Background Posaconazole (PSZ), is an antifungal prophylactic therapy that is used in haematological cancer patients. In 2010, PSZ was added to the formulary of the National Centre for Cancer Care & Research (NCCCR), the only adult cancer hospital in Qatar. Objective To conduct a drug use evaluation (DUE) study of PSZ at NCCCR. Method A retrospective, single centred, observational DUE study was conducted to include a convenient sample of haematological cancer patients who used PSZ prophylactically in 2010. All 31 patients were nominated; 20 patients profiles were reviewed. Data were collected using a pre-prepared collection sheet and descriptive analysis was performed. Results One patient was excluded as he was not a haematological cancer patient. All remaining 19 patients received PSZ for prophylaxis and were compliant. More than 50% of patients received proton pump inhibitors concurrently with PSZ. Only 1 case had a recorded recommendation regarding the administration of PSZ with food. Five patients received a vincristine based chemotherapy protocol, one of which developed seizures. Two patients developed mild breakthrough fungal infection while on PSZ. Conclusions The PSZ practice in NCCCR abides by its regulations of use. However, clear recommendations regarding administration of PSZ with meals is essential. PSZ co-administration with proton pump inhibitors should be either stopped or managed by PSZ therapeutic drug monitoring to avoid PSZ sub-therapeutic levels. Possible serious drug interactions in patients treated with vincristine based chemotherapy should be highlighted and monitored.
SummaryWhat is known and objective: It has been suggested that pyridoxine has an antilactogenic effect. Studies of the efficacy of pyridoxine in suppressing lactation have reported conflicting results. The aim of this review was to evaluate the effectiveness and safety of high-dose pyridoxine in post-partum lactation inhibition. Methods:This systematic review included published trials that compared the efficacy and/or safety of pyridoxine to placebo or to other pharmacological agents for the inhibition of post-partum lactation. We searched PubMed, Embase, ScienceDirect, CINAHL, AMED, the Cochrane library and the clinical trials registry to identify relevant literature. No limit was imposed on the year of publication of the studies, and the review included studies published until 15 January 2016. Two reviewers independently extracted data and assessed the risk of bias. Results and discussion:Seven studies were included, with a total of 1155 women, of which 471 women received pyridoxine. Three studies were randomized controlled trials, whereas the remaining four studies were non-randomized controlled trials. All of the included studies were relatively small (n=18-482). The studies compared pyridoxine with placebo, bromocriptine and/or stilboestrol. Pyridoxine was given orally, with a total daily dose of 450-600 mg for 5-7 days. Two trials (n=349 participants) indicated that pyridoxine was effective in inhibiting lactation in approximately 95% of the enrolled patients. All other studies failed to demonstrate pyridoxine efficacy through either clinical assessment or prolactin level measurements. Pyridoxine safety was assessed by two trials in which no serious untoward side effects were reported. Overall, the risk of bias for most of the studies was low to moderate.What is new and conclusion: Current evidence supporting the effectiveness of highdose pyridoxine in the inhibition of post-partum lactation is inconsistent and insufficient. Larger randomized trials are needed to confirm the efficacy of pyridoxine in post-partum lactation inhibition. K E Y W O R D Sbreastfeeding, lactation inhibition, lactation suppression, pyridoxine, vitamin B6
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