Annals of Pharmacotherapy最新文献

{"title":"Evaluating the Concomitant Use of Diltiazem or Verapamil With Direct Oral Anticoagulants: A Meta-analysis.","authors":"Kazuhiko Kido, Mikiko Shimizu, Tsuyoshi Shiga, Masayuki Hashiguchi","doi":"10.1177/10600280251323955","DOIUrl":"https://doi.org/10.1177/10600280251323955","url":null,"abstract":"<p><strong>Background: </strong>Diltiazem and verapamil are combined p-glycoprotein and moderate CYP3A4 inhibitors which significantly increase the concentrations of direct oral anticoagulants (DOACs) and may increase the risks of bleeding. Multiple real-world studies compared the concomitant therapy of diltiazem/verapamil and DOACs versus the DOAC monotherapy groups, but their main findings were contradictory.</p><p><strong>Objective: </strong>To evaluate the risks of bleeding and stroke between the concomitant therapy of diltiazem/verapamil and DOACs and DOAC monotherapy.</p><p><strong>Methods: </strong>A meta-analysis was performed to compare the concomitant therapy of diltiazem/verapamil and DOACs versus DOACs. Database searches through November 16, 2024 were performed using MEDLINE and Google Scholar. The primary outcome was major bleeding. The secondary outcomes included stroke or systemic embolism and gastrointestinal bleeding.</p><p><strong>Results: </strong>A total of 6 studies were included in this meta-analysis. It showed that the concomitant therapy of DOAC and diltiazem/verapamil was significantly associated with increased risks of major bleeding (odds ratio [OR] = 1.38; 95% CI = 1.24, 1.54; <i>P</i> < 0.01; <i>I</i>² = 0%) and gastrointestinal bleeding (OR = 1.19; 95% CI = 1.03, 1.37; <i>P</i> = 0.01; <i>I</i>² = 0%) compared with the DOAC monotherapy group. The concomitant therapy group was also significantly associated with the lower risk of stroke or systemic embolism compared with the DOAC monotherapy group (OR = 0.83; 95% CI = 0.73, 0.93; <i>I</i>² = 0%).</p><p><strong>Conclusion and relevance: </strong>This meta-analysis found that the concomitant therapy of DOACs with diltiazem/verapamil increases the risks of bleeding outcomes compared with the DOAC monotherapy group.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251323955"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Monotherapy and Combination Therapy With Antipsychotic Medications for Intensive Care Unit Delirium: A Retrospective Cohort Study.","authors":"Anh Nguyen, Justin Chang, Timothy Allison-Aipa, Paul Albini","doi":"10.1177/10600280251322199","DOIUrl":"https://doi.org/10.1177/10600280251322199","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic medications continue to be frequently prescribed by clinicians in the intensive care unit (ICU) for delirium, despite inconclusive data.</p><p><strong>Objective: </strong>To determine if using a combination of antipsychotics reduces the time patients spend in delirium compared with monotherapy.</p><p><strong>Methods: </strong>This was a single-center, retrospective, cohort medical record review of patients who scored positive on Confusion Assessment Method for the ICU (CAM-ICU) and received antipsychotic therapy. Patients were excluded if they received any antipsychotics prior to hospital admission or had a Richmond Agitation-Sedation Scale (RASS) scores of -4 or -5 at the time of CAM-ICU assessment. The primary outcome was duration of delirium. The secondary outcomes included ICU length of stay (LOS), hospital LOS, overall mortality, occurrence of adverse events (AEs), and whether antipsychotics were continued at hospital discharge.</p><p><strong>Results: </strong>A total of 84 patients were included, of these 45 and 39 received monotherapy and combination therapy, respectively. Median Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly higher in the monotherapy group (18 vs 13, <i>P</i> = 0.006). Median duration of delirium was not significantly different between the monotherapy and combination therapy groups (8 vs 8 days, <i>P</i> = 0.932). Median ICU and hospital LOS, and occurrence of AEs were not significantly different. A significant difference in mortality was found between monotherapy and combination therapy (31% vs 10%, <i>P</i> = 0.02). Antipsychotics were continued at hospital discharge in 64% of the monotherapy and in 44% of the combination therapy group.</p><p><strong>Conclusion and relevance: </strong>In patients with ICU delirium, there was no difference in duration of delirium among patients receiving monotherapy compared with combination therapy with antipsychotics, though they may be sicker and have a higher mortality. Patients commonly remain on antipsychotics at hospital discharge, the implications of which warrant further study.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251322199"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Cholinesterase Inhibitor Medication on QTc Interval in Memory Clinic Patients.","authors":"Hanna Karita Isotalo, Joanna Karoliina Lehtovaara, Laura Linnea Ekblad, Maria Susanna Nuotio, Ville Lauri Johannes Langén","doi":"10.1177/10600280251328530","DOIUrl":"https://doi.org/10.1177/10600280251328530","url":null,"abstract":"<p><strong>Background: </strong>Cholinesterase inhibitors (ChEIs)-donepezil, rivastigmine, and galantamine-are beneficial in treating Alzheimer disease (AD). However, due to their impact on extra-cerebral acetylcholine signaling, concerns about cardiac adverse effects, including QT interval prolongation, persist. Despite this, evidence-based guidelines for electrocardiogram (ECG) monitoring during ChEI treatment are lacking, and prior studies on ChEIs and corrected QT intervals (QTc) yield inconsistent findings.</p><p><strong>Objective: </strong>This study aimed to investigate the association between ChEI use and changes in QTc intervals among older adults.</p><p><strong>Methods: </strong>We collected retrospective data from first-time visitors to the geriatric memory clinic of Turku City Hospital in 2017 and 2019. We included patients who were newly prescribed ChEIs and had ECG data available (n = 126, mean age 81.1 years, 56.3% female). QTc prolongation was defined as ≥460 ms in females and ≥450 ms in men. Paired <i>t</i> tests compared QTc means before and during ChEI use, and McNemar tests analyzed changes in the proportion of prolonged QTc.</p><p><strong>Results: </strong>Mean ± SD QTc (ms) before versus during ChEI use was: 420.8 ± 24.0 versus 423.9 ± 28.0 (<i>P</i> = .13) for donepezil; 416.0 ± 20.4 versus 416.5 ± 26.1 (<i>P</i> = .92) for galantamine; 416.1 ± 22.3 versus 409.6 ± 20.1 (<i>P</i> = .30) for rivastigmine; and 419.7 ± 23.4 versus 421.5 ± 27.3 (<i>P</i> = .34) for all ChEIs. Prolonged QTc occurred in 7.9% of patients before versus 12.7% during ChEI use (<i>P</i> = .21).</p><p><strong>Conclusion and relevance: </strong>We found no statistically significant association between ChEI use and QTc interval prolongation or an increased proportion of pathological QTc values during ChEI treatment. Larger studies are warranted to establish evidence-based recommendations on ECG monitoring during ChEI medication.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251328530"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gabapentinoïds and Hip Fracture: A Pharmacovigilance Comparative Study Between Gabapentin and Pregabalin.","authors":"Jean-Louis Montastruc","doi":"10.1177/10600280251336244","DOIUrl":"https://doi.org/10.1177/10600280251336244","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251336244"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Courses of Fidaxomicin Followed by Oral Vancomycin and the Effect on Recurrence of <i>Clostridioides difficile</i> Infections.","authors":"Irene-Constantina Papamanolis, Nicholas Stornelli, Nathan Everson, Zayd Ahmad, Meghan Kamrada, Ellen Rachel Lockhart, Lauren McDaniel","doi":"10.1177/10600280251332946","DOIUrl":"https://doi.org/10.1177/10600280251332946","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridioides difficile</i> infection (CDI) causes a significant national health care burden. Literature has demonstrated lower rates of CDI recurrence with fidaxomicin compared with oral vancomycin. However, patients are sometimes switched to oral vancomycin before completing a fidaxomicin course.</p><p><strong>Objective: </strong>The objective of this study is to evaluate rates of CDI recurrence in full courses of fidaxomicin versus partial courses of fidaxomicin followed by a switch to oral vancomycin.</p><p><strong>Methods: </strong>In this single-center, retrospective, cohort study of adults with CDI, patients were screened for inclusion if they received either a full 10-day course of fidaxomicin or partial course of fidaxomicin followed by a switch to oral vancomycin. The primary outcome was the rate of CDI recurrence within 30 days after completion of initial therapy determined by a positive CDI test and initiation of treatment.</p><p><strong>Results: </strong>Ninety-nine patients received a full course of fidaxomicin, and 95 patients received a partial course of fidaxomicin followed by oral vancomycin. Mean age was lower in the full course group compared with the partial course (65.3 years vs 71.5 years, <i>P</i> < 0.002). <i>Clostridioides difficile</i> infection recurrence occurred in 5.1% of the full course group and 7.4% of the partial therapy group (<i>P</i> = 0.503) at 30 days and 13.1% versus 14.7% (<i>P</i> = 0.747) at 90 days. <i>Clostridioides difficile</i> infection-related readmissions at 30 days were similar in the full course and partial course groups (7.1% vs 4.2%, <i>P</i> = 0.389).</p><p><strong>Conclusion and relevance: </strong>Partial courses of fidaxomicin followed by oral vancomycin had similar 30-day CDI recurrence compared with full course fidaxomicin.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251332946"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dupilumab Use in Eosinophilic Esophagitis: Analysis of the FDA Adverse Event Reporting System Database.","authors":"Michael B Andrews, Hiba Khan, Douglas G Adler","doi":"10.1177/10600280251336243","DOIUrl":"https://doi.org/10.1177/10600280251336243","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251336243"},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitions of Care Pharmacist Impact Following Hospitalization for Acute Myocardial Infarction.","authors":"Morgan Santalucia Augustine, Olivia Roberts, Christina Sarubbi, John Alex Toler, Nastaran Gharkholonarehe","doi":"10.1177/10600280241278791","DOIUrl":"10.1177/10600280241278791","url":null,"abstract":"<p><p><b>Background:</b> Patients admitted with acute myocardial infarction (AMI) are at high risk for morbidity and rehospitalizations. Pharmacists can play a vital role in secondary prevention by providing services such as medication reconciliation and patient education upon discharge. <b>Objective:</b> The purpose of this study was to evaluate the impact of a pharmacist-led transitions of care (TOC) service on readmissions in patients hospitalized with AMI. <b>Methods:</b> This single center, pre-post observational cohort study evaluated adults with AMI who received pharmacist TOC services compared with a historical cohort who did not. Patients were excluded if they underwent cardiac surgery during admission. The primary outcome was the difference in 90-day cardiovascular (CV)-related readmissions. Secondary outcomes included 30- and 90-day all-cause readmissions, 30-day CV-related readmissions, and patients discharged on defect-free guideline-directed medical therapy (GDMT) for AMI. <b>Results:</b> There were 252 patients in each cohort included. No difference was found in 90-day CV readmissions, with a rate of 10.7% in the pre-TOC group versus 9.9% in the post-TOC group (OR 0.937, 95% CI [0.493, 1.769]; <i>P</i> = 0.842). Patients discharged on defect-free GDMT significantly increased from 61.5% pre-TOC to 87.7% post-TOC (OR 5.424, 95% CI [3.204, 9.468]; <i>P</i> < 0.001). There were no significant differences found in other key secondary outcomes. <b>Conclusion and relevance:</b> This study did not find a significant difference in hospital readmissions after implementation of a pharmacist-led TOC service. However, the service was associated with a significant increase in patients discharged on defect-free GDMT. Further studies are needed to confirm the impact of increased GDMT on clinical outcomes.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"439-445"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Ganciclovir Dosing for the Management of Cytomegalovirus in Solid Organ Transplant Recipients Receiving Sustained Low-Efficiency Dialysis.","authors":"Jinfan Aaron Zhang, Paula Brown, Jennifer Harrison, Marisa Battistella","doi":"10.1177/10600280241283966","DOIUrl":"10.1177/10600280241283966","url":null,"abstract":"<p><strong>Background: </strong>The optimal dosing of intravenous ganciclovir in patients receiving sustained low-efficiency dialysis (SLED) remains unclear.</p><p><strong>Objective: </strong>The primary objective is to characterize the dosing of ganciclovir for treating and preventing cytomegalovirus (CMV) in Solid Organ Transplant Recipients receiving SLED. The secondary objective is to evaluate the safety and efficacy of the dosing practices described in this study.</p><p><strong>Methods: </strong>Retrospective review of electronic medical records from solid organ transplant recipients (SOTRs) admitted to the Medical Surgical Intensive Care Unit at the Toronto General Hospital (TGH) between November 28, 2016, and September 1, 2021, was conducted. Patients concurrently receiving ganciclovir and SLED were included.</p><p><strong>Results: </strong>Among the 27 encounters for CMV prevention, 18 patients underwent 8-hour SLED, 6 underwent 24-hour SLED, and 3 received other SLED durations. Most patients (80%) on 8-hour SLED began ganciclovir at 2.5 mg/kg/d, whereas 80% of those on 24-hour SLED started at 5 mg/kg/d. No breakthrough viremia occurred at 5 mg/kg/d, with 1 instance at 2.5 mg/kg/d. Cytopenia rates were higher at 5 mg/kg/d (33% vs 20%). For treatment (n = 20), 16 patients underwent 8-hour SLED, 2 underwent 24-hour SLED, and 2 underwent 12-hour SLED. Most (75%) on 8-hour SLED started at 2.5 mg/kg/d, whereas all on 24-hour SLED began at 5 mg/kg/d. Viral eradication rates were 75% and 60% at 2.5 and 5 mg/kg/d, respectively, with higher cytopenia rates at 5 mg/kg/d (37.5% vs 0%). Dose adjustments were primarily in response to refractory disease or cytopenia.</p><p><strong>Conclusion and relevance: </strong>At our institution, ganciclovir dosing patterns suggest that for patients requiring 8-hour SLED, there is clinician comfort in using 2.5 mg/kg/d for prevention and 5 mg/kg/d for treatment. In 24-hour SLED, 5 mg/kg/d may be considered for prevention. Higher doses may be considered for CMV treatment; however, we found greater variability in the dosing practices for these patients. Further research with larger sample sizes and ganciclovir drug-level assessments is needed to optimize dosing strategies for CMV treatment.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"406-414"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Peripherally Infused Sympathomimetic Vasopressors in the Intensive Care Unit and Emergency Department.","authors":"Albert Zichichi, Ryan Wallace, Jessica Daniell, Ginger Rouse, Paul Ahearn, Mahmoud Ammar","doi":"10.1177/10600280241284796","DOIUrl":"10.1177/10600280241284796","url":null,"abstract":"<p><strong>Background: </strong>Sympathomimetic vasopressors may be administered through a peripheral catheter, but there are limited data available on the safety of peripheral use.</p><p><strong>Objective: </strong>The purpose of this study was to analyze the safety of peripherally infused sympathomimetic vasopressors.</p><p><strong>Methods: </strong>A multicenter, retrospective observational study was conducted to evaluate patients who received peripheral vasopressors. The study's primary outcome was to assess the incidence of extravasation during the administration of peripheral vasopressors. Secondary outcomes include avoidance of central venous catheter (CVC) placement and institution protocol deviations.</p><p><strong>Results: </strong>There were 198 patients included in the study, of which 142 patients received norepinephrine, 48 patients received phenylephrine, and 8 patients received epinephrine peripherally. Extravasation events occurred in 11 (5.6%) patients. Seven patients required a pharmacologic antidote and 10 patients required a warm compress. No significant differences were seen in characteristics of patients who extravasated compared with those who did not. Protocol deviations identified during the study included 24 (12.1%) patients receiving doses above the protocol maximum, 19 (9.6%) with a body mass index above the protocol maximum, and 45 (22.7%) patients receiving peripheral vasopressor over 24 hours. The majority of patients were able to avoid CVC placement (59.1%).</p><p><strong>Conclusion and relevance: </strong>Peripherally infused sympathomimetic vasopressors are safe to administer up to 24 hours with a low incidence of extravasation events while avoiding CVC placement in the majority of patients.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"397-405"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Safety in Gender-Affirming Hormonal Treatments: An Observational Study on Adverse Drug Events Using the Food and Drug Administration Adverse Event Reporting System Database.","authors":"Michael K Laidlaw, Sarah Jorgensen","doi":"10.1177/10600280241278913","DOIUrl":"10.1177/10600280241278913","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"491-492"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}