Drug dosage adjustment of patients with impaired renal function at hospital discharge in a teaching hospital.

BACKGROUND: Inappropriate dosing and the risk of toxicities are common with the patients with impaired renal function. Therefore, appropriate dosing is obligatory to prevent the drug toxicities. The present study was performed to investigate the appropriateness of dosage adjustment of the drugs that are toxic to kidney and/or metabolized or eliminated (TEM) by kidney. METHODS: A retrospective study was performed at the time of hospital discharge in the patients with impaired renal function. All patients with renal clearance ≤50 ml/min/1.73 m² were included for the analysis. Data with respect to patient's clinical, medications and their dosages, laboratory findings were extracted from medical record section. RESULTS: At discharge, there were a total of 848 prescribed drugs in 116 impaired renal function patients. Of them 404 were classified as TEM medication. Dose adjustment according to renal function was judged as necessary in 135 TEM medications and 28 were deemed to be used with caution. Among these, 108 (80% of 135) medications were considered appropriate in dosing, whereas 27 (20%) were inappropriate. Total 14 (10.37%) and 13 (9.63%) times of inappropriate dosing were found in those with moderate and severe renal impairment, respectively. The frequency of inappropriate dosing was not significantly different from moderate than that of the severe renal impairment (p > 0.05). CONCLUSIONS: The results of the study demonstrated that dosage adjustment of TEM drugs in patients with impaired renal function is less than optimum in a considerable number of patients at hospital discharge. Awareness raising and monitoring system for inappropriate dosing is critical to improve the quality of care in patients with renal dysfunction.

The period prevalence of catamenial epilepsy at Prasat Neurological Institute, Bangkok.

The study was performed to assess the period prevalence of catamenial epilepsy in Thai female epileptic patients. Such a condition is defined as seizures related to menstruation which occur for at least 2 consecutive months within 1 patient during 4 days prior to and/or 6 days after the onset of menstruation. Patients with regular menstruation aged between 15-50 years attending the Out-Patient Department of Prasat Neurological Institute in Bangkok from 1 November, 1995 to 31 January, 1996 were recruited. Patients and/or their relatives were interviewed directly or by telephone using a questionnaire concerning menstrual history, seizures related to menstruation and they were requested to record these data for 2 further consecutive months. In cases where the interview could not be directly performed, a mailed questionnaire was used instead. All information was considered together with information reviewed from the OPD cards. Forty-six from 467 epileptic patients were considered to have catamenial epilepsy. The period prevalence thus was 98.5 in 1,000 women at risk and the mode of frequency of seizure occurrence was 2 days before menstruation. Generalized seizure was found more common in these patients than partial seizure. In particular, general tonic-clonic seizure and complex partial seizure were the most common for each type, respectively. About 70 per cent of the patients used more than 1 anti-convulsant drugs to control their seizures. Some have received other drug supplements to relieve seizure exacerbation but only mild improvement was observed. No change in body weights measured in 2 or 1 day before menstruation, on the first menstrual day and in 1 day after menstruation was demonstrated in all patients. The results suggest that catamenial epilepsy is one of the clinically significant problems of seizure control in Thai female epileptic patients and multifactors may be involved in this condition.