Analysis of potential drug interactions in medical clinic sector in a Hospital of João Pessoa - PB

Abstract The objective of this study was to evaluate drug interactions based on medical records of patients hospitalized in University Hospital Lauro Wanderley (UHLW) in João Pessoa-PB, Brazil. This was a quantitative, descriptive study with a cross-sectional design. This research was conducted in the medical clinic of the above hospital by analyzing pharmaceutical intervention in medical records. The investigated samples consisted of all medical profiles with drug interaction information of patients hospitalized from June 2016 to June 2017. Most of these drug interactions were determined and classified by Micromedex® Solutions database. This research was approved by the Ethics Committee in Institutional Human Research, protocol number 2.460.206. In total, 331 drug interactions were found in 131 medical profiles. Dipyrone, enoxaparin, sertraline, ondansetron, quetiapine, tramadol, bromopride, amitriptyline, and simvastatin were medications that showed highest interactions. According to Anatomical Therapy Classification (ATC), drugs that act on the central nervous system result in more interactions. The most prevalent interaction was between dipyrone and enoxaparin. Some limitations of this study are the lack of notifications and data on drug interactions.

Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group.

BACKGROUND: The study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital drugs formulary. Before the intervention, the formulary contained four of the five low molecular weight heparins (LMWHs) marketed in Spain. The intervention consisted of withdrawing two LMWHs (bemiparin and dalteparin) from the formulary and restricting the use of another (tinzaparin), leaving only enoxaparin as an unrestricted prescription LMWH. Accordingly, the aim of this study was to evaluate the effect on in- and outpatient drug prescriptions of removing and restricting the use of several LMWHs in a hospital drugs formulary. METHODS: We used a natural, before-after, quasi-experimental design with a control group and monthly data from January 2011 to December 2016. Based on data drawn from official Public Health Service sources, the following dependent variables were extracted: defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID), DDD per 100 stays per day, and expenditure per DDD. RESULTS: The two compounds that were removed from the formulary registered an immediate decrease at both an intra- and out-of-hospital level (66.6% and 55.6% for bemiparin and 73.0% and 92.2% for dalteparin, respectively); similarly, the compound that was restricted also registered an immediate decrease (36.1% and 9.0% at the in- and outpatient levels, respectively); in contrast, the remaining LMWH (enoxaparin) registered an immediate, significant increase at both levels (44.9% and 32.6%, respectively). The intervention led to an immediate reduction of 6.8% and a change in trend in out-of-hospital cost/DDD; it also avoided an expenditure of €477,317.1 in the 21 months following the intervention. CONCLUSIONS: The results indicate that changes made in a hospital drugs formulary towards more efficient medications may lead to better use of pharmacotherapeutic resources in its health catchment area.

Comparação de Custo da enoxaparina e dos novos anticoagulantes orais dabigatran e rivaroxaban na profilaxia do tromboembolismo venoso / Cost comparison between enoxaparin and new oral anticoagulants dabigatran and rivaroxaban in venous thromboembolism prophylaxis

Venous thromboembolism, an important complication that is easily prevented during surgery, is among the few clinicai entities wherein the use of prophylaxis has been found to be effective, such as in the case of antibiotic prophylaxis for the prevention of surgical site infections. The objectives of prophylaxis are to reduce the incidence of deep vein thrombosis, minimize the risk of long-term complications such as chronic venous insufficiency and pulmonary hypertension, and prevent death caused by pulmonary embolism. In this study, we aimed to provide current information to plastic surgeons on the therapeutic options for prophylaxis of venous thromboembolism as well as to compare treatment costs of the drugs enoxaparin, dabigatran, and rivaroxaban. Method: For comparison, the prophylaxis regimen was started 6 hours after the surgery and continued for 10 days. The end user price was obtained from an internet search that included leading pharmacy chains. Results: The patient costs of the new oral anticoagulants dabigatran and rivaroxaban were lower than that of enoxaparin. Conclusions: The cost of venous thromboembolism prophylaxis consisting of the new oral anticoagulants dabigatran and rivaroxaban is lower than that of low molecular weight heparin.

O tromboembolismo venoso é uma complicação importante altamente evitável em cirurgia, sendo uma das poucas entidades clínica em medicina passíveis de profilaxia comprovadamente eficiente, assim como ocorre na profilaxia antibiótica da infecções cirúrgicas. A profilaxia tem por objetivo diminuir a incidência de trombose venosa profunda minimizar os riscos das complicações a longo prazo da insuficiência venosa crônica e hipertensão pulmonar, bem como prevenir a morte consequente de embolia pulmonar. Este estudo tem por objetivo atualizar os cirurgiões plásticos quanto às medicações que podem ser adotadas na profilaxia do tromboembolismo venoso bem como comparar o custo dessas medicações (enoxaparina dabigatran e rivaroxaban). Método: Para efeito de comparação foi adotado um esquema de profilaxia iniciado 6 horas após o fim da cirurgia e mantido por 1O dias. A pequisa foi realizada na internet entre as principais redes farmacêuticas, levando em conta custo para o consumidor. Resultados: Os novos anticoagulantes orais dabigatran e rivaroxaban apresentaram custo menor para o paciente. Conclusões: Os novos anticoagulantes orais dabigatran e rivaroxaban possuem custo menor na profilaxia do tromboembolismo venoso em comparação à heparina de baixo peso molecular.