Interacciones farmacológicas potenciales entre antihipertensivos y otros medicamentos de uso crónico / Potential drug interactions between antihypertensive drugs and other chronic use drugs

Objetivo. Determinar en el ámbito de Atención Primaria la frecuencia de las potenciales interacciones farmacológicas de los medicamentos antihipertensivos. Diseño. Estudio observacional transversal. Emplazamiento. Centro de salud de características urbanas. Participantes. Trescientos veintitrés pacientes seleccionados mediante muestreo consecutivo a partir de tarjetas de largo tratamiento. Nivel de confianza del 95 %; precisión ± 5 %; proporción esperada de interacciones del 30 %. Sujetos: pacientes hipertensos que consumen medicación antihipertensiva. Variables: medicación antihipertensiva, otros fármacos de uso crónico y datos sociodemográficos. Para valorar las combinaciones inadecuadas se utilizó la Guía de Interacciones de Fármacos 2002 de la Sociedad Española de Farmacia Hospitalaria. Análisis de datos: descripción de variables, pruebas de comparación de medias y proporciones en grupos independientes. Mediciones principales. Consumo de antihipertensivos, medicación concomitante, presencia de interacciones según las fichas técnicas de la Sociedad Española de Farmacia Hospitalaria y variables sociodemográficas. Resultados. Edad media de 64,33 años ± 12,24 DE (rango: 32-97), porcentaje de mujeres del 57 %. Número medio de otros medicamentos 3,56 ± 1,45 DE. La distribución con porcentajes de medicamentos antihipertensivos fue: calcioantagonistas: 29 (13,2 %); inhibidores de la enzima conversora de la angiotensina: 225 (70 %); antagonistas del receptor de la angiotensina II: 47 (19,6%); betabloqueantes: 24 (7,2%); alfabloqueantes: 47 (14,6%); alfa-betabloqueantes: 4 (1,2%), y diuréticos: 75 (38,7%). Presentaron alguna interacción moderada o grave el 19,5 % de los pacientes (IC 95 %: 15,2-23,8). Las principales interacciones fueron: enalapril y diuréticos ahorradores de potasio: 8 (2,4 %); captopril y ácido acetilsalicílico: 7 (2,2%); captopril y alopurinol: 3 (0,9 %); nifedipino y omeprazol: 4 (1,2%); nifedipino y antidiabéticos orales: 2 (0,6 %); verapamil y calcio: 2 (0,6 %); doxazosina y diuréticos: 11 (3,4 %); doxazosina y digoxina: 1 (0,3 %); inhibidores de la enzima conversora de la angiotensina o antagonistas del receptor de la angiotensina II y diuréticos como enalapril y tiacidas: 20 (6,2%). La proporción de interacciones no fue significativamente diferente en ambos sexos y tampoco la edad media fue diferente desde el punto de vista estadístico en los pacientes con o sin alguna interacción. Conclusiones. Es elevada la proporción de pacientes consumidores de medicación antihipertensiva que presentan interacciones moderadas o graves, especialmente en el caso del enalapril, captopril, nifedipino, verapamil y doxazosina. Determinadas interacciones pueden ser la causa de un mal control de las cifras tensionales o descompensación de otras patologías. Frente al riesgo potencial de las interacciones de los medicamentos antihipertensivos el médico de Atención Primaria debe considerar, cada vez más por su mayor utilización, la compatibilidad de los mismos con el resto de los fármacos

Objective. To determine the frequency of potential drug interactions of antihypertensive drugs in the Primary Health Care Setting. Design. Cross-sectional observational study. Site. Urban health care center. Participants. 323 patients selected by consecutive sampling from long treatment cards. 95 % confidence interval. Accuracy ± 5 %. Expected proportion of interactions 30 %. Subjects: hypertensive patients who take antihypertensive drugs. Endpoints: antihypertensive drugs, other chronic use drugs, and sociodemographic data. To assess inadequate combinations, the 2002 Drug Interactions Guide of the Spanish Society of Hospital Drugs was used. Data analysis: description of endpoints, mean comparison tests and proportions in independent groups. Main measurements. Use of antihypertensive drugs, concomitant medications, presence of interactions according to Spanish Society of Hospital Drug data sheets and sociodemographic endpoints. Results. Mean age of 64.33 years ± 12.24 SD (range: 32-97), percentage of women 57 %. Mean number of other drugs 3.56 ± 1.45 SD. Distribution with percentages of antihypertensive drugs was: calcium antagonists: 29 (13.2 %); ACEIs: 225 (70 %); ARA II: 47 (19.6 %); beta blockers: 24 (7.2 %); alpha blockers: 47 (14.6%); alpha-beta blockers: 4 (1.2 %) and diuretics: 75 (38.7%). A total of 19.5 % of the patients had some moderate or serious interaction (95 % CI: 15.2-23.8). The main interactions were: enalapril and potassium saving diuretics: 8 (2.4 %); captopril and ASA: 7 (2.2%); captopril and allopurinol: 3 (0.9 %); nifedipine and omeprazole: 4 (1.2 %); nifedipine and oral antidiabetics: 2 (0.6 %); verapamil and calcium 2 (0.6 %); doxazosine and diuretics: 11 (3.4%); doxazosine and digoxine 1 (0.3 %), ACEI or ARA II and diuretics as enalapril and thiazides: 20 (6.2 %). The proportion of interactions was not significantly different in both genders and the mean age was also not different from the statistical point of view in patients with or without some interaction. Conclusions. The percentage of patients using antihypertensive drugs who have moderate or serious interactions is high, especially in the case of enalapril, captopril, nifedipine, verapamil and doxazosine. Certain interactions may be the cause of poor control of tension values or decompensation of other diseases. Faced with the potential risk of the interactions of antihypertensive drugs, the Primary Health care physician should increasingly consider the compatibility of these with the remaining drugs due to its greater useObjective. To determine the frequency of potential drug interactions of antihypertensive drugs in the Primary Health Care Setting. Design. Cross-sectional observational study. Site. Urban health care center. Participants. 323 patients selected by consecutive sampling from long treatment cards. 95 % confidence interval. Accuracy ± 5 %. Expected proportion of interactions 30 %. Subjects: hypertensive patients who take antihypertensive drugs. Endpoints: antihypertensive drugs, other chronic use drugs, and sociodemographic data. To assess inadequate combinations, the 2002 Drug Interactions Guide of the Spanish Society of Hospital Drugs was used. Data analysis: description of endpoints, mean comparison tests and proportions in independent groups. Main measurements. Use of antihypertensive drugs, concomitant medications, presence of interactions according to Spanish Society of Hospital Drug data sheets and sociodemographic endpoints. Results. Mean age of 64.33 years ± 12.24 SD (range: 32-97), percentage of women 57 %. Mean number of other drugs 3.56 ± 1.45 SD. Distribution with percentages of antihypertensive drugs was: calcium antagonists: 29 (13.2 %); ACEIs: 225 (70 %); ARA II: 47 (19.6 %); beta blockers: 24 (7.2 %); alpha blockers: 47 (14.6%); alpha-beta blockers: 4 (1.2 %) and diuretics: 75 (38.7%). A total of 19.5 % of the patients had some moderate or serious interaction (95 % CI: 15.2-23.8). The main interactions were: enalapril and potassium saving diuretics: 8 (2.4 %); captopril and ASA: 7 (2.2%); captopril and allopurinol: 3 (0.9 %); nifedipine and omeprazole: 4 (1.2 %); nifedipine and oral antidiabetics: 2 (0.6 %); verapamil and calcium 2 (0.6 %); doxazosine and diuretics: 11 (3.4%); doxazosine and digoxine 1 (0.3 %), ACEI or ARA II and diuretics as enalapril and thiazides: 20 (6.2 %). The proportion of interactions was not significantly different in both genders and the mean age was also not different from the statistical point of view in patients with or without some interaction. Conclusions. The percentage of patients using antihypertensive drugs who have moderate or serious interactions is high, especially in the case of enalapril, captopril, nifedipine, verapamil and doxazosine. Certain interactions may be the cause of poor control of tension values or decompensation of other diseases. Faced with the potential risk of the interactions of antihypertensive drugs, the Primary Health care physician should increasingly consider the compatibility of these with the remaining drugs due to its greater use

Interacciones farmacológicas potenciales entre antihipertensivos y otros medicamentos de uso crónico / Potential drug interactions between antihypertensive drugs and other chronic use drugs

Objetivo. Determinar en el ámbito de Atención Primaria la frecuencia de las potenciales interacciones farmacológicas de los medicamentos antihipertensivos. Diseño. Estudio observacional transversal. Emplazamiento. Centro de salud de características urbanas. Participantes. Trescientos veintitrés pacientes seleccionados mediante muestreo consecutivo a partir de tarjetas de largo tratamiento. Nivel de confianza del 95 %; precisión ± 5 %; proporción esperada de interacciones del 30 %. Sujetos: pacientes hipertensos que consumen medicación antihipertensiva. Variables: medicación antihipertensiva, otros fármacos de uso crónico y datos sociodemográficos. Para valorar las combinaciones inadecuadas se utilizó la Guía de Interacciones de Fármacos 2002 de la Sociedad Española de Farmacia Hospitalaria. Análisis de datos: descripción de variables, pruebas de comparación de medias y proporciones en grupos independientes. Mediciones principales. Consumo de antihipertensivos, medicación concomitante, presencia de interacciones según las fichas técnicas de la Sociedad Española de Farmacia Hospitalaria y variables sociodemográficas. Resultados. Edad media de 64,33 años ± 12,24 DE (rango: 32-97), porcentaje de mujeres del 57 %. Número medio de otros medicamentos 3,56 ± 1,45 DE. La distribución con porcentajes de medicamentos antihipertensivos fue: calcioantagonistas: 29 (13,2 %); inhibidores de la enzima conversora de la angiotensina: 225 (70 %); antagonistas del receptor de la angiotensina II: 47 (19,6%); betabloqueantes: 24 (7,2%); alfabloqueantes: 47 (14,6%); alfa-betabloqueantes: 4 (1,2%), y diuréticos: 75 (38,7%). Presentaron alguna interacción moderada o grave el 19,5 % de los pacientes (IC 95 %: 15,2-23,8). Las principales interacciones fueron: enalapril y diuréticos ahorradores de potasio: 8 (2,4 %); captopril y ácido acetilsalicílico: 7 (2,2%); captopril y alopurinol: 3 (0,9 %); nifedipino y omeprazol: 4 (1,2%); nifedipino y antidiabéticos orales: 2 (0,6 %); verapamil y calcio: 2 (0,6 %); doxazosina y diuréticos: 11 (3,4 %); doxazosina y digoxina: 1 (0,3 %); inhibidores de la enzima conversora de la angiotensina o antagonistas del receptor de la angiotensina II y diuréticos como enalapril y tiacidas: 20 (6,2%). La proporción de interacciones no fue significativamente diferente en ambos sexos y tampoco la edad media fue diferente desde el punto de vista estadístico en los pacientes con o sin alguna interacción. Conclusiones. Es elevada la proporción de pacientes consumidores de medicación antihipertensiva que presentan interacciones moderadas o graves, especialmente en el caso del enalapril, captopril, nifedipino, verapamil y doxazosina. Determinadas interacciones pueden ser la causa de un mal control de las cifras tensionales o descompensación de otras patologías. Frente al riesgo potencial de las interacciones de los medicamentos antihipertensivos el médico de Atención Primaria debe considerar, cada vez más por su mayor utilización, la compatibilidad de los mismos con el resto de los fármacos

Objective. To determine the frequency of potential drug interactions of antihypertensive drugs in the Primary Health Care Setting. Design. Cross-sectional observational study. Site. Urban health care center. Participants. 323 patients selected by consecutive sampling from long treatment cards. 95 % confidence interval. Accuracy ± 5 %. Expected proportion of interactions 30 %. Subjects: hypertensive patients who take antihypertensive drugs. Endpoints: antihypertensive drugs, other chronic use drugs, and sociodemographic data. To assess inadequate combinations, the 2002 Drug Interactions Guide of the Spanish Society of Hospital Drugs was used. Data analysis: description of endpoints, mean comparison tests and proportions in independent groups. Main measurements. Use of antihypertensive drugs, concomitant medications, presence of interactions according to Spanish Society of Hospital Drug data sheets and sociodemographic endpoints. Results. Mean age of 64.33 years ± 12.24 SD (range: 32-97), percentage of women 57 %. Mean number of other drugs 3.56 ± 1.45 SD. Distribution with percentages of antihypertensive drugs was: calcium antagonists: 29 (13.2 %); ACEIs: 225 (70 %); ARA II: 47 (19.6 %); beta blockers: 24 (7.2 %); alpha blockers: 47 (14.6%); alpha-beta blockers: 4 (1.2 %) and diuretics: 75 (38.7%). A total of 19.5 % of the patients had some moderate or serious interaction (95 % CI: 15.2-23.8). The main interactions were: enalapril and potassium saving diuretics: 8 (2.4 %); captopril and ASA: 7 (2.2%); captopril and allopurinol: 3 (0.9 %); nifedipine and omeprazole: 4 (1.2 %); nifedipine and oral antidiabetics: 2 (0.6 %); verapamil and calcium 2 (0.6 %); doxazosine and diuretics: 11 (3.4%); doxazosine and digoxine 1 (0.3 %), ACEI or ARA II and diuretics as enalapril and thiazides: 20 (6.2 %). The proportion of interactions was not significantly different in both genders and the mean age was also not different from the statistical point of view in patients with or without some interaction. Conclusions. The percentage of patients using antihypertensive drugs who have moderate or serious interactions is high, especially in the case of enalapril, captopril, nifedipine, verapamil and doxazosine. Certain interactions may be the cause of poor control of tension values or decompensation of other diseases. Faced with the potential risk of the interactions of antihypertensive drugs, the Primary Health care physician should increasingly consider the compatibility of these with the remaining drugs due to its greater use

[Pharmacological interactions of statins]. / Interacciones farmacológicas de las estatinas.

OBJECTIVE: To determine in primary care the frequency of pharmacological interactions of statins. DESIGN: Transversal observational study.Setting. Urban health centre.Participants. 384 patients taking statins who were chosen by systematic sampling based on long-treatment cards (95% CI, accuracy 5% and expected proportion of possible interactions unknown). MAIN MEASUREMENTS: Consumption of statins, the accompanying medication taken, presence of interactions according to the technical details of statins (Spanish Medication Agency, Ministry of Health and Consumption) and social and demographic variables. RESULTS: In 55 patients (14.3%) (95% CI, 10.8%-17.8%) one of the statin interactions with the other drugs was checked, especially with acenocoumarol, digoxin and anti-acid drugs. In patients with some interaction, the mean number of other drugs was significantly higher (4.51.5 vs 3.31.9 SD; P<.001). 19.1% of men and 10.8% of women showed interactions, the difference being statistically significant (P=.02). By means of logistic regression, both masculine gender (OR=1.8) and taking of other medication in quantities of 5 or more (OR=2.7) appeared as variables associated with the presence of interactions. CONCLUSIONS: The potential pharmacological interactions of statins reach 14.3% of patients with hypercholesterolaemia who take medication long-term. The possibility of reaching high plasma concentrations of statins and/or of modifying the therapeutic effect of various drugs enables a more appropriate use of statins to be recommended, with prescription of those statins that metabolise less through the P450 cytochrome.

Interacciones farmacológicas de las estatinas / Pharmacological interactions of statins

Objetivo. Determinar en el ámbito de atención primaria la frecuencia de potenciales interacciones farmacológicas de las estatinas. Diseño. Estudio observacional transversal. Emplazamiento. Centro de salud de características urbanas. Participantes. Se seleccionó a 384 pacientes consumidores de estatinas mediante muestreo sistemático a partir de las cartillas de largo tratamiento (nivel de confianza del 95 por ciento, precisión del ñ 5 por ciento y proporción esperada de posibles interacciones desconocida).Mediciones principales. Consumo de estatinas, medicación concomitante, presencia de interacciones según las fichas técnicas de las estatinas (Agencia Española del Medicamento. Ministerio de Sanidad y Consumo) y variables sociodemográficas. Resultados. En 55 pacientes (14,3 por ciento; IC del 95 por ciento, 10,8-17,8 por ciento) se comprobó alguna de las interacciones de las estatinas con el resto de los fármacos, sobre todo con acenocumarol, digoxina y antiácidos. Entre los pacientes con alguna interacción, el número medio de otros medicamentos fue significativamente superior (DE, 4,5 ñ 1,5 frente a 3,3 ñ 1,9; p < 0,001). Presentaron interacciones el 19,1 por ciento de los varones y el 10,8 por ciento de las mujeres, resultando la diferencia estadísticamente significativa (p = 0,02). Mediante regresión logística, tanto el sexo masculino (OR= 1,8) como el consumo de otros medicamentos en número de 5 o más (OR = 2,7) aparecieron como variables asociadas a la presencia de interacciones. Conclusiones. Las potenciales interacciones farmacológicas de las estatinas alcanzan al 14,3 por ciento de los pacientes con hipercolesterolemia que consumen medicación de forma crónica. La posibilidad de alcanzar concentraciones plasmáticas elevadas de estatinas o de modificar el efecto terapéutico de diversos fármacos permite aconsejar un uso más apropiado de aquéllas, prescribiendo las que utilizan en menor medida el citocromo P-450 para su metabolismo (AU)

Degradation of poly[bis(glycine ethyl ester)phosphazene] in aqueous media.

The degradation of poly[bis(glycine ethyl ester)phosphazene] in aqueous media was studied by following the appearance of some of its expected by-products in solution. Disc-shaped polymer slabs of 12 mm diameter and 1.2 mm thickness were prepared by compression moulding, followed by incubation in aqueous media under carefully controlled conditions of pH and temperature. Low molecular weight by-products (phosphate and glycine) were assayed for up to 60 d using ultraviolet and visible spectroscopy. Slabs placed in pH 12.0 media at 20 degrees C took 16 d to disappear completely (no longer visible), while at 37 and 47 degrees C this occurred in 12 d. Also, slabs placed in pH 7.0 and 4.0 media took 60 and 24 d, respectively, to disappear at 47 degrees C. However, at 20 and 37 degrees C only some of the material disappeared at pH 7.0 after 60 d. In all cases, the cumulative fractional loss of by-products from the slabs was < 1, indicating the presence in solution of other species which were unaccounted for. This study showed that poly[bis(glycine ethyl ester)phosphazene] slabs have a lifetime in physiological media which makes them an acceptable support for short-term controlled drug release, and complements others, in which polyphosphazenes were used for a similar application.

[Fatal strongyloidiasis in an immunodepressed patient following renal transplantation]. / Estrongiloidiasis fatal en paciente inmunodeprimido pos-trasplante renal.

Occurrence of fatal hyperinfection with Strongyloides stercoralis in an immunodepressed patient after kidney transplantation is reported. Physiopathology of the illness is discussed and the seriousness of the hyperinfection syndrome is stressed. Endoscopy with duodenal biopsy is useful for the establishment of diagnosis.

[Bouble-blind unilateral comparison of difluocortolone valerate and flumethasone pivalate ointments]. / Doppelblindprüfung im Halbseitenvergleich zwischen Diflucortolonvalerianat und Flumethasonpivalat in Salbenform

A 0.1% diflucortolone valerate ointment was investigated in a randomised double-blind contralateral comparison against a 0.2% flumethasone ointment in 52 selected patients with neither weeping nor very dry dermatoses. The results are presented and commented on according to indications.