Concomitant use of capecitabine and proton pump inhibitors - Is it safe?

BACKGROUND: Capecitabine is a commonly used oral chemotherapy agent. Recent data suggest that concurrent use of proton pump inhibitors may reduce the efficacy of capecitabine by decreasing its absorption through increased gastric pH. Since proton pump inhibitors are widely used, we evaluated the supportive evidence for the probability of occurrence and potential seriousness of this drug interaction. METHODS: The probability of occurrence was evaluated based on the clinical, pharmacokinetic and in vitro evidence using the Drug Interaction Probability Scale. The possibility of seriousness was assessed based on the potential impact on the therapeutic intent of capecitabine therapy. RESULTS: The probability of occurrence of the interaction is doubtful. Clinical findings from two retrospective post hoc analyses showed inconsistent trends towards reduced survival. Pharmacokinetics studies found no significant decrease in systemic capecitabine level with concurrent gastric acid suppression with antacid or food intake. In vitro data do not support the proposed mechanism of reduced capecitabine absorption due to increased gastric pH. The possibility of seriousness varies depending on the treatment intent of capecitabine therapy. The most and least serious possible outcome would be reduced possibility of cure or survival and symptom control, respectively. CONCLUSION: Although the possible outcome may be serious, the probability of interaction between capecitabine and proton pump inhibitors is doubtful. Therefore, we suggest that intervention should be limited to minimal change to existing therapy plan. This may include routinely ascertaining the need for proton pump inhibitor use. Alternate acid suppressing agents may be considered based on the therapeutic intent of capecitabine therapy.

Pharmacists’ perceptions of the impact of care they provide / Percepciones de los farmacéuticos de los cuidados que ellos proporcionan

Limitations on health care resources necessitate careful focus on activities that lead to the greatest improvement in patient outcomes. Despite the importance of aligning pharmacists' time with activities deriving the most impact, there is a paucity of literature on the correlations between pharmacists' perceptions of the impact of their activities, how they actually spend their time and how these align with published evidence of impacts on patient outcomes. Objective: To reveal hospital pharmacists' perceptions of the impacts of their clinical activities and to characterize the correlation between the activities performed and both their perceptions of and the published evidence for their impacts on patient care. Methods: Observational qualitative interviews and quantitative questionnaires were conducted with each participant (N=21) to characterize their work day and determine their perceptions of the impact of their activities. A systematic literature review catalogued pharmacists' activities with impact on patient outcomes. Primary endpoint: degree of correlation in three pair-wise comparisons between pharmacists' perceptions of impact, time allotted to activities, and published evidence of impact. Results: Pharmacists' time spent was positively and significantly correlated with their perception of impact (P=0.037) but not with the published evidence of impact (in either of the two analytical scenarios). The correlation between published evidence and pharmacists' perceptions of impacts was on the threshold of statistical significance with a moderate strength of association in one of the two analytical scenarios used. Conclusions: Pharmacists dedicate more of their clinical time to activities they perceive to have greater impact. However, these perceptions and their time allocation does not correlate well with published evidence, and some misperceptions about impacts deserve correction. More rigorous research is needed to quantify the value of pharmacist services to the health care system, however designing such studies to isolate the value of specific activities will be challenging (AU)

Las limitaciones en los recursos sanitarios obligan a centrarse claramente en las actividades que llevan a mayores mejorías en los resultados de los pacientes. A pesar de la importancia de alinear el tiempo de los farmacéuticos con las actividades que producen el mayor impacto, hay poca literatura sobre la correlación entre las percepciones de los farmacéuticos sobre el impacto de sus actividades y como emplean realmente su tiempo y como este se aliena con la evidencia publicada sobre el impacto en los resultados de los pacientes. Objetivo: Revelar las percepciones de los farmacéuticos hospitalarios sobre el impacto de sus actividades clínicas y caracterizar la correlación entre las actividades realizadas y sus percepciones y la evidencia publicada sobre el impacto de sus cuidados. Métodos: Se realizaron entrevistas observacionales cualitativas y cuestionarios cuantitativos con cada participante (N=21) para caracterizar su trabajo diario y determinar sus percepciones sobre el impacto de sus actividades. Una revisión sistemática catalogó las actividades de los farmacéuticos y su impacto sobre los resultados de los pacientes. Resultado primario: grado de correlación entre tres comparaciones emparejadas entre las percepciones de los farmacéuticos sobre el impacto, el tiempo destinado a las actividades y la evidencia publicada sobre ese impacto. Resultados: El tiempo de los farmacéuticos estaba positiva y significativamente correlacionado con su percepción con su percepción del impacto (P=0,037), pero no con la evidencia publicada del impacto (en cualquiera de los dos escenarios de análisis). La correlación entre la evidencia publicada y las percepciones del impacto estaba en el umbral de la significación estadística con una fuerza moderada de asociación en uno de los dos escenarios utilizados. Conclusiones: Los farmacéuticos dedican más tiempo clínico a las actividades que ellos perciben de mayor impacto. Sin embargo, estas percepciones y el tiempo dedicado no se correlacionan bien con la evidencia publicada y existe alguna mala interpretación sobre los impactos que merece corrección. Se necesita una investigación más rigurosa para cuantificar el valor de los servicios farmacéuticos sobre el sistema sanitario, sin embargo, será difícil diseñar esos estudios que aíslen el valor específico de las actividades (AU)

Pharmacists' perceptions of the impact of care they provide.

UNLABELLED: Limitations on health care resources necessitate careful focus on activities that lead to the greatest improvement in patient outcomes. Despite the importance of aligning pharmacists' time with activities deriving the most impact, there is a paucity of literature on the correlations between pharmacists' perceptions of the impact of their activities, how they actually spend their time and how these align with published evidence of impacts on patient outcomes. OBJECTIVE: To reveal hospital pharmacists' perceptions of the impacts of their clinical activities and to characterize the correlation between the activities performed and both their perceptions of and the published evidence for their impacts on patient care. METHODS: Observational qualitative interviews and quantitative questionnaires were conducted with each participant (N=21) to characterize their work day and determine their perceptions of the impact of their activities. A systematic literature review catalogued pharmacists' activities with impact on patient outcomes. Primary endpoint: degree of correlation in three pair-wise comparisons between pharmacists' perceptions of impact, time allotted to activities, and published evidence of impact. RESULTS: Pharmacists' time spent was positively and significantly correlated with their perception of impact (P=0.037) but not with the published evidence of impact (in either of the two analytical scenarios). The correlation between published evidence and pharmacists' perceptions of impacts was on the threshold of statistical significance with a moderate strength of association in one of the two analytical scenarios used. CONCLUSIONS: Pharmacists dedicate more of their clinical time to activities they perceive to have greater impact. However, these perceptions and their time allocation does not correlate well with published evidence, and some misperceptions about impacts deserve correction. More rigorous research is needed to quantify the value of pharmacist services to the health care system, however designing such studies to isolate the value of specific activities will be challenging.