The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
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Case Reports Comparative Study
Evaluating and assessing dabigatran drug interactions.
Dabigatran is a novel oral direct thrombin inhibitor that has been shown to have beneficial outcomes in the prevention of thromboembolic stroke in patients with atrial fibrillation. Its advantages compared with warfarin may include decreased laboratory monitoring (e.g., international normalized ratio), minimal cytochrome P450 drug interactions, lack of dietary interactions, and faster onset of action. However, dabigatran is still associated with drug interactions, as will be reviewed through a patient case. Consultant pharmacists should carefully review a patient&s medication profile and evaluate the pros and cons of dabigatran therapy as its use becomes more prevalent.
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To describe the clinical outcomes, patient acceptance, and economic effect associated with tablet splitting. ⋯ Tablet splitting does not seem to significantly affect clinical outcomes related to management of hypertension, cholesterol, or psychiatric disorders, nor influence overall patient adherence.
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To describe the product integrity and ethical/ legal issues associated with tablet splitting. ⋯ The majority of the studies associated with tablet splitting reveal large fluctuations in weight/dosage, but few studies evaluate variability with narrow therapeutic index medications. Therefore, the clinical impact of these variations is not globally applicable across medication classes. Although tablet splitting has the potential to save patients and health care organizations a significant amount of money, appropriateness of tablet splitting should be determined for individual medications and individual patients. Assessments should include an evaluation of patient understanding and physical abilities for tablet splitting.
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Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality and represents the fourth leading cause of death in the world. Roflumilast is the first oral phosphodiesterase inhibitor indicated to reduce the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and history of exacerbations. Roflumilast and its active metabolite have been associated with increased cyclic adenosine monophosphate (cyclic AMP) in the lungs and positive responses with inflammatory markers. ⋯ Adverse effects include weight loss, diarrhea, nausea, and psychiatric disturbances. Roflumilast may be associated with significant drug-drug interactions with CYP3A4 inducers (strong) and immunosuppressants. Roflumilast is a promising new agent in the treatment of COPD; however, additional studies comparing roflumilast with inhaled corticosteroids plus long-acting bronchodilators are needed.
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Review Comparative Study
Warfarin versus dabigatran: comparing the old with the new.
Warfarin is an oral anticoagulant for treatment and prevention of venous and arterial thromboembolism. It requires regular monitoring and patient adherence to a variety of lifestyle factors that can influence its effect. Dabigatran is an oral direct thrombin-inhibitor recently approved for stroke prevention in atrial fibrillation. ⋯ Clinical studies have revealed both agents to be effective, with comparable rates for major bleeding. Divergent recommendations have been offered by consensus guidelines. A patient-specific approach involving the perspectives of informed patients is most reasonable.