33% were found to have DDIs. We detected 29 (0.9%) A, 380 (11.8%) B, 2494 (77.7%) C, 289 (9%) D, and 18 (0.6%) X risk rating category DDIs among the prescriptions. Prescriptions of female patients and patients aged between 65 and 72 years showed significantly higher number of DDIs. The frequency of DDIs increased both with the number of drugs and combined preparations per prescription. Acetylsalicylic acid and salbutamol were the most frequently prescribed drugs ...

This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID‐19 with a positive RT‐PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day 2 and Day 4 of the therapy. Laboratory findings of the patients (n = 21) and in‐hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID‐19. The median favipiravir trough concentration (C0‐trough) on Day 2 was 21.26 (interquartile range [IQR], 8.37–30.78) μg/mL, whereas it decreased significantly to 1.61 (IQR, 0.00–6.41) μg/mL on Day 4, the area under the concentration–time curve decreased by 68.5%. Day 2 C0‐trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID‐19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.

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Background:If used during pregnancy it is known that colchicine passes through the placenta to the fetus1. Although it has been shown to increase the risk of congenital malformations in animal studies, there is no increase in undesirable results in humans2. The guidelines indicate that the use of colchicine in pregnancy and lactation is appropriate3,4. However, data from clinical studies and case reports for the use of colchicine during pregnancy are not sufficient.Objectives:The aim of this study was to evaluate pregnant and/or nursing patients who were consulted to our teratology information center for colchicine use.Methods:Colchicine treated patients during pregnancy was included in this study. Patients consulted to our information service between 2012- 2018 were evaluated for risk assessment of colchicine. Information regarding pregnancy outomes was recorded by telephone interviews with patients.Results:Indications for colchicine use in 34 cases (33 patients; one of them had pregnancy twice) were familial Mediterranean fever (n=21), Behcet’s disease (n=9), systemic lupus erythematosus (n=1), ankylosing spondylitis (n=1) and vasculitis (n=1). Of the cases, 22 used the drug in pregnancy and lactation, 12 used only in pregnancy period. Of the 34 pregnancies, three had elective termination of pregnancy (the reason in one case was cytomegalovirus infection, the other is unplanned-unwanted and the other was unknown) and three had spontaneous abortion.Twenty eight had given birth, 19 of them were term and 9 of them were preterm. Delivery mode of 18 were caesarean and 10 of them were vaginal birth. A total of 30 live birth infant (two twins) exposed to colchicine due to their mother’s treatment. Twenty three infant was healthy and the remaining 7 had different problems. Four of them cardiac [minor cardiac septal defect which not needs operation (n=2), pink tetralogy of fallot (n=1), heart valve stenosis (n=1)], nephrolithiasis, inguinal hernia and death (respiratory distress after birth) (table 1).Conclusion:Currently, systematic review and meta-analysis driven data suggests that colchicine does not significantly increase the incidence of foetal malformations or miscarriage and colchicine for FMF should not be withheld on this basis during pregnancy. Although the causality between colchicine use and the above reported mostly cardiac and rare problems such as tetralogy of fallot is not proven, the contribution of colchicine cannot be ruled out totally and should be beard in mind in cases of colchicine use for indications other than FMF or Behçet’s disease.References: [1] Indraratna PL, et al. Use of colchicine in pregnancy: a systematic review and meta-analysis. Rheumatology (Oxford). 2018 Feb 1;57(2):382-387.[2] reprotox.org[3] Götestam Skorpen C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810.[4] .Breastfeeding and Maternal Medication. World Health Organization, Geneva, Switzerland,1995Table 1List of unhea...