Pharmacoepidemiology and drug safety
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Pharmacoepidemiol Drug Saf · Oct 2009
Case ReportsOverdose of methyldopa, indapamide and theophylline resulting in prolonged hypotension, marked diuresis and hypokalaemia in an elderly patient.
An 89-year-old man with a history of hypertension, chronic obstructive pulmonary disease, personality disorder and previous attempts of self-poisoning attempted suicide by swallowing two mouthfuls of tablets (methyldopa 250 mg, theophylline SR 200 mg, indapamide 2.5 mg and paracetamol 500 mg). He had prolonged, severe hypotension, necessitating the use of 3000 ml of Gelofusine and almost 2 days of intravenous norepinephrine infusion. He had marked diuresis for 4.5 days, requiring continuous and bolus infusions of intravenous fluids. ⋯ Intracellular shift of potassium results in hypokalaemia. The prescribing physicians should recognise elderly patients at a high risk of self-poisoning and avoid using drugs with a high toxicity in overdose (e.g. theophylline and methyldopa). Restricting access to hazardous drugs (in overdose) would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities.
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Pharmacoepidemiol Drug Saf · Oct 2009
ReviewComparison of adverse events between oral and intravenous formulations of antimicrobial agents: a systematic review of the evidence from randomized trials.
Some clinicians may favor a strategy of early switch to oral antimicrobial therapy for patients responding to initial intravenous therapy. An important relevant consideration refers to the comparative safety and tolerability between oral and intravenous antimicrobial therapy. LITERATURE SEARCH/STUDY SELECTION: We sought to evaluate the above-mentioned issue by performing a systematic review of randomized studies comparing the occurrence of adverse events between oral and intravenous antimicrobial therapy with the same agents. ⋯ There are only limited comparative data regarding the adverse events associated with the administration of the same antimicrobial agents by the oral and intravenous route. Our review indicates that the adverse event profile of oral and intravenous antimicrobial therapy does not differ considerably; however, this issue requires validation by further studies.
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Pharmacoepidemiol Drug Saf · Oct 2009
Comparative StudyWhat can primary care prescribing data tell us about individual adherence to long-term medication?-comparison to pharmacy dispensing data.
To assess the predictive value of general practice electronic prescribing records with respect to adherence to long-term medications as compared to claims-based pharmacy dispensing data. ⋯ There is potential for general practices to identify substantial levels of long-term medication adherence problems through their electronic prescribing records. Significant further adherence problems could be detected if an e-pharmacy network allowed practices to match dispensing against prescriptions.
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Pharmacoepidemiol Drug Saf · Oct 2009
Drug safety alert generation and overriding in a large Dutch university medical centre.
To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre. ⋯ Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.