Association of ABCB1 [C3435T] and ABCC1 [G2012T] polymorphisms with clinical response to atorvastatin in Iranian patients with primary hyperlipidemia

Background: Atorvastatin is prescribed for the primary and the secondary prevention of coronary artery diseases. A wide variation in inter-individual statin response suggests that genetic differences may contribute to this variation. This study investigated the association of ABCB1 [C3435T] and ABCC1 [G2012T] polymorphisms with clinical response to atorvastatin in Iranian primary hyperlipidemic patients

Methods: Individuals [n=179] with primary hypercholesterolemia were enrolled, and peripheral blood samples were collected. Genotyping of two polymorphisms were performed by amplification refractory mutation system PCR

Results: Following four weeks of treatment, a significant reduction of LDL-C was observed in variant groups [CT+TT] of ABCB1 [P=0.018] and wild-type group [GG] of ABCC1 genes [P=0.029]. Logistic regression analysis revealed a significant difference between male and female responses to 10 mg/day atorvastatin [P=0.004, odds ratio=0.2, CI 95%=0.06-0.6]

Conclusion: Our finding indicated that these polymorphisms may be attributed to LDL-C serum levels in the primary hypercholesterolemia patients receiving atorvastatin

Usage pattern and serum level measurement of amikacin in the internal medicine ward of the largest referral hospital in the south of Iran: a pharmacoepidemiological study

Background: The inappropriate use of aminoglycosides has harmful effects such as the development of resistant pathogens and the incidence of nephrotoxicity and ototoxicity. Therefore, drug utilization evaluation of these drugs may improve their usage remarkably. The aim of this study was to assess the usage pattern of amikacin in an internal medicine ward

Methods: This cross-sectional study was conducted in the Internal Medicine Ward of Nemazee Teaching Hospital, Shiraz, Iran, in 2011. The guideline for amikacin use was approved by the institutional Pharmacy and Therapeutics Committee, and the study criteria were developed to assess several parameters involved in amikacin therapy such as appropriateness of drug use, dosage, duration of therapy, toxicity monitoring, and serum concentration assay. Serum concentration was assayed using a Cobas Mira AutoAnalyzer. Clinical and paraclinical parameters such as glomerular filtration rate, culture, microbial sensitivity, white blood cell count, and fever were collected

Results: Sixty-three patients were evaluated. Fifty-seven percent of the patients needed dose readjustment; however, it was not performed for 89% of them. Culture between 48 and 72 hours after amikacin administration was not controlled for 79% of the patients. In 19% of the patients, optimum therapeutic effect was not achieved. The mean+/-SD of the trough and peak concentrations was 7.63 +/- 5.4 microg/mL and 15.67 +/- 7.79 microg/mL, respectively. Forty-five percent of the trough and 38% of the peak levels were within the therapeutic range. The overall adherence of amikacin usage to the guideline was only 48%

Conclusion: To achieve appropriate treatment and prevent toxic effects, we recommend that pharmacokinetic dosing methods, amikacin guideline, and serum monitoring be considered

Role of pharmacogenomics in statin responsiveness; A review

Statins have been used for decades as a successful cholesterol-lowering class of medicines. Statins are widely prescribed for the primary and secondary prevention of coronary artery disease. They reduce cardiovascular risk and improve health outcomes in people with cardiovascular disease. Although statins are considered as a safe medicine and are well tolerated by patients, prediction of an individual patient's response to statin therapy remains unclear. Variation to statin therapy has been attributed to both environmental and genetic factors. In this review, a number of candidate genes that affect statin pharmacokinetics and pharmacodynamics are discussed. Moreover, the association of demographic factors with statin response in related studies is described. In this article we have reviewed the literature concerning pharmacogenetic studies on statin response. Thirty seven English-language clinical trials, prospective or retrospective human investigations, case series, case reports, published between 1998 to 2015, were evaluated. Based on these data, there are some candidate genes that have been established as affecting genes on statin efficacy and suggest that drug therapy, based on individuals' genetic makeup, may result in a clinically important reduction in variation of statin response

Incidence of potential drug-drug interaction and related factors in hospitalized neurological patients in two iranian teaching hospitals

Reciprocal drug interactions are among the most common causes of adverse drug reactions. We investigated the incidence and related risk factors associated with mutual drug interactions in relation to prescriptions written in the neurology wards of two major teaching hospitals in Shiraz, southern Iran. Data was collected from hand-written prescriptions on a daily basis. Mutual drug interactions were identified using Lexi-Comp 2012 version 1.9.1. Type D and X drug interactions were considered as potential drug-drug interactions. The potential risk factors associated with drug-drug interactions included the patient's age and gender, number of medications and orders, length of hospitalization and the type of neurological disorder. To determine potential drug-drug interactions, relevant interventions were suggested to the physicians or nurses and the outcome of the interventions were documented. The study comprised 589 patients, of which 53% were males and 47% females, with a mean age of 56.65 +/- 18.19 SD years. A total of 4942 drug orders and 3784 medications were prescribed among which 4539 drug-drug interactions were detected, including 4118 type C, 403 type D, and 18 type X. Using a logistic regression model, the number of medications, length of hospitalization and non-vascular type of the neurological disorder were found to be significantly associated with potential drug-drug interactions. From the total interventions, 74.24% were accepted by physicians and nurses. Potentially hazardous reciprocal drug interactions are common among patients in neurology wards. Clinical pharmacists can play a critical role in the prevention of drug-drug interactions in hospitalized patients