Annals of Pharmacotherapy最新文献

{"title":"Evaluating the Role of Erythrocyte-Related Markers in Predicting Adenosine Response in Supraventricular Tachycardia.","authors":"Seth Carroll, Kathleen Soter, Mallory McGee, Lisa E Rein, Kevin McGurk, Ryan Feldman","doi":"10.1177/10600280251412354","DOIUrl":"10.1177/10600280251412354","url":null,"abstract":"<p><strong>Background: </strong>Supraventricular tachycardia (SVT) accounts for ~50 000 emergency department (ED) visits annually. Adenosine is a commonly used pharmacologic intervention, but predictors of success remain unclear. Erythrocytes rapidly clear adenosine from circulation and whether hematologic variables influence cardioversion outcomes is unknown.</p><p><strong>Objective: </strong>To evaluate whether hematocrit, hemoglobin or red blood cell (RBC) count, are associated with adenosine efficacy in treating SVT.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included adult ED patients treated with adenosine for SVT between January 2021 to August 2024. Logistic regression evaluated the association between hematologic variables and adenosine conversion, adjusting for weight-based dose and total calcium.</p><p><strong>Results: </strong>Of the 303 encounters representing 256 unique patients, 61% converted after the first adenosine dose and 70% converted overall. Hematologic variables were not associated with first-dose cardioversion. For total conversion, higher hematocrit (per 10%-unit increase) was significantly associated with reduced odds (OR 0.60; 95% CI 0.36-0.99; <i>P</i> = 0.045) of cardioversion, but only in calcium adjusted model. Among patients requiring multiple doses, higher hematocrit (per 10%-unit; OR 0.23; 95% CI 0.09-0.58; <i>P</i> = 0.002), hemoglobin (per 1 g/dL; OR 0.67; 95% CI 0.53-0.85; <i>P</i> < 0.001), and RBC count (per 1 million/µL; OR 0.44; 95% CI 0.21-0.93; <i>P</i> = 0.031) were associated with reduced odds of subsequent cardioversion in calcium adjusted models.</p><p><strong>Conclusion and relevance: </strong>Hematologic variables were not associated with initial adenosine cardioversion, but in patients requiring additional doses, higher erythrocyte markers were associated with reduced conversion, once accounting for total calcium. This may be due to increased erythrocyte mediated drug clearance. These findings warrant further research to inform clinical relevance.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"872-877"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994217","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":"FAQs About Pharmacist Management of Uncomplicated Lower Urinary Tract Infections.","authors":"Michael Klepser, Ross Tsuyuki, Nathan P Beahm, Alex J Adams","doi":"10.1177/10600280251407250","DOIUrl":"10.1177/10600280251407250","url":null,"abstract":"<p><p>Nontraditional models of care, including pharmacist-led management, have emerged to improve access to evidence-based cystitis treatment. Drawing from studies in Canada, New Zealand, the United Kingdom, and the United States, evidence demonstrates that pharmacists can safely and effectively manage cystitis using established protocols without compromising antimicrobial stewardship. These models expedite patient access to care while maintaining quality and safety. With more than 15 years of international experience supporting pharmacist-led cystitis management, policymakers and professional organizations have robust data to guide implementation and inform ongoing debates on optimizing care delivery.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"907-912"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146016907","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":"Evaluation of the Use of Primary Prevention Aspirin in Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant for Stroke Prevention.","authors":"Storee A Yzaguirre, Matthew R Rockhold, Thomas W Szymanski, Lauren Kunkel, Megan Vaughan, Seher Berzingi, Jordan L Lacoste","doi":"10.1177/10600280251401892","DOIUrl":"10.1177/10600280251401892","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines advise against use of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients with increased bleeding risk, including use of anticoagulation. However, limited data exist regarding safety and efficacy of low-dose aspirin (75 to 100 mg daily) for primary prevention of ASCVD in patients with atrial fibrillation (AF) receiving a direct oral anticoagulant (DOAC) for thromboembolism prevention.</p><p><strong>Objective: </strong>This study aimed to evaluate the safety and effectiveness of low-dose aspirin for primary ASCVD prevention in patients with AF who are receiving DOAC therapy.</p><p><strong>Methods: </strong>This multicenter, retrospective cohort study evaluated apixaban or rivaroxaban plus low-dose aspirin for primary prevention of ASCVD (combination therapy group) compared with those receiving DOAC monotherapy in patients 18 to 79 years of age with AF and no history of ASCVD. The primary safety endpoint was incidence of major bleeding per 100 patient-years, defined by the International Society on Thrombosis and Hemostasis criteria. Secondary endpoints included incidence of clinically relevant non-major bleeding (CRNMB), hospitalization for an ASCVD event, and death.</p><p><strong>Results: </strong>A total of 611 patients were included (411 DOAC monotherapy and 200 combination therapy), contributing 973 patient-years of follow-up. Incidence of major bleeding was significantly lower in the DOAC monotherapy group (1.37 vs 5.74 per 100 patient-years; relative risk [RR] = 0.35, 95% confidence interval [CI] = 0.16-0.77, <i>P</i> = 0.006). On multivariable analysis, combination therapy remained independently associated with major bleeding (odds ratio= 3.15, 95% CI = 1.32-7.79, <i>P</i> = 0.010). The combination group also experienced a significantly higher incidence of CRNMB. No difference in ischemic events was observed between groups.</p><p><strong>Conclusion and relevance: </strong>In patients with AF and no history of ASCVD, the addition of low-dose aspirin to DOAC therapy significantly increased risk of major bleeding and CRNMB without reducing ischemic events. These findings support deprescribing aspirin for primary prevention in this population to minimize bleeding risk while maintaining thromboembolic prevention.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"833-842"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145832938","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":"Compounded Semaglutide and Tirzepatide Products Use Unique Formulations but Efficacy and Safety Largely Unknown.","authors":"Jordyn Belcourt, Amy Sapowadia, C Michael White","doi":"10.1177/10600280261421979","DOIUrl":"10.1177/10600280261421979","url":null,"abstract":"<p><strong>Background: </strong>With the shortage of innovator semaglutide or tirzepatide products resolved, compounding pharmacies can only legally sell unique products. Unique products could have a different route of administration or dosing, or could include additional pharmaceutical ingredients.</p><p><strong>Objective: </strong>To identify and characterize compounded semaglutide and tirzepatide products that differ from available FDA-approved products.</p><p><strong>Methods: </strong>We searched compounding sites between February 3, 2025, and March 20, 2025, using key terms <i>[\"compounded semaglutide,\" \"compounded tirzepatide,\" and \"compounded GLP-1s\"]</i> on Google looking for products with a strength, route of administration, and/or formulation that differed from commercially available products.</p><p><strong>Results: </strong>We identified 33 unique semaglutide and/or tirzepatide products. Two-thirds contained semaglutide, and one-third contained tirzepatide. Forty-eight percent of products contained either semaglutide or tirzepatide with some combination of cyanocobalamin, glycine, niacinamide, docusate, or ondansetron. The 17 single active ingredient products were provided in sublingual (82%) or oral disintegrating tablet (ODT) (18%) formulations. Only 18% of included compounded products reported information about beyond use date and preferred storage conditions. Twenty-eight percent reported preferred storage conditions.</p><p><strong>Conclusion and relevance: </strong>We found little justification for adding nutrients or docusate sodium to combination subcutaneous semaglutide or tirzepatide products. There is a rationale for adding ondansetron, but evidence for subcutaneous administration is lacking. There is a rationale for fashioning sublingual or ODT formulations, but whether these formulations offer advantages over innovator oral tablets has not been determined. The popularity of these products as an alternative to FDA-approved medications is concerning, given the lack of evidence for safety and efficacy.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"902-906"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197226","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":"Melatonin: Helpful or Harmful?","authors":"Lauren M Hynicka, Jessica Battaglia","doi":"10.1177/10600280261418736","DOIUrl":"10.1177/10600280261418736","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"918-919"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117649","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 and Efficacy of the Prescribing Practices of Ketamine for Pain and Agitation in the Medical Intensive Care Unit.","authors":"Shaelyn Cooper, MaryEllen Antkowiak, Derek Devine, Rebecca Nashett Wren","doi":"10.1177/10600280251410532","DOIUrl":"10.1177/10600280251410532","url":null,"abstract":"<p><strong>Background: </strong>Ketamine has analgesic and sedative properties that are thought to reduce opioid tolerance and opioid-induced hyperalgesia. For this reason, ketamine may be used to manage pain and agitation, although the literature evaluating its use for this purpose is limited.</p><p><strong>Objective: </strong>To describe the prescribing practices of ketamine in the medical intensive care unit (MICU) as it pertains to pain and agitation, as well as assess measures of safety and efficacy.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study of critically ill patients who received a ketamine infusion for pain and/or agitation between June 2021 and August 2024. The primary outcome was opioid consumption, reported in oral morphine milligram equivalents (MME), and sedative use pre- versus post-ketamine initiation. Secondary outcomes included paired mean pain scores, proportion of time within goal Richmond Agitation-Sedation Scale score range, and incidence of adverse events.</p><p><strong>Results: </strong>For the 78 patients included, there was no difference in analgesic use pre- versus post-ketamine initiation (60 vs 45 MME; <i>P</i> = 0.677). No differences were observed in sedative doses required pre- versus post-ketamine initiation (5.3 vs 3.4 mg of benzodiazepines; <i>P</i> = 0.508, 0.9 vs 1.1 μg/kg/h of dexmedetomidine; <i>P</i> = 0.062, and 44 vs 44 μg/kg/min of propofol; <i>P</i> = 0.180). There was a median paired difference of -1 point on the pain scale ([interquartile range -1, 0]; <i>P</i> = 0.030) after ketamine initiation. Ketamine was associated with an increased incidence of hallucinations (1.3% vs 6.4%; <i>P</i> = 0.046).</p><p><strong>Conclusion and relevance: </strong>To the authors' knowledge, this is the first study examining the use of ketamine for pain and/or agitation that specifically focuses on MICU patients. The clinical benefit of the routine use of ketamine for these indications in this patient population is unclear and may increase patients' risk of adverse effects such as hallucinations.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"860-865"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987716","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":"The Efficacy and Safety of Ketamine or Ketorolac Compared to Opioids in Painful Vaso-Occlusive Crisis: A Response and Subgroup Analysis.","authors":"May M Shehata, Justin P Reinert","doi":"10.1177/10600280251410921","DOIUrl":"10.1177/10600280251410921","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"922-924"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140966","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":"The High Cost of Gene Therapy: Managing Onasemnogene Abeparvovec's Economic Impact.","authors":"Eleonora Castellana, Maria Rachele Chiappetta","doi":"10.1177/10600280261416074","DOIUrl":"10.1177/10600280261416074","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"916-917"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028025","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":"Reply: Safety of Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal in Critically Ill Patients With Primary Neurological Injuries.","authors":"Robert Deveau, Adrian Wong, Ifeoma Mary Eche, Tuyen Yankama, Corey R Fehnel","doi":"10.1177/10600280251389143","DOIUrl":"10.1177/10600280251389143","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"925-926"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145720129","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":"Evaluation and Optimization of INR Goals in Patients With Mechanical Aortic Valves in a Pharmacist-Run Clinic: An Anticoagulation Stewardship Initiative.","authors":"Barbara Wang, Madison Hubert, Malgorzata Symons, Stacey Cohen Kaplon","doi":"10.1177/10600280251399028","DOIUrl":"10.1177/10600280251399028","url":null,"abstract":"<p><strong>Background: </strong>Patients with a mechanical aortic valve replacement (AVR) require lifelong anticoagulation with warfarin. International normalized ratio (INR) goals for mechanical AVRs can change throughout treatment as risk factors change. Appropriate INR goal selection is crucial as goals that stray from evidence-based recommendations can lead to increased risk of bleeding, thrombosis or unnecessary monitoring.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the appropriateness of INR goals in patients with mechanical AVRs and identify opportunities for pharmacist-led intervention.</p><p><strong>Methods: </strong>A cross-sectional quality improvement study was conducted at a safety net academic medical center's outpatient anticoagulation clinic. This quality improvement project was not formally supervised by the Institutional Review Board per their policies. Adult patients with isolated mechanical AVR actively managed on warfarin were included. Pharmacists determined whether INR goals were justified by clinical context and American and European valvular heart disease guidelines. When goals lacked clear justification, pharmacists contacted referring providers to recommend INR goal adjustment.</p><p><strong>Results: </strong>Of 100 identified patients, 81 met eligibility criteria including 24 (29.6%) with On-X valves and 57 (70.4%) with alternative mechanical AVRs. Nearly one-third of patients (23, 29.3%) had INR goals inconsistent with current guidelines. Pharmacist-led outreach resulted in 20 accepted recommendations (87.0%), representing 24.7% of the study population. On-X valve recommendations primarily involved reducing INR targets to 1.5 to 2.0 for patients at least 3 months postsurgery without other risk factors that would constitute a higher INR goal. The most common alternative mechanical valve interventions included increasing INR goals to 2.5 to 3.5 in those with thromboembolic risk factors and decreasing INR goals to 2.0 to 3.0 due to absence of thromboembolic risk factors.</p><p><strong>Conclusion and relevance: </strong>This stewardship initiative highlights the need for periodic INR goal review, as risk factors in patients with mechanical AVRs can change over time.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"852-859"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145853013","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}