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Background Potentially inappropriate medication (PIM) is associated with adverse outcomes like hospitalisation and death. The aim of this study was to assess the nationwide prevalence of PIM among aged Austrians in 2012. Methods We analysed pseudonymised claims data of all 19 Austrian Statutory health insurances including all prescriptions of beneficiaries aged ≥ 70 years which were reimbursed by the insurances in 2012. Drugs priced ≤ € 5.15 (which equals the co-payment demanded per prescription) could only be included in the analysis if persons were exempted from co-payment. Potential inappropriateness of prescriptions was assessed by means of a recently published Austrian PIM list containing 73 drugs to be avoided in older patients. Results In the full survey of persons aged ≥ 70 years, 52.4% of all 1,123,832 insurants were prescribed at least one reimbursed PIM prescription, with higher rates in women (56.9%) than in men (45.8%). The three most often identified PIM groups were non-steroidal anti-inflammatory drugs (28.9%), vasodilators (16.0%) and psychotropic drugs (12.5%). The three most often prescribed inappropriate single drugs included diclofenac (18.3%), ginkgo biloba (12.5%), and tramadol (8.9%). In insurants who were exempted from co-payment, PIM prevalence was 71.6% and 73.3%. In this person group, high prevalences were found for psychotropic PIM; 33.3% in permanently and 28.3% in temporarily exempted insurants. Conclusions PIM prescription has a high prevalence in the older Austrian population. Thus, Austria urgently needs a nationwide strategy to reduce the high overall prevalence of PIMs and especially of psychotropic PIMs. [ABSTRACT FROM AUTHOR]

Purpose: The transversus abdominis plane (TAP) block is a regional anesthetic technique used for pain control following abdominal surgical procedures. While a minimum of systemic side effects is usually expected after local anesthesia, it is unknown to which extent systemic absorption and redistribution to the abdominal wall contributes to the effects of anesthetics. The aim of this study was to determine concentration-time profiles of ropivacaine after the injection of 150 mg of ropivacaine into the lateral abdominal wall in various compartments. Methods: The microdialysis technique was used to measure ropivacaine in plasma as well as at abdominal wall sites cranial from the injection site (below the 12th rip) and caudal from the injection site (cranial from the iliac crest) and in the skeletal muscle tissue of the contra lateral thigh of eight healthy volunteers. Results: The mean exposure to ropivacaine measured as the area under the concentration-time curve was significantly higher at the two abdominal sites (240.9 ± 409.1 and 86.18 ± 133.50 μg h/mL, respectively) than in plasma (5.1 ± 1.0 μg h/mL) or in peripheral tissue (1.1 ± 1.2 μg h/mL). While the high mean concentrations of ropivacaine measured at the abdominal wall sites support the topical concept of the TAP block, the observed variability was striking. Conclusions: While the systemic pharmacokinetics was comparable between subjects, the local distribution of ropivacaine was highly variable after TAP block. [ABSTRACT FROM AUTHOR]

Objective: Desmopressin is usually administered intranasally in the treatment of central diabetes insipidus or nocturnal enuresis. The sublingual administration of desmopressin is expected to be an alternative to the intranasal route with advantages to children and to patients with allergic rhinitis or chronic rhinosinusitis. Therefore, the present study was carried out to explore the time-versus-concentration profile of desmopressin in plasma after sublingual administration to healthy volunteers. Subjects and methods: A total of 16 healthy male volunteers were enrolled in this open, exploratory, 1-period, randomized, dose-escalation study. Volunteers received a single sublingual dose of either 20, 40, 80, 160, 240 or 320 μg of desmopressin acetate. Desmopressin plasma concentrations were measured over a 12-hour period using a validated radioimmunoassay method. Safety and tolerability were assessed simultaneously. Results: Plasma concentrations of desmopressin were below the lower limit of quantification (LLOQ) of 5 pg/ml for doses lower than 80 μg. For the doses of 160μ320 μg the time-versus-concentration profiles were higher than the LLOQ. The area under the curve from 0–12 h (AUC0–12h) was 54.66 ± 25.92 pg × h/ml after the 160 μg dose, 104.38 ± 79.10 pg × h/ml following the 240 μg dose and 133.18 ± 181.84 pg × h/ml following the 320 μg dose. Given the data from previous experiments, the time-versus-concentration profile of desmopressin in plasma after a sublingual dose of 240 lag appeared to be ha the range of previously published data on an intranasal dose of 20 μg. Sublingual administration of desmopressin proved to be safe and was well tolerated by all volunteers. Conclusion: A very high inter-individual variability in desmopressin plasma concentrations was detected after sublingual administration. A sublingual dose of 240 μg of desmopressin appeared to result in a pharmacokinetic profile comparable to 20 μg administered intranasally. These data, however, need to be verified in a separate well-designed prospective clinical study. [ABSTRACT FROM AUTHOR]