Drug-drug interaction between valproic acid and meropenem: a retrospective analysis of electronic medical records from neurosurgery inpatients

2017 ◽  
Vol 42 (2) ◽  
pp. 221-227 ◽  
Author(s):  
Z.-P. Wen ◽  
S.-S. Fan ◽  
C. Du ◽  
T. Yin ◽  
B.-T. Zhou ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Drug Drug Interaction

Erythropoiesis stimulating agent (ESA) administration at Hb <10 g/dL for chemotherapy-induced anemia (CIA) following the National Coverage Decision (NCD)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20627-e20627
Author(s):  
S. A. Hulnick ◽  
G. Hess ◽  
J. Hill ◽  
H. N. Viswanathan ◽  
R. J. Nordyke
Keyword(s):  
Retrospective Analysis ◽  
Cancer Patients ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Darbepoetin Alfa ◽  
Epoetin Alfa ◽  
Coverage Decision ◽  
Medicare Coverage

e20627 Background: Medicare coverage of ESA treatment for CIA was changed in 7/07 to a hemoglobin (Hb) < 10 g/dL prior to administration. We describe the proportion of ESA administrations at Hb < 10 g/dL over four quarters following the NCD. Methods: A retrospective analysis of ESA administrations from 7/07 - 6/08 using Varian and Impac electronic medical records for 304,654 cancer patients from 91 practice sites across 19 states. Episodes of ESA treatment were identified within chemotherapy episodes. A > 42 day gap in ESA use identified a completed ESA episode and a > 90 day gap in chemotherapy identified a chemotherapy episode. Hb ≤ 7 days prior to ESA administration date was identified for each ESA episode. The percent of ESA administrations at Hb < 10 g/dL was measured from Q3 07 to Q2 08 for darbepoetin alfa (DA) and epoetin alfa (EA) stratified by age. Results: For patients age ≥ 65, the percent of ESAs administered at Hb < 10 g/dL increased from Q3 07 to Q2 08 for initial and maintenance administrations. A less pronounced trend was observed in patients age < 65. Maintenance administrations at Hb < 10 g/dL in patients age < 65 were significantly lower for EA vs. DA. Conclusions: ESA administrations have been increasingly administered at Hb < 10 g/dL. A higher proportion of Medicare-eligible patients received maintenance ESA administrations at Hb < 10 g/dL. [Table: see text] [Table: see text]

Antiretroviral concentrations in the presence and absence of valproic acid

2020 ◽  
Vol 75 (7) ◽  
pp. 1969-1971
Author(s):  
A Calcagno ◽  
J Cusato ◽  
M Ferrara ◽  
A De Nicolò ◽  
A Lazzaro ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Plasma Concentrations ◽  
Integrase Inhibitor ◽  
Major Effect ◽  
Therapeutic Drug ◽  
Hiv Integrase ◽  
Drug Drug Interaction ◽  
Underlying Mechanisms ◽  
Protein Displacement

Abstract Objectives An unexpected drug–drug interaction has been recently reported between dolutegravir, an HIV integrase inhibitor, and valproic acid. Despite there being several potential underlying mechanisms, plasma protein displacement has been suggested. The aim of this study was to assess plasma concentrations of several antiretrovirals when administered with or without valproic acid. Methods We performed a therapeutic drug monitoring registry analysis and identified patients concomitantly taking antiretrovirals and valproic acid and without clinical affecting conditions or interacting drugs. Results One hundred and thirty-four patients were identified. Median (IQR) age and BMI were 49.7 years (45–56) and 23.4 kg/m2 (20.8–26.3) and 78 were male (58.2%). Despite small groups, we observed no major effect on antiretroviral exposure, even when considering highly protein-bound compounds (such as etravirine), with the exception of dolutegravir trough concentrations [median (IQR) = 132 ng/mL (62–227) in individuals on valproic acid versus 760 ng/mL (333–1407) in those not receiving valproic acid]. Conclusions Valproic acid does not have a major effect on antiretrovirals other than dolutegravir. The mechanism of this unexpected drug–drug interaction may be the combination of protein displacement, reduced absorption and CYP3A4 induction.

scholarly journals Use of an On-demand Drug–Drug Interaction Checker by Prescribers and Consultants: A Retrospective Analysis in a Swiss Teaching Hospital

Drug Safety ◽  
2013 ◽  
Vol 36 (6) ◽  
pp. 427-434 ◽  
Author(s):  
Patrick Emanuel Beeler ◽  
Emmanuel Eschmann ◽  
Christoph Rosen ◽  
Jürg Blaser
Keyword(s):  
Drug Interaction ◽  
Retrospective Analysis ◽  
Teaching Hospital ◽  
On Demand ◽  
Drug Drug Interaction

scholarly journals Esophageal, Gastric, and Duodenal Histologic Findings in Patients with Feeding Difficulties

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2822
Author(s):  
Jensen Edwards ◽  
Craig Friesen ◽  
Amy Issa ◽  
Sarah Edwards
Keyword(s):  
Abdominal Pain ◽  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Feeding Disorders ◽  
Feeding Intolerance ◽  
Feeding Difficulties ◽  
Feeding Program ◽  
Abnormal Pathology

Currently, there are inconsistencies in the recommendations of when to obtain an esophagogastroduodenoscopy (EGD) in children with feeding difficulties. The aim of our study was to identify EGD findings in patients presenting to a large, outpatient feeding program. Additionally, we investigated the presence of any relationship between abnormal pathology seen on biopsies (inflammation) and symptoms of feeding intolerance such as vomiting, gagging, retching, or abdominal pain. Retrospective analysis of electronic medical records (EMRs) was conducted for all new patients aged 0–17 years presenting to the Multidisciplinary Feeding Clinic. Three hundred and thirty patients (50.2%) had an EGD with complete biopsies. Of these 330 patients, biopsies revealed esophagitis in 40%, gastritis in 33.6%, and duodenitis in 15.2%. Overall, 61.21% had an abnormal pathology in at least one site. We found that children with feeding disorders commonly have esophagitis, gastritis, and/or duodenitis and that symptoms are poor predictors of pathology. This study underscores the importance of gastrointestinal evaluation as part of a multidisciplinary evaluation in patients with feeding difficulties.

The dolutegravir/valproic acid drug–drug interaction is primarily based on protein displacement

2021 ◽  
Author(s):  
P D J Bollen ◽  
H A B Prins ◽  
A Colbers ◽  
K Velthoven-Graafland ◽  
B J A Rijnders ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Controlled Trial ◽  
Underlying Mechanism ◽  
Hiv Rna ◽  
Parallel Increase ◽  
Drug Drug Interaction ◽  
To Receive ◽  
Protein Displacement

Abstract Objectives The dolutegravir/valproic acid drug–drug interaction (DDI) is suggested to be caused by protein displacement. Here, we assess the underlying mechanism. Methods Participants in a randomized controlled trial investigating valproic acid as an HIV latency reversing agent were recruited in a predefined pharmacokinetic substudy if they were on once-daily 50 mg dolutegravir-containing combination ART (cART) for &gt;12 months with a plasma HIV-RNA &lt;50 copies/mL (trial registration: ClinicalTrials.gov NCT03525730). Participants were randomized to receive 30 mg/kg/day valproic acid orally (divided into two equal doses) for 14 days or not. Total and unbound dolutegravir concentrations were measured on day 0 (before intake of valproic acid and 6 h after intake of valproic acid) and on days 1, 7, 14 and 42. Intra- and inter-subject dolutegravir concentrations and geometric means (GMs) were evaluated. Results Six of 10 participants on dolutegravir were randomized to receive valproic acid. During 14 days of valproic acid treatment, the GM total dolutegravir concentration decreased sharply from 1.36 mg/L on day 0 to 0.85, 0.31 and 0.20 mg/L on days 0, 1, 7 and 14, respectively, while total dolutegravir concentrations in the controls remained comparable during the same period: 1.27–1.49 mg/L. We observed a parallel increase in unbound dolutegravir fractions ranging from 0.39% to 0.58% during valproic acid administration, compared with 0.25% to 0.28% without valproic acid. Unbound dolutegravir concentrations were above the established in vitro EC90 value for unbound dolutegravir in 85% of the tested samples. Conclusions This study confirms protein displacement as the main mechanism for this DDI, although additional mechanisms might be involved too. If dolutegravir is taken with food, this DDI is probably not clinically relevant.

Electronic palliative care coordination system (EPaCCS) in practice: A useful tool?

2019 ◽  
pp. bmjspcare-2019-001897
Author(s):  
Pablo Millares Martin
Keyword(s):  
Palliative Care ◽  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Care Coordination ◽  
Medical Records ◽  
Place Of Death ◽  
Coordination System ◽  
Coordination Systems ◽  
Share Information

ObjectivesFirst, to assess if Electronic Palliative Care Coordination Systems (EPaCCS) was used by different organisations as a tool to share information; second, to assess whether there was a measurable benefit with patients dying at their preferred place of death.MethodsA retrospective analysis of the 65 decedents from last 12 months in the registered list of a single practice in Leeds was conducted.ResultsEPaCCS was present in 24 patients (36.9%). It was used by more than one organisation in 17 cases (70.9%). It facilitated death at the preferred place in 19 of the 20 cases (95%) were preferences were recorded.ConclusionsEPaCCS within the organisation was not used as widely as it could have been presumed. Having a patient with an EPaCCS in the electronic medical records did not imply there was sharing of information among the different organisations involved. Although there was a clear impact on individuals dying at their preferred place of death, preferences were not necessarily recorded in EPaCCS.

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