The use of potentially inappropriate medications among the Lithuanian elderly according to Beers and EU(7)-PIM list - a nationwide cross-sectional study on reimbursement claims data.

WHAT IS KNOWN AND OBJECTIVE: The prevalence and risk factors for prescribing and using potentially inappropriate medications (PIMs) has been extensively researched in Western Europe and the United States of America; however, research in Central and Eastern Europe remains highly limited. According to a recent systematic review, the overall estimated weighted prevalence of PIM prescribing in community-dwelling elderly in Europe (expressed as a percentage of patients or prescriptions with ≥1 PIM) was 22·6% (95% CI: 19·5%-26·7%). The main objective of this study was to investigate the prevalence of use of PIMs among the elderly in Lithuania according to different sets of published explicit criteria and compare the results with similar research carried out in other European countries. METHODS: This was a retrospective, observational cross-sectional population-based (n = 431 625) study using the medicines reimbursement claims data covering a 1-year period. The use of PIMs was measured based on 2003 Beers criteria, 2015 AGS Beers criteria and the EU(7)-PIM list. The prevalence was measured as the percentage of patients with at least 1 PIM during 1-year period. Multivariate logistic regression was used to identify risk factors for PIM prescription. RESULTS AND DISCUSSION: The prevalence of PIM use varied from 24·1% according to 2003 Beers criteria and 25·9% according to 2015 AGS Beers criteria, to 57·2% according to the EU(7)-PIM list. Polypharmacy and increasing age had increased the risk of PIM use. Women had an increased risk for prescription of the EU(7)-PIM listed medications compared with men, whereas for Beers drugs the risk in women was lower. Benzodiazepines were the most commonly prescribed PIMs according to all criteria. WHAT IS NEW AND CONCLUSION: The use of PIMs is highly prevalent among the Lithuanian elderly and there is a great need of interventions to improve the pharmacotherapy in this age group.

Augmented renal clearance--an evolving risk factor to consider during the treatment with vancomycin.

WHAT IS KNOWN AND OBJECTIVE: Augmented renal clearance (ARC) is a new phenomenon in patients' pathophysiology without universally accepted aetiology and with various incidence rates most often described in critically ill patients in the Intensive Care Unit (ICU). The objective of this retrospective observational comparative study was to estimate the incidence rate of ARC in patients with different medical conditions employing steady state trough vancomycin serum concentrations (VSCss) for analysis. METHODS: All patients tested for VCSss during two years (2010-2011) in a tertiary level hospital were analysed and 77 VSCs were eligible for analysis: 38 (50%) and 39 cases were assigned to the ARC (eCrClCG (creatinine clearance, estimated by Cockcroft-Gault) > 130 mL/min) and the control groups (eCrClCG in the range 90-130 mL/min) respectively. RESULTS AND DISCUSSION: Patients' age, mechanical ventilation and haemodynamically unstable status had significant association with ARC occurrence (P < 0.05). Majority of ARC patients (11 patients (61 %)) were managed in non-ICU settings. ARC event showed statistically significant higher risk for under dosage (RR (relative risk for subtherapeutic VSCss), 1.84; 95% CI, 1.23\x962.74; P = 0.011), and the correlation between different thresholds (eCrClCG >130 mL/min, ≥140 mL/min and ≥150 mL/min) for ARC and VSCss allows to predict decrease of VSCss in case of eCrClCG ≥150 mL/min: every increase of eCrClCG by 40 mL/min predicts clinically relevant decrease of VSCss by 1 mmol/L (1.49 mg/mL). WHAT IS NEW AND CONCLUSION: ARC cases lead to the doubled risk of subtherapeutic VSC, and this phenomenon is a significant event in patients in any hospital department. Investigation of medical patients' status relevant to this phenomenon needs to be continued.

Ibogaine, an anti-addictive drug: pharmacology and time to go further in development. A narrative review.

Ibogaine is an indole alkaloid derived from the bark of the root of the African shrub Tabernanthe iboga. Psychoactive properties of ibogaine have been known for decades. More recently, based on experimental data from animals and anectodal reports in human, it has been found that this drug has anti-addictive effects. Several patents were published between 1969 and 1995. The pharmacology of ibogaine is quite complex, affecting many different neurotransmitter systems simultaneously. However, the pharmacological targets underlying the physiological and psychological actions of ibogaine are not completely understood. Ibogaine is rapidly metabolized in the body in noribogaine. The purpose of this article was to review data from the literature concerning physicochemical properties, bio-analytical methods, and pharmacology of ibogaine; this article will be focused on the use of this drug as anti-addictive agent.