Pharmacoepidemiology and drug safety
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Pharmacoepidemiol Drug Saf · Aug 2007
Comparative StudyChannelling of SSRIs and SNRIs use in the Tayside population, Scotland.
To compare the user profiles of the two classes of drug, using the Tayside Medicines Monitoring Unit (MEMO) record-linkage database. ⋯ There was clear evidence that SSRI and SNRI were used in patient groups with different characteristics. This channelling sometimes favoured an improved mortality outcome and sometimes favoured a worse outcome. Overall there was no mortality difference between the two classes of drugs.
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Pharmacoepidemiol Drug Saf · Aug 2007
Use of anxiolytic or hypnotic drugs and total mortality in a general middle-aged population.
The aim of the study was to evaluate the effect of the consumption of anxiolytic or hypnotic drugs on total mortality in a general population. ⋯ Daily users of anxiolytic or hypnotic drugs in our study showed higher crude mortality than non-users. However, after adjusting lifestyle and socio-economic variables the difference was markedly reduced suggesting that the remaining excess mortality is due to residual confounding.
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Pharmacoepidemiol Drug Saf · Aug 2007
Inadequacy of fluconazole dosing in patients with candidemia based on Infectious Diseases Society of America (IDSA) guidelines.
Based on Infectious Diseases Society of America (IDSA) guidelines, inappropriate fluconazole therapy in patients with candidemia is defined as an empiric dose <6 mg/kg/d, <12 mg/kg/d after Candida glabrata identification, or continued fluconazole use after identification of Candida krusei. However, the extent to which inappropriate antifungal therapy is due to improper dosing or drug selection has not been well investigated. The objectives of this study were to assess the incidence of inappropriate fluconazole therapy in patients with candidemia and to identify variables associated with inappropriate therapy. ⋯ A high prevalence of suboptimal dosing of fluconazole given empirically or after Candida species identification was documented. Increased weight and CRCL were significant predictors of inadequate fluconazole doses.
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Pharmacoepidemiol Drug Saf · Aug 2007
Comparative StudyRelationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States.
The goal of these studies was to determine the relationship between prescribed use of opioid analgesics and their non-medically related use (abuse) at a regional level across the country. ⋯ We found that there was a very strong correlation between therapeutic exposure to opioid analgesics, as measured by prescriptions filled, and their abuse. There were, however, geographical loci that represented outliers in which abuse was disproportionately high relative to therapeutic use (>95th percentile), most of which were in very small urban, suburban, and rural areas. The rank order of abuse shows that buprenorphine products, extended release (ER) oxycodone and methadone are the most intensely abused prescription opioid analgesics, with hydrocodone the least abused, when the data are corrected for degree of exposure, i.e., cases/1000 persons filling a prescription. If, on the other hand, one uses the number of cases/100 000 population, hydrocodone ranked as high as ER oxycodone and all other drugs grouped together at very low levels of abuse. Since the latter conclusion ignores therapeutic exposure, we conclude that the rate of abuse of highly efficacious opioid analgesics is best expressed as cases of abuse/1000 persons filling a prescription, which yields the best possible estimate of the risk-benefit ratio of these drugs.