Systematic comparison of four sources of drug information regarding adjustment of dose for renal function

Vidal, Liat; Shavit, Maya; Fraser, Abigail; Leibovici, Leonard

doi:10.1136/bmj.38476.471088.3a

Cited by 101 publications

(68 citation statements)

References 2 publications

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“…Moreover, there is a confirmed lack of consistency in the different consulted sources. This situation is also found in the general dosage recommendations as well as in the available kinetic data of drugs, mainly in the E H , as it happens in the adjustment for renal insufficiency (25).…”

Section: Discussionmentioning

confidence: 96%

Drug dosage recommendations in patients with chronic liver disease

Periáñez-Párraga

Martínez-López

Ventayol-Bosch

et al. 2012

Rev. esp. enferm. dig.

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Chronic liver diseases (CLD) alter the kinetics of drugs. Despite dosage adjustment is based on Child-Pugh scores, there are no available recommendations and/or algorithms of reference to facilitate dosage regimens.A literature review about dose adjustment of the drugs from the hospital guide -which are included in the list of the WHO recommended drugs to be avoided or used with caution in patients with liver disease-was carried out. The therapeutic novelties from the last few years were also included. In order to do so, the summary of product characteristics (SPC), the database DrugDexMicromedex, the WHO recommendations and the review articles from the last 10 years in Medline were reviewed. Moreover, the kinetic parameters of each drug were calculated with the aim of establishing a theoretical recommendation based on the proposal of Delcò and Huet.Recommendations for 186 drugs are presented according to the SPC (49.5%), DrugDex-Micromedex (26.3%) and WHO (18.8%) indications; six recommendations were based on specific publications; the theoretical recommendation based on pharmacokinetic parameters was proposed in four drugs.The final recommendations for clinical management were: dosage modification (26.9%), hepatic/analytical monitoring of the patient (8.6%), contraindication (18.8%), use with caution (19.3%) and no adjustment required (26.3%).In this review, specific recommendations for the practical management of patients with chronic liver disease are presented. It has been elaborated through a synthesis of the published bibliography and completed by following a theoretical methodology.

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Section: Discussionmentioning

confidence: 96%

Drug dosage recommendations in patients with chronic liver disease

Periáñez-Párraga

Martínez-López

Ventayol-Bosch

et al. 2012

Rev. esp. enferm. dig.

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“…Previously, Vidal et al and Khanal et al had described six categories of dose adjustment methods [9,16] and we modified their categories. Using this modified classification, we compared the consistency of information and its presentation in each of the five sources.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Concordance Among Different Drug Information Sources Regarding the Recommendations for Dosage Adjustment in Renal Impairment

Choi¹,

Ah²,

Sun³

et al. 2016

Int J Clin Pharmacol Pharmacother

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Background: It is very important to prescribe appropriate drugs and adjust medication and dosage for optimal disease management not only to maximize patient outcomes, but also to minimize adverse events. So, the accuracy of drug information and consistency among different resources would have a significant effect on drug therapy. Objectives: We aimed to evaluate the concordance among five drug information sources regarding the recommendations for dosage adjustment in renal impairment. Methods:The five drug information resources were selected the Korean National Formulary Drug (KNF), the British national formula 2013 (BNF 65), Daily Med in USA, Lexicomp-online, and Drug Prescribing in Renal Failure (DPRF, 5th ed.). After having classified the degrees of renal function and defined the terms used for the dosing methods, we analyzed the concordance in dosing recommendations in renal deficiency among the information sources by calculating Fleiss Kappa. Results: In the dosing adjustments of patients with renal insufficiency, there were some cases of contraindicated drugs that were not matched in each reference. Statistical analysis of the concordance of four references, except DPRF, and evaluation of 168 of the drugs that were mentioned in all four sources showed the Fleiss Kappa coefficientto be 0.243. This indicatesfair agreement among the data. Conclusion: Fair agreement was observed among 4 sources. This may be owing to discrepancies in the frequency of updating drug information sources. We suggest that the quantitative standard be used to classify renal function and to maintain consistency in definition of renal impairment.

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“…However, a previous systematic assessment of drug dosage recommendations for various degrees of renal function revealed that tertiary drug information references may not be suitable for clinical use because of wide variation in the recommendations. 10 The authors of a recent editorial revealed that less than 20% of currently used drugs have been studied in the setting of CRRT.…”

Section: Introductionmentioning

confidence: 99%