Pharmacotherapy最新文献

{"title":"Prevalence of potentially inappropriately prescribed medications among older adults receiving peritoneal dialysis.","authors":"Armando Silva Almodovar, Macarius Donneyong, Eric Seiber, Milap C Nahata","doi":"10.1002/phar.70008","DOIUrl":"10.1002/phar.70008","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of exposure to supratherapeutic doses or contraindicated medications based on renal dosing criteria, also known as potentially inappropriately prescribed medications (PIPM), is currently unknown among patients on peritoneal dialysis (PD). The primary objective of this study was to evaluate the prevalence of PIPM in the first year of PD among Medicare patients in the United States.</p><p><strong>Methods: </strong>This was a retrospective longitudinal cohort analysis of patients starting PD in 2018 in the United States Renal Data System database. Inclusion criteria were patients >65 years of age, continuously enrolled in Medicare Part D for 12 months, and prescribed ≥1 medication(s) at the start of dialysis. Prevalence of exposure to PIPM was determined at the start of dialysis and quarterly over 1 year. Logistic regression evaluated which patient characteristics (age, sex, race, Hispanic ethnicity, rurality, social deprivation index (SDI), United States region, polypharmacy, and diagnosis of diabetes and hypertension) were associated with exposure to ≥1 PIPM at the start of PD.</p><p><strong>Results: </strong>There were 3760 patients included, and 28% were exposed to PIPM at the start of dialysis, and 21.8% were still exposed by the end of the first year. Patients with ≥4 versus <4 medications were at 2.8-14.1 times the odds of being exposed to PIPM (<0.001). Other key characteristics associated with exposure to PIPM were age ≥85 versus <75 years (adjusted odds ratio [aOR] 0.67, 95% confidence interval [CI] 0.48-0.95 p = 0.03), living in the South versus the Northeast (aOR 1.30 95% CI 1.02-1.66, p = 0.04), and diagnosis of diabetes (aOR 1.52, 95% CI 1.29-1.78, p < 0.001).</p><p><strong>Conclusion: </strong>This study found that approximately 20%-30% of patients receiving PD were exposed to PIPM from 2018 to 2019. Results from this study support the need to create medication management programs to decrease exposure to PIPM.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"203-210"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin requirements after switching from GLP-1 receptor agonist to dual GIP/GLP-1 receptor agonist in patients with type 2 diabetes mellitus.","authors":"Alexa M Lahey, Karolyn Duprey, Riley C Montague, Aric D Schadler, Kristina W Naseman","doi":"10.1002/phar.70009","DOIUrl":"10.1002/phar.70009","url":null,"abstract":"<p><strong>Introduction: </strong>With recent clinical implementation of tirzepatide, patients with type 2 diabetes mellitus (T2DM) are transitioning from glucagon-like peptide 1 receptor agonists (GLP-1 RA) to a dual gastric inhibitory polypeptide (GIP)/GLP-1 RA-like tirzepatide. Limited literature is available for insulin dose adjustments for patients concurrently using insulin during this transition. In clinical trials, tirzepatide has shown greater glycated hemoglobin (A1c) reduction and glucose-lowering effects compared to GLP-1 RAs, such as semaglutide, suggesting a potential elevated risk of hypoglycemia without proactive insulin adjustments.</p><p><strong>Objectives: </strong>The primary objective of this study was to assess the percent change in daily insulin requirements 6 months after transitioning patients from GLP-1 RAs to tirzepatide.</p><p><strong>Methods: </strong>This retrospective cohort study includes patients with T2DM who transitioned from a GLP-1 RA to tirzepatide while concurrently using insulin therapy. Patient-reported doses of insulin and study medications were collected by chart review by investigators, along with baseline demographics and adverse effects as additional endpoints.</p><p><strong>Results: </strong>Sixty-six patients were included. The median insulin dose reduced from 101 units at baseline to 71 units after 6 months, with a median decrease of 9.5 units (p < 0.001). The median percent change in insulin dose was -9.2%. Patients with a baseline A1c of 8.0% or lower required a larger decrease in insulin compared to patients with a higher baseline A1c (-22.6% vs. 0%, p = 0.018). The intensity of GLP-1 RA and tirzepatide, determined by agent and dose, did not show a difference in insulin requirements (p = 0.279 and p = 0.317, respectively). Hypoglycemia occurred in eight patients (12.1%).</p><p><strong>Conclusion: </strong>Patients require a reduction in insulin when transitioning from GLP-1 RAs to tirzepatide, especially if baseline A1c is less than or equal to 8.0%. Larger, comparative studies need to be performed to provide specific recommendations for various doses and product types of incretin receptor agonists.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"220-226"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracellular dried blood spot metabolite concentrations for assessing antiretroviral adherence and HIV progression.","authors":"Julie B Dumond","doi":"10.1002/phar.70001","DOIUrl":"10.1002/phar.70001","url":null,"abstract":"","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"152-154"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential role of GLP-1 receptor agonists in osteoarthritis.","authors":"Mackenzie Ryan, Saige Megyeri, Wes Nuffer, Jennifer M Trujillo","doi":"10.1002/phar.70005","DOIUrl":"10.1002/phar.70005","url":null,"abstract":"<p><p>Osteoarthritis (OA) is the most common form of arthritis, affecting over 500 million people globally. Current treatments are primarily symptom-focused, with no approved therapies to halt disease progression. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in type 2 diabetes (T2D) and obesity, demonstrate significant weight loss and glucose-lowering effects and have been shown to possess anti-inflammatory properties. Given the central role of inflammation and metabolic dysfunction in OA, this review examines the potential utility of GLP-1 RAs in OA management, focusing on both indirect effects, such as weight reduction, and possible direct effects on inflammatory pathways and cartilage preservation. Clinical studies suggest that GLP-1 RAs may benefit people with OA by reducing weight, improving glycemic control, and modulating inflammatory markers relevant to OA progression. Notable findings include significant weight loss and pain reduction in people with knee OA (KOA) treated with semaglutide in the STEP-9 trial. In other studies, GLP-1 RAs have shown potential to lower oxidative stress and pro-inflammatory cytokines, such as tumor necrosis factor (TNF-α) and interleukin (IL)-6, with reductions in OA-related pain and functional impairment observed in some cohorts. However, results vary, with some studies showing limited effects, potentially linked to the degree of weight loss achieved. Although some studies report variability in pain relief, likely influenced by the degree of weight loss achieved, GLP-1 RAs have shown overall promise in reducing both OA symptoms and markers associated with disease progression. This emerging evidence supports the utility of GLP-1 RAs as a potential disease-modifying option for OA, offering a dual benefit in metabolic and joint health. Future research should focus on establishing the long-term efficacy and safety and elucidating the mechanism by which GLP-1 RAs influence OA pathology.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"177-186"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of prescription medication use that can exacerbate heart failure among US adults with heart failure.","authors":"Alexander R Zheutlin, Joshua A Jacobs, Joshua D Niforatos, Alexander Chaitoff","doi":"10.1002/phar.4648","DOIUrl":"10.1002/phar.4648","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure (HF) affects more than 6 million adults in the United States, contributing to substantial morbidity, mortality, and health care costs. Despite advances in medical care, many medications can exacerbate HF, yet their prevalence of use remains unknown. This study examined the national use of prescription medications that could exacerbate HF in adults with self-reported HF.</p><p><strong>Methods: </strong>We analyzed data from US adults with self-reported HF in the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2020. Medications known to exacerbate HF, identified from HF guidelines, were documented through pill bottle reviews. Weighted estimates were used to calculate prevalence overall and by sex, race and ethnicity, and level of evidence for avoidance. Multivariable logistic regression models calculated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for the use of these high-risk medications by sex and race and ethnicity.</p><p><strong>Results: </strong>A total of 687 participants, representing 5.2 million U.S. adults with HF after applying sampling weights, were included (mean age, 66.1 [95% CI 64.9, 67.4] years; 50.4% female [95% CI 45.9%, 55.0%]). Overall, 14.5% (95% CI 10.4%, 19.5%; n = 92) of adults with HF were prescribed at least one medication known to exacerbate HF, with the most common being diltiazem, meloxicam, and ibuprofen. Use of these medications was not significantly different by sex nor by race and ethnicity. Of these medications, 21.7% (95% CI 10.7%, 38.8%) had level A evidence warning against use, and 78.3% (95% CI 61.2%, 89.3%) had B level evidence.</p><p><strong>Conclusion: </strong>Over one-seventh of U.S. adults with HF were likely to have been prescribed medications that could exacerbate the condition, underscoring the need to optimize care. Reducing high-risk medication use may mitigate HF exacerbations and improve outcomes in this vulnerable population.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"155-160"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of hyponatremia among older adults exposed to selective serotonin reuptake inhibitors and thiazide diuretics.","authors":"Trisha Matsuura, Abdelrahaman G Tawfik, Kenechukwu C Ben-Umeh, Philip D Hansten, Daniel C Malone","doi":"10.1002/phar.70004","DOIUrl":"10.1002/phar.70004","url":null,"abstract":"<p><strong>Objective: </strong>Hyponatremia is a common electrolyte disorder among older adults that can cause serious adverse effects. The purpose of this study was to assess the risk of hyponatremia with the concurrent use of selective serotonin reuptake inhibitors (SSRIs) and thiazide diuretics in an older population.</p><p><strong>Methods: </strong>Two retrospective nested case-control studies were conducted with exposure to an SSRI or a thiazide diuretic. Persons of interest were those enrolled in Medicare and who received parts A, B, and D benefits from 2017 to 2019 and who were receiving either an SSRI or thiazide diuretic. Cases were individuals with a diagnosis of hyponatremia. Controls had no documented history of hyponatremia. A logistic regression was conducted to determine the odds of hyponatremia.</p><p><strong>Results: </strong>Of the 551,298 patients receiving a SSRIs, the mean age was 77.8 years (Standard Deviation (SD) ± 8.0 years), 69% were female, and 91.23% were classified as White. We identified 701,007 individuals receiving a thiazide diuretic, with a mean age of 77.1 years (SD ± 7.2 years), 60.2% female, and 82.72% White. The prevalence of hyponatremia was 10.4% in patients taking thiazides alone and 9.0% in those taking SSRIs alone. On the other hand, patients on both medications had a hyponatremia prevalence of approximately 13.0%. Among SSRI users, the adjusted odds ratio (OR) of hyponatremia with concomitant use of thiazide diuretics was 1.24 (95% Confidence Interval (CI): 1.22-1.26). For thiazide users, the adjusted OR of hyponatremia with exposure to SSRIs was 1.27 (95% CI:1.24-1.29).</p><p><strong>Conclusion: </strong>The concurrent use of thiazide diuretics and SSRIs is associated with an increased risk of hyponatremia in older populations.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"169-176"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing discordance rate of estimated glomerular filtration rate between serum creatinine-based calculations and cystatin-C-based calculations in critically ill patients.","authors":"Victoria L Williams, Anthony T Gerlach","doi":"10.1002/phar.70000","DOIUrl":"10.1002/phar.70000","url":null,"abstract":"<p><strong>Introduction: </strong>The use of serum creatinine (SCr) for drug dosing has significant limitations and is influenced by many non-kidney factors. Cystatin C (cysC) is an alternative or additional marker of kidney function that is less affected by non-kidney factors. Although cysC may be useful in hospitalized patients, the use of cysC to calculate drug dosing in critically ill patients has been incompletely investigated.</p><p><strong>Objective: </strong>The objective of this study was to determine the rate of discordance in estimated glomerular filtration rate (eGFR) between SCr-based calculations and SCr/cysC-based calculations that affect drug dosing in critically ill patients.</p><p><strong>Methods: </strong>This was a single-center, retrospective, observational cohort study at an academic medical center including critically ill adult patients admitted in 2023 with SCr and cysC ordered. Data were collected via chart review. Demographic data were analyzed via descriptive statistics. Discordance, defined as the percentage of times at which there is at least one discrepancy in kidney dosing for a medication using Cockcroft-Gault (CG) creatinine clearance versus Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR creatinine-cystatin C (eGFRcr-cys) equations, was analyzed via Wilcoxon matched pair signed ranked sum. eGFR calculations were normalized for patients' body surface area for comparison.</p><p><strong>Results: </strong>The study population included 232 patients (53.02% female; mean age 58.7 +/- 14.9 years; with 62.5% in medical, 23.28% in surgical, and 8.62% in neurological intensive care) with a median SCr of 0.94 mg/dL IQR [0.57-1.58] and median cysC of 1.92 mg/L IQR [1.27-2.77]. The median clearance rates were 68.5 mL/min (45.3-111.5) for CG and 53.9 mL/min (30.9-80.7) for CKD-EPI eGFRcr-cys; p < 0.001. The discordance rate across all study drugs was 32.3% (75/232). The four most common study drugs demonstrating discordance were cefepime 40.6% (52/128), vancomycin 38.3% (46/120), levetiracetam 35.1% (13/37), and piperacillin/tazobactam 11.6% (5/43).</p><p><strong>Conclusion: </strong>Clinically significant discordance exists between SCr and SCr/cysC-based estimates of kidney function. This study established a discordance rate, as defined by drug dosing, of 32.3% in adult patients admitted to the ICU.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"161-168"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-titration from risperidone to clozapine utilizing clozapine serum concentrations: A case report.","authors":"Nicolette Centanni, Kayla Garvey, Elizabeth Mullany, Stephanie Nichols","doi":"10.1002/phar.4649","DOIUrl":"10.1002/phar.4649","url":null,"abstract":"<p><strong>Introduction: </strong>Clozapine and risperidone are second-generation antipsychotics used in the treatment of schizophrenia. There are no guidelines on cross-titration of antipsychotics and, additionally, there is a paucity of published data to support the potential utility of using serum drug levels to guide dosing in these situations.</p><p><strong>Case report: </strong>A 68-year-old female patient with a history of schizophrenia, taking risperidone and fluoxetine, and a recent diagnosis of Parkinson's disease was admitted to the hospital after a fall at home. During the patient's hospital stay, utilizing serum clozapine levels as guidance, the patient was cross-titrated from risperidone 12 mg daily to a final dose of clozapine 75 mg daily over the span of 17 days, in the setting of multiple possible drug-drug interactions.</p><p><strong>Discussion: </strong>There is no evidence-based guidance on transitioning patients from one antipsychotic to another especially in the setting of drug-drug interactions. In this case, the patient was successfully transitioned from risperidone to clozapine using serum clozapine levels and clinical status to guide decision-making.</p><p><strong>Conclusions: </strong>Utilizing serum clozapine levels may be helpful in guiding dose changes during antipsychotic cross-titration, especially when multiple drug interactions are involved.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"187-190"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Intravenous ketamine successfully treats treatment-resistant catatonia in schizophrenia: A case report\".","authors":"João Gama Marques, Josef Finsterer","doi":"10.1002/phar.4647","DOIUrl":"https://doi.org/10.1002/phar.4647","url":null,"abstract":"","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":"45 2","pages":"145-146"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associating regulatory actions on diclofenac use with Danish trends in utilization by route of administration 1999-2023.","authors":"Anna Emilie Møller, Anne Bech-Drewes, Lotte Rasmussen, Søren Friis, Morten Schmidt","doi":"10.1002/phar.4643","DOIUrl":"10.1002/phar.4643","url":null,"abstract":"<p><strong>Aims: </strong>With the growing evidence of cardiovascular risks associated with diclofenac use, regulatory measures governing its application and sales have intensified since 2008. We evaluated the association between central regulatory actions and trends in diclofenac use in Denmark from 1999 to 2023, according to different dosage forms and routes of administration.</p><p><strong>Methods and results: </strong>Data on diclofenac sales in Denmark from 1999 to 2023 were retrieved from the publicly available web database MEDSTAT, based on the Danish Register of Medicinal Products Statistics. The annual sales of various diclofenac dosage forms, including systemic (tablets, modified-release dosage forms, and suppositories) and topical (nonspecific and ophthalmic) dosage forms, were calculated and displayed by sales unit. From 1999 to 2008, sales of all systemically administered diclofenac forms increased: tablets by 51% (2000-2008), modified-release dosage forms by 40% (2003-2007), and suppositories by 44% (1999-2008). Thereafter, sales of tablets declined by 86% and modified-release dosage forms by 90% through 2023. The sales of suppositories declined somewhat lesser, by 34%, during 2008 to 2018 and then increased by 67% through 2023. Sales of nonspecific topical diclofenac increased by several thousandfold from 2005, although with brief periods of decline.</p><p><strong>Conclusion: </strong>Sales of systemically administered diclofenac dosage forms, particularly tablets and modified-release drugs, declined by approximately 90% from about 2008 to 2023, indicating compliance with Danish and international regulatory actions. Conversely, sales of topically administered diclofenac increased heavily from 2005 to 2023, denoting a policy-driven shift toward these lower risk dosage forms.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"104-110"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}