Background Polypharmacy and the use of a particular group of drugs including benzodiazepines, neuroleptics, antidepressants, antihypertensives, diuretics, acetylcholinesterase inhibitors and proton pump inhibitors have been associated with the risk of falls and subsequent hip fracture (HF). Purpose Assess the association between polypharmacy and the use of drugs related to falls and analyse the mortality in older patients with HF. Materials and methods This is a population-based retrospective case-control study. The case group consists of patients aged≥75 years admitted to a tertiary hospital with HF after accidental fall during the year 2010. 61 patients without HF of internal medicine service were randomised as the control group. To compare comorbidity between both groups Charlson index was used. SPSS was used to estimate update Bayesian OR and 95% credible intervals (CI). Results 61 patients were admitted with HF. The relationship in the control group was 1:1. Mean age 83.3±4.8 years (60.7% women) for the case group versus 81.97±4.04, p=0.12. The number of drugs consumed was 7.2±3.3 in older with HF versus 4.9±2.1, p<0.05. Statistically significant differences were founded (p<0.05) in: benzodiazepines (OR 3.87, CI 1.77 to 8.46); antidepressants (OR 3.26, CI 1.18 to 9.02) and diuretics (OR 2.58, CI 1.24 to 5.39). The 34.42% of patients with HF died before 1 year, compared to 9.8% in the control group (p <0.05, OR 5.7, 95% CI 2.1 to 15). Mean Charlson index was 4.16 for HF and 3.62 for control group (p=0.14). Conclusions The risk of HF in the older increases with the number of medications taken and the use of benzodiazepines, antidepressants and diuretics. The mortality in the older with HF is three times higher than the control group, which is consistent with published studies. These studies show death rate among 17–33% after the first year of suffering HF>.
ObjectivesTo identify the independent risk factors of primary non-adherence to chronic concomitant treatment in HIV-positive patients, and to measure primary and secondary non-adherence rates to chronic treatments, and secondary non-adherence to antiretroviral therapy and the prevalence of concomitant chronic diseases.MethodsWe conducted a retrospective study that included HIV-infected patients with antiretroviral treatmentwho attended the pharmaceutical care office between January and December 2012. The dependent variable was primary non-adherence to concomitant prescription drugs for chronic diseases. To know the predictors of concomitant primary non-adherence, we performed a univariate analysis and a multivariate binary logistic regression model to identify the independent predictors of primary non-adherence to co-medication.ResultsOut of 598 patients analysed, 333 patients had a new co-medication prescribed during the studied period. The number of comorbidities per patient was 2.3 and the patients were treated with an average of 3.4 drugs. The rates of primary and secondary non-adherence to co-medication were 8.4% and 44.4%, respectively. The co-occurrence of primary and secondary non-adherence was 24.9%. The number of comorbidities (p=0.001) and co-medications (p=0.001) was significantly higher in patients who had primary non-adherence to co-medication. Furthermore, there was a statistically significant relationship between primary non-adherence and patients treated with psychotropic drugs (p=0.03). The multivariate analysis showed the independent predictor of primary non-adherence to co-medication was the number of co-medications (p<0.001).ConclusionOne-third of new concomitant medications prescribed to HIV-positive patients were never filled from the pharmacy. The number of co-medications was identified as a predictor of primary non-adherence to chronic concomitant treatment in HIV-infected population.
BackgroundImatinib has a high likelihood of drug interactions due to hepatic oxidative metabolism.PurposeTo evaluate the incidence and severity of interactions between imatinib and home treatment of oncohaematology patients.Material and methodsRetrospective observational study of oncohaematology patients treated with imatinib between January and March 2014. The following data were collected: age, sex, diagnosis, date of start and end of treatment with Imatinib and concomitant prescribed medicines. Imatinib interactions with other drugs were assessed by the software tool Micromedex 2.0. These were classified as: contraindicated, severe, moderate and mild.Results24 patients were included. 58% were men (n = 14) with a mean age of 61 years. The main indication for imatinib was chronic myeloid leukaemia (54%). 164 prescriptions were analysed. The most prescribed therapeutic groups were: analgesics (19%), antidepressants and anxiolytics (16%), antihypertensives (11%) and gastric protectors (10%). 16 interactions between imatinib and concomitant treatment were detected, affecting 50% of patients. 69% were severe interactions and 31% moderate interactions. 6 patients had one severe interaction, 2 had two severe interactions, 1 patient suffered a severe and a moderate interaction and 2 patients each had two moderate interactions. Severe interactions were due to paracetamol (n = 8), acenocoumarol (n = 2) and amiodarone (n = 1). Moderate interactions were for itraconazole (n = 2), tamsulosin (n = 1), ketoconazole (n = 1) and levothyroxine (n = 1). The effect of severe interactions was reviewed and no clinical relevance was detected to date. These patients were selected for special monitoring by the pharmacist.ConclusionLike other studies on the subject, our study shows that there are numerous interactions between imatinib and other drugs. The interactions detected are severe or moderate. It is important to keep track of patients treated with imatinib who take paracetamol due to the very frequent use of this drug.ReferenceFarm Hosp 2014;38(4):338–363No conflict of interest.
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