European journal of clinical pharmacology
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Eur. J. Clin. Pharmacol. · Sep 2016
Impact of age, gender and CYP2C9/2C19 genotypes on dose-adjusted steady-state serum concentrations of valproic acid-a large-scale study based on naturalistic therapeutic drug monitoring data.
Valproic acid (VPA) has an extensive interindividual pharmacokinetic variability. Published data regarding the impact of gender, age, and CYP2C9/2C19 genetics on VPA variability are conflicting, and the purpose of present study is to clarify the effect of these factors on dose-adjusted steady-state serum VPA concentration (C:D ratio) in a large, naturalistic patient material. ⋯ The present study shows that age and gender significantly influence VPA serum concentration. In order to obtain similar drug exposure, our findings suggest that older female patients would generally require 30-50 % lower dosing of VPA compared to younger males. Moreover, we conclude that CYP2C9/2C19 genotype is not relevant for variability in VPA exposure.
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Eur. J. Clin. Pharmacol. · Aug 2016
Multicenter StudyPro re nata (as needed) medication in nursing homes: the longer you stay, the more you get?
Injudicious pro re nata (PRN) or as needed prescribing can lead to polypharmacy, potentially harmful drug interactions and total drug doses exceeding the maximum recommended. Despite the known risks and the widespread administration, there is a paucity of current research examining the use of PRN drugs in nursing homes. Therefore, we examined characteristics of PRN drug use and potential predictors in nursing homes. ⋯ The high prevalence of PRN medication should be taken into account when considering polypharmacy and inappropriate drug prescribing or using screening tools like the STOPP/START (screening tool of older persons' potentially inappropriate prescriptions/screening tool to alert doctors to right) criteria in nursing homes. Physicians should regularly reconsider the need of each PRN drug on the medication schedule. Moreover, the high prevalence of PRN medication and the association with length of stay highlights the importance of an accurate documentation.
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Eur. J. Clin. Pharmacol. · Aug 2016
Persistent analgesic use and the association with chronic pain and other risk factors in the population-a longitudinal study from the Tromsø Study and the Norwegian Prescription Database.
Analgesics are commonly used drugs. The long-term effectiveness is mostly unproven, while the risk of several serious adverse effects is well established. We aimed to estimate the prevalence and incidence of persistent analgesic use and the association with chronic pain and sociodemographic and comorbid risk factors. ⋯ This study showed a relatively low prevalence of persistent analgesic use and that the majority of persons reporting chronic pain do not use analgesics persistently.
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Eur. J. Clin. Pharmacol. · Jul 2016
Clinical TrialPopulation pharmacokinetics and probability of target attainment of meropenem in critically ill patients.
Patients admitted to intensive care unit (ICU) with Klebsiella pneumoniae infections are characterized by high mortality. The aims of the present study were to investigate the population pharmacokinetics parameters and to assess the probability of target attainment of meropenem in critically ill patients to provide information for more effective regimens. ⋯ Several factors may influence meropenem pharmacokinetics in ICU patients. Continuous i.v. infusions of meropenem seem to be more effective than standard regimens to achieve optimal therapeutic targets.
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Eur. J. Clin. Pharmacol. · Jul 2016
Clinical TrialPharmacokinetics of cefoperazone/sulbactam in critically ill patients receiving continuous venovenous hemofiltration.
Cefoperazone/sulbactam (CFP/SUL) is a β-lactam/β-lactamase inhibitor combination with little data available for the development of effective dosing guidelines during continuous renal replacement therapy. This study aimed to investigate the pharmacokinetics (PK) of cefoperazone/sulbactam in critically ill patients on continuous venovenous hemofiltration (CVVH). ⋯ PK of cefoperazone/sulbactam was altered in critically ill patients undergoing CVVH. Therapeutic drug monitoring would be recommended to individualize the dose regimen.