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Local medical systems (LMSs) are complex and dynamic, encompassing local perceptions of diseases, prevention and treatment strategies, and evaluations of therapeutic responses. These systems are not isolated and interact with other medical systems, such as the biomedical system. The interaction between these systems creates a "contact zone", which some authors refer to as intermedicality, involving both competitive and complementary interactions. However, there is limited discussion in the literature regarding the complexity of these interactions. Some studies seek to understand this interaction through the lens of hybridization, a concept introduced to ethnobiology by Ana Ladio and Ulysses Albuquerque. The authors conceptualize hybridization as "discrete structures and practices coming together to form a new practice not necessarily implying homogenization." They discuss hybridization in the context of medicinal plants used in urban settings and propose seven hybridization subprocesses to gain a deeper understanding of this phenomenon. In this study, we update these hybridization subprocesses, expanding the concepts to comprehend the specific interaction of resources from LMS and biomedical systems known and used by different human groups. In this context, we propose a new subprocess and have made adjustments to the existing subprocesses to encompass the diversity of possible interactions between medicinal plants and pharmaceuticals, providing evidence from the literature demonstrating interactions that can be classified within the proposed subprocesses. Furthermore, we discuss, from a theoretical standpoint, how these subprocesses may have implications for the resilience of medical systems. Moreover, we propose a flowchart that can be utilized to identify these hybridization subprocesses in intermedicality contexts in future studies. These classifications are crucial because they enable us to comprehend the complexity of interactions between medicinal plants and pharmaceuticals, as well as the impacts that these different interactions can have on the resilience of LMSs., (© 2023. The Author(s).)

Adequate pharmacotherapy in critically ill patients is challenging for many clinicians. Disease-related pathophysiological changes often lead to complex therapy strategies including many intensive care treatments (e.g. invasive ventilation, renal replacement therapy). These measures often influence drug prescribing and dosing. Therefore, in organ dysfunction such as renal and liver impairment reduced drug elimination has to be considered by adapting drug dosing towards elimination rates. Moreover, as intensive care medicine often includes the use of multiple drugs the risk for drug-drug interactions increases. The current article gives an overview about the complexity of individual pharmacotherapy in intensive care units whilst providing information for its clinical implementation.

Electronic health records (EHR) represent a rich and relatively untapped resource for characterizing the true nature of clinical practice and for quantifying the degree of inter-relatedness of medical entities such as drugs, diseases, procedures and devices. We provide a unique set of co-occurrence matrices, quantifying the pairwise mentions of 3 million terms mapped onto 1 million clinical concepts, calculated from the raw text of 20 million clinical notes spanning 19 years of data. Co-frequencies were computed by means of a parallelized annotation, hashing, and counting pipeline that was applied over clinical notes from Stanford Hospitals and Clinics. The co-occurrence matrix quantifies the relatedness among medical concepts which can serve as the basis for many statistical tests, and can be used to directly compute Bayesian conditional probabilities, association rules, as well as a range of test statistics such as relative risks and odds ratios. This dataset can be leveraged to quantitatively assess comorbidity, drug-drug, and drug-disease patterns for a range of clinical, epidemiological, and financial applications.

Objective: The objective of this study is to estimate the amount of severe drug-drug interaction warnings per medical specialist group triggered by prescribed drugs of a patient before and after the introduction of a nationwide eMedication system in Austria planned for 2015., Methods: The estimations of interaction warnings are based on patients' prescriptions of a single health care professional per patient, as well as all patients' prescriptions from all visited health care professionals. We used a research database of the Main Association of Austrian Social Security Organizations that contains health claims data of the years 2006 and 2007., Results: The study cohort consists of about 1 million patients, with 26.4 million prescribed drugs from about 3,400 different health care professionals. The estimation of interaction warnings show a heterogeneous pattern of severe drug-drug-interaction warnings across medical specialist groups., Conclusion: During an eMedication implementation it must be taken into consideration that different medical specialist groups require customized support.

Pulmonary hypertension (PH) is a rare and life-threatening disease. Over past two decades, rapid advancements in treatment techniques have significantly improved the prognosis of two major subgroups of PH entities: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Given the underlying pathological feature of in situ thrombosis of small arteries, anti-coagulation was previously considered to be a supportive therapy for PAH to improve prognosis. However, due to a lack of robust evidence, it is not recommended by the current guidelines. In contrast, lifelong anticoagulation is recommended for CTEPH patients to prevent thrombus recurrence and in situ thrombosis, based on the thromboembolic etiology. Furthermore, with the advent of direct oral anticoagulants, there are now more options for anti-coagulation therapy in PH. Nevertheless, due to the complexity of PH etiology and the heterogeneity of treatment approaches, anti-coagulation management remains challenging. This article reviews and evaluates the current status and safety issue of anti-coagulation therapy for PH patients, providing guidance and insights for clinical practice and research in this field.

Background an objectives. Dementia and its associated behavioral and psychological symptoms (BPSD) significantly impact patients’ quality of life, healthcare systems, and caregivers. Current treatments often include antipsychotic medications; however, their efficacy and safety profiles require careful evaluation. This review aimed to examine the use of antipsychotics in dementia, focusing on their role, efficacy, adverse effects, and clinical monitoring guidelines. Materials and methods. We conducted a thorough literature review in PubMed and Medline databases, using search terms like “dementia”, “BPSD”, “antipsychotics”, “adverse effects”, and “clinical guidelines”. Our analysis encompassed a range of research studies, including meta-analyses, randomized controlled trials, observational studies, and clinical practice guidelines. Results. While antipsychotics can be effective in managing severe BPSD symptoms like agitation and psychosis, their use carries an increased risk of mortality, stroke, and other adverse effects. Therefore, strict adherence to clinical guidelines and close monitoring are crucial to minimize these risks. Importantly, nonpharmacological interventions should always be the first-line treatment for BPSD whenever possible. Conclusions. Antipsychotics may be necessary for severe BPSD when nonpharmacological approaches are insufficient. Clinicians must carefully weigh the potential benefits against significant risks, utilizing the lowest effective doses, strict monitoring protocols, and considering alternative pharmacological options when possible. Unveiling safer and more specific BPSD treatments is a critical area for continued research.

Protein kinases act as central molecular switches in the control of cellular functions. Alterations in the regulation and function of protein kinases may provoke diseases including cancer. In this study we investigate the conformational states of such disease-associated kinases using the high sensitivity of the kinase conformation (KinCon) reporter system. We first track BRAF kinase activity conformational changes upon melanoma drug binding. Second, we also use the KinCon reporter technology to examine the impact of regulatory protein interactions on LKB1 kinase tumor suppressor functions. Third, we explore the conformational dynamics of RIP kinases in response to TNF pathway activation and small molecule interactions. Finally, we show that CDK4/6 interactions with regulatory proteins alter conformations which remain unaffected in the presence of clinically applied inhibitors. Apart from its predictive value, the KinCon technology helps to identify cellular factors that impact drug efficacies. The understanding of the structural dynamics of full-length protein kinases when interacting with small molecule inhibitors or regulatory proteins is crucial for designing more effective therapeutic strategies.

Introduction: Prescription of Potentially Inappropriate Medication (PIM) among elderly patients is becoming a global concern. There has been an increase in the number of elderly patients coming for operative procedures, especially in orthopaedic surgery, due to the association of advanced age with chronic musculoskeletal conditions, such as osteoarthritis, and an increased incidence of fragility fractures. Aim: To determine the prevalence of polypharmacy and PIMs among elderly patients undergoing orthopaedic surgery. Materials and Methods: A retrospective observational study was conducted from February 2022 to April 2022 in the Orthopaedic Department of Anaesthesiology, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India. Hospital records of 130 patients aged 65 years and above, who underwent orthopaedic surgeries from January 2016 to December 2021, were included. The prescriptions during the perioperative period were analysed for polypharmacy, defined as the use of five or more drugs. The American Geriatric Society (AGS) 2019 Beers criteria were used to identify PIMs, drug interactions, and drugsyndrome interactions. Chi-square tests were performed on clinically significant variables to assess their effect on hospital stay, with a p-value of

Two copper(II) mixed ligand complexes with dicarboxylate bridges were prepared and studied, namely [Cu2(μ-fu)(pmdien)2(H2O)2](ClO4)2 (complex No. 5) and [Cu2(μ-dtdp)(pmdien)2(H2O)2](ClO4)2 (complex No. 6), where H2fu = fumaric acid, pmdien = N,N,N′,N″,N″ pentamethyldiethylenetriamine, and H2dtdp = 3,3′-dithiodipropionic acid. The copper atoms are coordinated in the same mode by the tridentate pmdien ligand and oxygen of water molecules, and they only differ in the dicarboxylate bridge. This work is focused on the study of the inhibitory effect of these potential antimicrobial drugs on the activity of the most important human liver drug-metabolizing enzymes, cytochromes P450 (CYP), especially their forms CYP2C8, CYP2C19, and CYP3A4. The obtained results allow us to estimate the probability of potential drug interactions with simultaneously administrated drugs that are metabolized by these CYP enzymes. In conclusion, the presence of adverse effects due to drug–drug interactions with concomitantly used drugs cannot be excluded, and hence, topical application may be recommended as a relatively safe approach.

Background: Natural health products (NHPs), including vitamins, minerals, and herbal supplements, are the most common complementary and alternative medicine (CAM) among cancer patients. Our survey determined the attitudes and behaviors of cancer patients toward natural complementary therapies that should be considered to implement an integrative approach in the future. Methods: Our survey was conducted in four hospitals in Belgium. Questionnaires were posted online from October 2020 to October 2021 for cancer patients. Descriptive statistics were used to analyze the data. A χ 2 test was applied to study the type of NHP consumed according to diagnosis time. Fischer's exact test compared patients who had changed their consumption since diagnosis and those who had not. Results: Out of 349 questionnaires collected, only 59 met all inclusion criteria. 83.1 % of the patients agreed that conventional medicine (CM) could benefit from complementary therapies, but they did not estimate (72.3 % of the patients) that those latter are more effective than conventional medicine. More than half of the patients used five or more NHPs. The most frequent NHPs consumed daily were vitamins (64.4 %), followed by other products (i.e., probiotics, gemmotherapy, birch sap and omega 3/6) (42.4 %) and herbs (40.7 %). Almost all patients started taking NHPs before their cancer diagnosis, but 72.7 % have changed their consumption significantly (p = 0.009) since their diagnosis. Boosting the immune system (79.7 %) and limiting conventional treatment side effects (76.9 %) were the most common reasons for NHPs' use. 74.4 % of the patients did not take complementary therapies to delay or avoid conventional treatment. Conclusions: The combination and high diversity of NHPs consumption highlight the importance of educating patients and healthcare providers (HCPs) about the risk of drug interactions associated with these natural products. Most cancer patients are more interested in using this non-mainstream medicine to complement their conventional treatment than as an alternative. Knowing the patients' reasons and understanding patients' attitudes toward NHPs will be essential for HCPs to address NHPs' use. [ABSTRACT FROM AUTHOR]

This narrative review critically examines the utilization of Selective Serotonin Reuptake Inhibitors (SSRIs) in managing coexisting depression and heart failure (HF), integrating findings from various studies, clinical trials, and observational data. SSRIs, pivotal in treating mood and anxiety disorders by elevating synaptic serotonin levels, have been observed to potentially impact cardiovascular health. Specifically, SSRIs like sertraline show promise in enhancing endothelial function and exerting anti-inflammatory effects, which are beneficial in conditions like HF with preserved ejection fraction (HFpEF). Furthermore, SSRIs demonstrate favorable outcomes in reducing platelet aggregation and modulating the renin-angiotensin-aldosterone system (RAAS), suggesting a multifaceted role in HF management. However, their safety profile, particularly concerning bleeding risks, QTc prolongation, and drug interactions, necessitates careful consideration. Despite theoretical and molecular evidence supporting SSRIs' beneficial effects in HF, clinical data remain inconclusive, highlighting the need for further research. This review aims to provide a comprehensive understanding of SSRIs' effectiveness, safety, and potential benefits in treating depression and HF, offering insights for evidence-based decision-making and future research directions.

The clinical context of drug interactions detected by automated analysis systems is particularly important in older patients with multimorbidities. We aimed to provide unique, up-to-date data on the prevalence of potentially inappropriate medications (PIMs) and drug–drug interactions (DDIs) in the Polish geriatric population over 80 years old and determine the frequency and the most common PIMs involved in DDIs. We analyzed all non-prescription and prescription drugs in a representative national group of 178 home-dwelling adults over 80 years old with excessive polypharmacy (≥10 drugs). The FORTA List was used to assess PIMs, and the Lexicomp® Drug Interactions database was used for DDIs. DDIs were detected in 66.9% of the study group, whereas PIMs were detected in 94.4%. Verification of clinical indications for the use of substances involved in DDIs resulted in a reduction in the total number of DDIs by more than 1.5 times, as well as in a nearly 3-fold decrease in the number of interactions requiring therapy modification and drug combinations that should be strictly avoided. The most common PIMs involved in DDIs were painkillers, and drugs used in psychiatry and neurology. Special attention should be paid to DDIs with PIMs since they could increase their inappropriate character. The use of automated interaction analysis systems, while maintaining appropriate clinical criticism, can increase both chances for a good therapeutic effect and the safety of the elderly during treatment processes.

In recent years, several changes have occurred in the management of chronic immunological conditions with the emerging use of targeted therapies. This two-phase cross-sectional study was conducted through structured in-person interviews in 2018–2019 and 2022. Additional data sources included ambulatory medical records and the itemized reimbursement reporting interface of the National Health Insurance Fund. Drug interactions were analyzed using the UpToDate Lexicomp, Medscape drug interaction checker, and Drugs.com databases. The chi-square test was used, and odds ratios (ORs) were calculated. In total, 185 patients participated. In 53% of patients (n = 53), a serious drug–drug interaction (DDI) was identified (mean number: 1.07 ± 1.43, 0–7), whereas this value was 38% (n = 38) for potential drug–supplement interactions (mean number: 0.58 ± 0.85, 0–3) and 47% (n = 47) for potential targeted drug interactions (0.72 ± 0.97, 0–5) in 2018. In 2022, 78% of patients (n = 66) were identified as having a serious DDI (mean number: 2.27 ± 2.69, 0–19), 66% (n = 56) had a potential drug–supplement interaction (mean number: 2.33 ± 2.69, 0–13), and 79% (n = 67) had a potential targeted drug interactions (1.35 ± 1.04, 0–5). Older age (>60 years; OR: 2.062), female sex (OR: 3.387), and polypharmacy (OR: 5.276) were identified as the main risk factors. Screening methods and drug interaction databases do not keep pace with the emergence of new therapeutics.

Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.

Objective:Drug-drug interaction (DDI) is related with complications and diminished efficacy of medications throughout the treatment process. Intensive care units (ICU) involve patients who are at elevated risk of potential drug-drug interactions (pDDI).Materials and Methods:Here, we identified potential DDIs in similar patient groups in ICUs in Turkey. Invitations were sent to 20 hospitals in Turkey for a multicenter point prevalence study. Patient orders were determined for potential DDI using the Lexi Interact Online Interaction Checker software. Of 236 patients whose data were collected, patients

AbstractBackground: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly utilized to reduce pain, inflammation, and fever. This study aimed to assess patterns of use and awareness of NSAID-related side-effects in an adult Jordanian. And the associations with sociodemographic factors. Methods: This cross-sectional study among a representative sample of 604 adults >18 years. A validated, self-administered questionnaire was used to collect basic sociodemographic data from the participants, as well as information regarding NSAID use. Results: Most respondents were NSAID users (65.7%), female (53.4%) and under 50 years of age (74.5%). Overall, 42.6% had been prescribed NSAIDs by a physician. Male gender and smoking were negatively correlated with NSAIDs use (multivariable odds ratio [OR]: 0.5, 95% confidence interval [CI]: 0.4–0.8, p = 0.001 and OR: 0.6, 95% CI 0.4–0.8, p = 0.003). In contrast, the Ministry of Health Insurance was associated with NSAIDs use with OR: 1.6, 95% CI: 1.1–2.6, p = 0.03. Overall, 65.1% were aware of kidney NSAID-related side-effects and 22.4% were aware of the increased risk of asthma and allergy. Conclusion: Despite the high frequency of NSAID use in the Jordanian general population, there is limited knowledge of their side-effects as well as drug interactions. This is cause for concern, particularly as many participants reported having been prescribed NSAIDs by physicians without adequate patient safety education.

Background/Aims Chronic hepatitis C (CHC) is the second leading cause of liver-related mortality and is more prevalent in the elderly population in Korea. Decisions to initiate treatment and selection of proper antiviral agents may be challenging among elderly patients due to relevant comorbidities, comedications, and drug-drug interaction (DDI). It may be helpful to understand the current demographic status and comorbidities of CHC patients in the country. Methods Patients aged ≥ 18 years and diagnosed with CHC (KCD-7 code B18.2) were extracted from the Korean Health Insurance Review & Assessment Service database in 2018. Data on comorbidities and comedications were assessed and potential DDIs were analyzed. Results A total of 50,476 patients with CHC, with a mean age of 60.3 years and 46.7% male patients were identified. The proportion of patients with cirrhosis, hepatocellular carcinoma, and liver transplantation was 6.0%, 4.1%, and 0.3%, respectively and 37.2% of patients were more than 65 years of age. The three most common comorbidities were diseases of the digestive system (83.7%), respiratory system (58.2%), and musculoskeletal system and connective tissue (57.6%). The three most common comedications were analgesics (91.6%), gastrointestinal agents (85%), and antibacterials (80.3%). Lipid-lowering agents and anticonvulsants were prescribed in 28.5% and 14.8% of patients. Rate of potential DDI for contraindication was 2.2%, 13.1%, and 15.6% with sofosbuvir/velpatasvir, ledipasvir/sofosbuvir, and glecaprevir/pibrentasvir. Conclusions With the increasing age of patients with CHC, comorbidity, comedication, and potential DDI should be considered when choosing antivirals in Korea. Sofosbuvir-based regimens showed favorable DDI profiles among Korean patients.

Introduction: multimorbidity, polypharmacy, and problems related to medication are common both, in aging people with HIV and in those diagnosed in advanced ages. Objective: To describe the demographics, clinical characteristics, and pro-blems related to medication in patients ≥ 50 years old with new diagnosis of HIV. Methods: A descriptive transversal study. This study included patients ≥ 50-year-old, with new diagnosis of infection with HIV, who attended four HIV healthcare programs in the city of Medellín, Colombia, between January 2013 and December 2016. Results: 493 patients were analyzed. 62.7% (n=309) were in WHO clinical stage 3. 49.5% (n=244) had at least one definitory condition of AIDS, with wasting syndrome (23.7%, n=117) and tuberculosis (16.8%, n=82) being the most frequent ones. At the time of diagnosis, the median of CD4 and viral load was 176 cells/mL (IQR 59-352) and 117,323 copies/mL (IQR 28,237-411,139), respectively. 59% (n=291) had non-infectious comorbidities, with the two most common being arterial hypertension (22.3%, n=110) and dyslipidemia (14.2%, n=70). 66.1% (n=326) of patients had problems related to medication, being the most frequent: drug interactions (61.1%, n=301), polypharmacy with ARV drugs (53.1%), potentially inappropriate medication (7.9%, n=39), and high anticholinergic risk (2.4%, n=12). Conclusion: at the time of diagnosis, HIV-positive older adults frequently have multimorbidity, polypharmacy, and drug interactions. The diagnosis of HIV in this population is very delayed and the presence of opportunistic infections is frequent.

Introduction: Immunosuppressants (ISS) are the most crucial tools used in the therapeutic regimens of transplant recipients. Nevertheless, these drugs are not the only ones adopted by patients; therefore, knowing the possible drug-drug interactions (DDIs) between immunosuppressants and other drugs commonly used in kidney transplant recipients is essential to ensure the effectiveness and safety of treatments. Objective: Analyze the DDIs between the immunosuppressants and other commonly used medications on kidney transplant adult recipients with active medical records undergoing post-transplant follow-up for 4.4 years (mean). Methods: First, we performed a cross-sectional study based on patients’ records, in which the patient’s profile and drugs used were examined, and after we analyzed DDIs by the Micromedex Drug Interactions ® database. Results: We analyzed 176 patients with a mean age of 47.6(± 12.5); most were male (67.7%), and the majority received a kidney from a deceased donor (81.4%). Patients were exposed to 15.0 (±5.4) different medicines after the transplantation, and 7.4 (±4.0) of these medicines were simultaneous. After analyzing the DDIs according to the severity of interaction, documentation quality interaction effect, clinical management and probable interaction mechanism, the most frequent interaction was with tacrolimus, classified as moderate, and the 3 major causes of interaction occurred with azathioprine according to the Micromedex database. The primary medicines involved with immunosuppressant interactions were proton pump inhibitors, ranitidine, domperidone, amlodipine, enalapril, allopurinol, cyclobenzaprine, amitriptyline, fluoxetine, and ciprofloxacin. These DDIs’ effects were related to, mainly, increase their immunosuppressant activity. Discussion: Although the immunosuppressants analyzed lacked many clinical DDIs significance with other medicines, the healthcare team needs to monitor their DDIs’ effects to prevent and minimize side effects in transplanted recipients.

Emergency medicine is a busy department with a huge flow of patients with multiple complaints. The department caters to a large cohort of patients simultaneously as well as administers many drugs. This can lead to potential drug interactions. With the advent of artificial intelligence (AI) and language learning model (LLM) we can use these AI enabled programs to help us be cautious yet judicious in our drug delivery and also be a careful vigilante to prevent drug interactions in these patients.

Objective:Polypharmacy brings with it the risk of potential drug interaction. This study aimed to investigate polypharmacy, potential drug interactions, the drug interactions causing neurological symptoms in geriatric patients with epilepsy, and diffenrences between drug interaction databases.Methods:The study included patients with epilepsy aged 65 and over (the demographic information, antiepileptic drug use, other chronic diseases, and medications of the patients were retrospectively recorded from their files). The use of 5 or more drugs was accepted as polypharmacy. Potential drug interactions were checked from 2 open access databases (database-1; database-2), and interacting drugs, interaction types, clinical results, and differences between databases were determined.Results:This study included 126 patients (56 females/70 males), the mean age was 73.13 ± 7.42 (65-92), and the mean duration of antiepileptic drug (69.8% monotherapy) use was 9.08 ± 13.68 (0.5-58) years. The most commonly used antiepileptic drug was levetiracetam (69.8%). Totally 88 patients had at least 1 central nervous system disease (except epilepsy), and 116 had a chronic diseases other than central nervous system disease. Polypharmacy frequency was 75.4%. The most commonly used drug groups with the highest potential drug interaction risk were antihypertensives (69%), antia ggreg ant-a ntico agula nts (67%), statins (44%), proton pump inhibitors (41%), and antidepressants (39%). The major, intermediate, and minor potential drug interactions for database-1 and database-2 were 44 versus 53; 586 versus 428, and 127 versus 70, respectively. The most important potential drug interactions were the increased risk of hemorrhage and thrombotic events, arrhythmia, and blood pressure changes.Conclusion:It is important to know about potential drug interactions (especially involving cardiac drugs, antidepressants, statins, and proton pump inhibitors) in the evaluation of the entire neurological picture of geriatric epilepsy patients.

Background Hospitalized COVID-19 patients with comorbidities receive more complex drug therapy. This increases the probability of potential drug-drug interactions (pDDIs). Studies on pDDIs in hospitalized patients with COVID-19 in countries with limited resources like Indonesia during the later period of the disease are still limited. This study aims to identify the pattern of pDDIs in hospitalized COVID-19 patients with comorbidities and their associated factors, especially in the second wave of the disease in Indonesia. Methods This study was a longitudinal-retrospective study observing hospitalized COVID-19 patients with comorbidities using medical record data in June–August 2021 at a public hospital in a region in Indonesia. pDDIs were identified using the Lexicomp® database. Data were descriptively analyzed. Factors associated with important pDDIs were analyzed in multivariate logistic regression model. Results A total of 258 patients with a mean age of 56.99 ± 11.94 years met the inclusion criteria. Diabetes mellitus was the most common comorbidity experienced by 58.14% of the patients. More than 70% of the patients had one comorbidity and the average number of administered drugs was 9.55 ± 2.71 items per patient. Type D pDDIs, which required modification of therapeutic regimens, amounted to 21.55% of the total interactions. Only the number of drugs was significantly and independently associated with type D pDDIs (adjusted odds ratio 1.47 [1.23–1.75], p

Abstract Background and Aims Quetiapine is an atypical antipsychotic predominantly metabolized by the cytochrome P450 3A4 (CYP3A4) enzyme. We studied the risk of adverse events following coprescription of clarithromycin (a strong CYP3A4 inhibitor) versus azithromycin (not a CYP3A4 inhibitor) in quetiapine users. Materials and Methods This was a population‐based retrospective cohort study from 2004 to 2020 in Ontario, Canada in adult quetiapine users newly co‐prescribed clarithromycin (n = 16,909) or azithromycin (n = 25,267). The primary outcome was the composite of hospital encounters with encephalopathy (defined as a diagnosis of delirium, disorientation, transient alteration of awareness, transient ischemic attack, or unspecified dementia), a fall, or a fracture within 30 days of new coprescription. Secondary outcomes were individual components of the composite outcome, hospital encounter with computed tomography (CT) head scan, and all‐cause mortality. Results Coprescription of clarithromycin versus azithromycin with quetiapine was associated with a higher risk of the primary composite outcome (365 of 16,909 clarithromycin users [2.2%] vs. 309 of 16,929 azithromycin users [1.8%]; absolute risk increase, 0.34% [95% confidence interval, CI, 0.04–0.63]; relative risk [RR], 1.19 [95% CI, 1.02–1.38]). This was primarily driven by an increase in fragility fractures (78 of 16,909 clarithromycin users [0.5%] vs. 45 of 16,923 azithromycin users [0.3%]; absolute risk increase, 0.20% [95% CI, 0.07–0.32]; RR, 1.74 [95% CI, 1.21–2.52]). Hospital encounters with a CT head scan were higher in clarithromycin users (220 of 16,909 [1.3%] vs. 175 of 16,923 azithromycin users [1.0%]; absolute risk increase, 0.27% [95% CI, 0.04–0.50]; RR, 1.26 [95% CI, 1.04–1.54]), but there was no difference in hospital encounters with encephalopathy, falls, or all‐cause mortality between macrolide groups. Conclusion Among adults taking quetiapine, concurrent use of clarithromycin compared with azithromycin was associated with a small but statistically greater 30‐day risk of a hospital encounter for encephalopathy, falls, or fracture, which was predominantly related to a higher rate of fragility fractures.

Introduction: The technique or approach used to provide pharmaceutical drugs to achieve a therapeutic effect in people or animals is known as drug delivery. Local anaesthetics, Non Steroidal Anti-inflammatory Drugs (NSAIDs), and antibiotics are the most generally recommended medicines in dentistry. Dentists must be upto date on dosage formulations and various drug delivery methods. Aim: To evaluate the knowledge about the Drug Delivery System (DDS) among oral healthcare professionals. Materials and Methods: This was a cross-sectional questionnaire survey was conducted on 75 dental students and oral healthcare professionals of both genders, in population, Mysore, India. A questionnaire consisting of 12 dichotomous ‘Yes’ or ‘No’ questions were used in the study. The study population was obtained by convenient random sampling. The questionnaire was created and verified by healthcare professionals with extensive teaching and clinical experience. The responses received during the period from August 2022 to September 2022 were subjected to statistical analysis. The study was analysed by descriptive statistics such as frequency and percentage. Results: All the 75 participants responded to the questionnaire and the response rate was 100%. The mean age of the participants in the present study was 22±2.3 years. A 92.00% (n=69) participants knew about various drug interactions. The participants had less knowledge about recent nano-based drug delivery. Only 42.66% (n=32) were acquainted with microneedle based transdermal delivery system, 33.33% (n=25) about nanocrystals and 21.33% (n=16) about 3D printing technology in DDS. A 97.33% (n=73) of the participated subjects thought that selection of appropriate DDS plays a role in its therapeutic efficacy. Conclusion: The recent advances in drug delivery methods are of little interest among the participants in the present study. Participants in our survey demonstrated a lack of basic and fundamental understanding of nanotechnologies, highlighting the critical need for increased awareness. This article has highlighted the importance of knowing various drug delivery methods and the current trends in approaches.

The European Medicine Agency (EMA) has defined Adverse Drug Reactions (ADRs) as “a noxious and unintended response to a medicine”, not including poisoning, accidental, or intentional overdoses. The ADR occurrence differs based on the approach adopted for defining and detecting them, the characteristics of the population under study, and the research setting. ADRs have a significant impact on morbidity and mortality, particularly among older adults, and represent a financial burden for health services. Between 30% and 60% of ADRs might be predictable and preventable, emerging as a result of inappropriate prescription, drug chemistry inherent toxicity, cell-specific drug toxicity, age- and sex-related anomalies in drug absorption, distribution, metabolism, and elimination (ADME), and drug–drug interactions (DDIs) in combination therapies or when a patient is treated with different drugs for concomitant disorders. This is particularly important in chronic diseases which require long-term treatments. Rapid developments in pharmacogenetics/genomics have improved the understanding of ADRs accompanied by more accurate prescriptions and reduction in unnecessary costs. To alleviate the burden of ADRs, especially in the elderly, interventions focused on pharmaceutical principles, such as medication review and reconciliation, should be integrated into a broader assessment of patients’ characteristics, needs, and health priorities. Digital health interventions could offer valuable solutions to assist healthcare professionals in identifying inappropriate prescriptions and promoting patient adherence to pharmacotherapies.

P-glycoprotein (P-gp) is an important transmembrane ATP-binding cassette (ABC) drug efflux transporter expressed in various human tissues such as the intestines, liver, kidneys, and blood-brain barrier. It limits the intracellular concentration of xenobiotics by pumping them out of the cells, affecting drug pharmacokinetics and therapeutic effects. With its broad substrate specificity, it has the potential to remove a wide range of drugs from Chinese materia medica (CMM), including conventional medicines and active compounds. Increasing evidence hasconfirmed the superior therapeutic effectiveness of CMM in treating a wide range of diseases worldwide, as well as in conjunction with western drugs. As a result, herbal medicine-drug compounds have prompted widespread concern, with the majority of these interactions involving transporters such as P-gp. This review systematically summarizes the inhibition or induction of P-gp expression/function by active CMM compounds and the underlying regulatory mechanisms. It will aid in improving understanding of the synergistic or inhibiting effects associated with transporter P-gp as well as rational safety concerns for using CMM, particularly in combination with drugs.

Simple Summary: Complementary and alternative medicine (CAM) therapies include a wide range of procedures and products that are often used by cancer patients to directly combat cancer and to protect normal cells from the toxic effects of conventional therapies. Most often, their use is self-prescribed based on a collection of scattered information from websites and advice from relatives or friends. In this paper, we examined the potential known benefits and harms associated with the most commonly used alternative treatments to provide a practical guide for caregivers and patients. CAM is used by about 40% of cancer patients in Western Countries, with peaks of 80% for breast cancer patients. Cancer patients use CAM to boost immune function, to control cancer symptoms and treatment-related side effects, and to improve health-related quality of life (HR-QoL) and survival. Unfortunately, self-prescription of natural remedies in cancer patients can lead to unexpected toxicities and can reduce the effectiveness of cancer therapy. Although CAM usually refers to all the "natural or organic" products/methods that are generally considered less toxic, there are concerns about drug interactions, especially in patients participating in clinical trials with experimental agents. Despite the claims of the promising and potential benefits made by prescribers, many CAMs lack clear scientific evidence of their safety and efficacy. Given the widespread use of CAM—both clearly declared and overt—in this review, we focused on the most important known data on the risk of interactions between biologics and oncology drugs with the goal of opening up CAM in accordance with the meaning of integrative medicine. [ABSTRACT FROM AUTHOR]

Pain represents one of the leading causes of suffering and disability worldwide. Currently available drugs cannot treat all types of pain and may have adverse effects. Hence, the use of pharmacological combinations is an alternative treatment strategy. Therefore, this study aimed to evaluate the combination of resveratrol and ketorolac through isobolographic analysis. CD1 mice were used to study the antinociceptive effect of this combination using the formalin test and the study was divided into two phases. In the first phase, four individual doses of each drug were evaluated, totaling eight testing groups. From these data, the median effective doses (ED50) of each drug were calculated. In the second phase, four testing groups were used to evaluate the combination of sub-doses of both drugs and obtain the experimental ED50. To evaluate gastric damage, five groups were employed, including indomethacin, vehicle, resveratrol, ketorolac, and combined resveratrol and ketorolac groups. Stomach samples from the mice were taken after 5 h of treatment, and the area of the ulcers was determined. Resveratrol plus ketorolac elicited a reduction in nociceptive behavior during both phases of the formalin test, and isobologram analysis revealed that the theoretical and experimental ED50 values of resveratrol and ketorolac did not differ significantly, implying an additive interaction between the drugs. Additionally, the drug combination did not generate gastric ulcers, thus enhancing the desired effects without increasing the adverse effects. Consequently, these findings substantiate the efficacy of the resveratrol and ketorolac combination in the formalin test, thereby highlighting its potential as a viable alternative for alleviating pain.

Patients with HIV-infection diagnosed at late stages usually have significant immunosuppression and demand simultaneous antiretroviral therapy and treatment of opportunistic infections. The presence of HCV coinfection makes treatment even more challenging because of possible adverse effects and drug-drug interactions. HCV cure in such clinical situations not only prevents fibrosis progression, but can also enhance virologic and/or immunologic response to antiretrovirals and thus effective treatment of opportunistic infections. Thorough consideration of all existing diseases and drug interactions of the combined therapy makes simultaneous treatment of HIV, chronic hepatitis C, and opportunistic infections not only possible but the best way to improve outcomes in a complex clinical situation.

РЕЗЮМЕ В статье представлен обзор литературы по проблеме лекарственных взаимодействий современных антипсихотиков. Описаны клинически значимые фармакокинетические и фармакодинамические взаимодействия антипсихотиков второго поколения с психотропными и соматотропными средствами при проведении комбинированной фармакотерапии. Раскрыты механизмы, лежащие в основе возникновения лекарственных взаимодействий. Показано, что наиболее часто лекарственные взаимодействия возникают на метаболическом уровне при участии изоферментов CYP1A2, CYP2D6 и CYP3A4. Мощные ингибиторы CYP3А4 (флувоксамин и флуоксетин) и CYP2D6 (флуоксетин и пароксетин) способны замедлять метаболизм антипсихотиков и приводить к развитию побочных эффектов. Особое внимание уделено проблеме фармакодинамических взаимодействий, связанных с удлинением интервала QT. Представлен перечень соматотропных средств, назначения которых следует избегать совместно с антипсихотиками второго поколения с целью профилактики развития нарушений сердечного ритма.

Introduction: Incidence of stroke is more frequently found among the elderly who are mostly dealing with co-morbidities and polypharmacy, were found to be significant in high risk of potential Drug-drug Interactions (pDDIs). Aim: To identify potential drug-drug interactions in ischaemic stroke patients. Materials and Methods: This retrospective study was conducted in the General Medicine Department at Justice KS Hegde Charitable Hospital, Mangaluru, Karnataka, India, from January 2018 to August 2020. All the stroke patient’s data were collected based on the inclusion criterion. Prescriptions were obtained from the case sheets and the pDDIs were identified using UpToDate software. Results: The mean age of the study population (N=350) was found to be 61.07±11.460 years, The incidence of stroke was high in males (66%) than in females (34%) from the total of 350 patients. The prescribing patterns were antiplatelet single (69.4%) and fixed-dose combination (1.42%), anticoagulants (11.14%), antihypertensive agents (63.42%), followed by lipid-lowering agents (65.14%) as single and fixed dose combinations (0.85%), gastrointestinal agents (70.57%). The class prescribed the most was antiplatelet agents (aspirin 61.4%). The total number of 402 pDDIs were found among 350 patients. Based on the Lexi-Interact® severity scale moderate interactions were the most commonly found then followed by the major and minor with 301 (74.87%), 66 (16.41%) and 35 (8.70%), respectively. The most frequent interaction found were clopidogrel with pantoprazole, and atorvastatin with clopidogrel with same incidence of in 44 (12.57%) patients. Conclusion: The majority of the interaction was found to be moderate interactions which were followed by major and minor interactions. The pDDIs mostly occurred among the antiplatelet agents, gastro-intestinal agents and antihypertensives.

Background: Currently, irrational uses of medicines becoming global problem largely in developing countries like Ethiopia. Inappropriate prescribing is a major cause for poor treatment outcome and higher costs. Hence, this study was aimed to investigate medicine prescribing practice and prescription errors using WHO medicine-utilization core indicators. Methods: A hospital based retrospective cross sectional study design was used to evaluate prescribing practices and prescription errors from September to October, 2024 at the OPD pharmacy using systematic random sampling technique while a prospective approach was employed for facility indicators. Presence of potential drug-drug interactions (DDIs) were evaluated using Medscape Online Drug Interaction Checker. Data were analyzed using SPSS version 25 and interpreted as tables and figures. Results: A total of 1019 medicines were prescribed in 524 prescriptions and 81.6% (n = 832) were actually dispensed. The percentage of antibiotic, injections and medicine prescribed from Essential Drug List was 33.9% (n = 345),3.5% (n = 36) and 92.3% (n = 941) respectively. The most frequently prescribed class of medicine were antibiotics 33.9% (n = 345). 65.1% (n = 341) were ≥2 medicines and 8.3% (n = 85) had at least one potential DDIs. Among overall DDIs, the monitor closely and serious level was 60% (n = 51) and 11.8% (n = 10) respectively. The average prescription error was 4.3. Prescription errors due to failure to mention diagnosis was 40.6% (n = 213). Conclusion: Based on findings, the prescribing practices had defects to the optimum value recommended by WHO and showed high prescription errors. Antibiotics prescribing was the major problem in practice. Remarkable DDIs were observed in prescribed medicines. Therefore, designing and implementing policy to improve medicine use practice is highly indispensable. [ABSTRACT FROM AUTHOR]

Hydroxychloroquine (HCQ) is a relatively safe drug, and has been emerged as one of the treatment options for the management of COVID-19. This review is from the viewpoint of cardiologists, and it covers the pharmacokinetics, pharmacodynamics, and mechanism of drug interaction of HCQ with the commonly used cardioactive drugs.

ABSTRACT BACKGROUND: The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications. OBJECTIVE: To evaluate the association between the use of drugs and frailty among community-dwelling older people. DESIGN AND SETTING: Cross-sectional study carried out among 580 older people in Uberaba (MG). METHODS: Data were collected at these older people's homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05). RESULTS: Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57). CONCLUSION: Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.

With the recent growth in oral anticancer agents (OAA), pharmacists working in the community have recognised the urgent need to develop safe and effective systems to administer and manage these drugs. For community pharmacists, education regarding OAA can be challenging, with a number of international surveys showing that many believe they have received inadequate education regarding OAA and feel uncomfortable educating their patients about these drugs. Patients prescribed OAA have also reported feeling unsupported, and this lack of support could lead to both under and overadherence to OAA, with an impact on efficacy and adverse events. Poor adherence can result in disease progression, treatment complications, reduced functional ability, and premature death. The current review, written by international authors from Europe, North America, and East Asia, set out to identify worldwide initiatives to support community pharmacists working with patients taking OAA. The authors identified one project, the Oral Anticancer Therapy – Safe and Effective initiative, that was developed in Germany in 2011 to aid community pharmacists in their interactions with patients prescribed OAA. The initiative, which has been rolled out across Germany, includes the creation of training programme content that can be delivered at regional meetings and monographs, which can be downloaded to educate both community pharmacists and their patients about individual OAA. As part of the Empowering Patients to Improve Health Care for Oral Chemotherapy (EPIC) programme, the European Society of Oncology Pharmacy (ESOP) has extended the German initiative to Slovenia and Estonia, with plans to launch the scheme in additional European countries in the autumn of 2018. Ultimately, it is hoped that better support of cancer patients in the community will improve adherence to OAA.

В статье описаны особенности психофармакотерапии пациентов с психическими расстроиствами,заболевших коронавируснои инфекциеи(COVID19).Актуальность этои темы определяется ситуациеи нарастающеи эпидемии в России и имеющимся опытом Китая и Италии,по казавшим,что в период эпидемии психиатрические пациенты были более уязвимы к ее распространению,чем здоровая популяция,и имели более высокии риск тяжелого течения заболевания и развития осложнении.В статье обсуждены возможные причины большеи уязвимости этого контингента больных к распространению инфекции,на основании анализа литературы приведены данные о возможных лекарственных взаимодеиствиях психотропных препаратов и лекарственных средств,использующихся для лечения пациентов с коронавируснои инфекциеи.Особое внимание уделено нежелательным реакциям,которые могут возникать у пациентов с гипертермиеи,дыхательнои и сердечнои недо статочностью при использовании психотропных препаратов,а также тактике купирования психомоторного возбуждения.Даны рекомендации по лечению пациентов с психическои патологиеи на фонеCOVID19,которые предусматривают коррекцию дозировок психотропных средств,использование препаратов с минимально выраженными побочными эффектами,учет возможных неблагоприятных лекарственных взаимодеи ствии препаратов при тщательном контроле соматического состояния больных.

Ситуация пандемииCOVID19в мире,ухудшение эпидемическои обстановки в нашеи стране,режим самоизоляции,нарастание страха в об ществе на фоне панических слухов и дезинформации,распространяемых в социальных сетях и средствах массовои информации,вызывают беспокоиство за судьбы пациентов,страдающих психическими заболеваниями,и ставят перед нашеи психиатрическои службои неотложные организационные и лечебные задачи.В качестве первоочередных целеи предлагается разделить потоки лиц,нуждающихся в психологическои поддержке и психиатрическои помощи,и организовать для них дистанционное предоставление этих услуг(телефоны горячеи линии и те лемедицинские консультации).С учетом опыта других стран,которые столкнулись с массовым распространениемCOVID19,выполнен обзор предлагаемых неотложных и профилактических организационнолечебных мероприятии и даны практические рекомендации по экстреннои временнои реорганизации психиатрическои службы,оказанию психологопсихотерапевтическои поддержки наиболее уязвимым группам на селения,включая медперсонал,непосредственно работающии с больнымиCOVID19,и по ведению психически больных с тяжелым острым респираторным синдромом(SARS).Особое внимание уделено особенностям психофармакотерапии таких пациентов с обзором потенциальных рисков развития побочных эффектов и осложнении,прежде всего связанных с дыхательнои функциеи,в том числе вследствие неблагоприятных лекарственных взаимодеиствии.

BACKGROUND: Statins are used as cholesterol-lowering drugs and may also have direct antimicrobial effects. OBJECTIVE: To evaluate synergic interactions between simvastatin and both amphotericin B and fluconazole, against environmental strains of Cryptococcus neoformans isolated from captive birds’ droppings. DESIGNAND SETTING: Experimental study conducted at Federal University of Piauí, Parnaíba, in collaboration with Federal University of Triângulo Mineiro, Uberaba, Brazil. METHODS: Statin susceptibility tests of Cryptococcus neoformans samples were performed as prescribed in standards. Interactions of simvastatin with amphotericin and fluconazole were evaluated using the checkerboard microdilution method. Presence of these interactions was quantitatively detected through determining the fractional inhibitory concentration index (FICI). RESULTS: Isolates of Cryptococcus neoformans were obtained from 30 of the 206 samples of dry bird excreta (14.5%) that were collected from pet shops and houses. Ten isolates were selected for susceptibility tests. All of them were susceptible to amphotericin and fluconazole. All presented minimum inhibitory concentration (MIC) > 128 µg/ml and, thus, were resistant in vitro to simvastatin. An in vitro synergic effect was shown through combined testing of amphotericin B and simvastatin, such that six isolates (60%) presented FICI < 0.500. Two isolates showed considerable reductions in MIC, from 1 µg/ml to 0.250 µg/ml. No synergic effect was observed through combining fluconazole and simvastatin. CONCLUSION: These results demonstrate that simvastatin should be considered to be a therapeutic alternative, capable of potentiating the action of amphotericin B. However, further studies are necessary to clarify the real effect of simvastatin as an antifungal agent.

Highly active antiretroviral therapy has led to greater life expectancy for human immun-deficiency virus (HIV)-positive patients. This was a report of 11 years of follow-up of an HIV-seropositive patient who underwent heart transplantation in 2006, with emphasis on the management challenges of complex drug interactions over time.

Abstract Precision medication entails selecting the precise medication, dose, and timing of administration. Multi‐drug interactions and genetics significantly affect precision medication. In this article, we present two simulated cases for real‐world applications of precision medication. Clinicians may need to acquire additional skills to apply the principles illustrated by these cases.

Tegoprazan is a novel potassium-competitive acid blocker. This study investigated the effect of drug–drug interaction on the pharmacokinetics and pharmacodynamics of tegoprazan co-administered with amoxicillin and clarithromycin, the first-line therapy for the eradication of Helicobacter pylori, using physiologically based pharmacokinetic and pharmacodynamic (PBPK/PD) modeling. The previously reported tegoprazan PBPK/PD model was modified and applied. The clarithromycin PBPK model was developed based on the model provided by the SimCYP® compound library. The amoxicillin model was constructed using the middle-out approach. All of the observed concentration–time profiles were covered well by the predicted profiles with the 5th and 95th percentiles. The mean ratios of predicted to observed PK parameters, including the area under the curve (AUC), maximum plasma drug concentration (Cmax), and clearance, were within the 30% intervals for the developed models. Two-fold ratios of predicted fold-changes of Cmax and AUC from time 0 to 24 h to observed data were satisfied. The predicted PD endpoints, including median intragastric pH and percentage holding rate at pH above 4 or 6 on day 1 and day 7, were close to the corresponding observed data. This investigation allows evaluation of the effects of CYP3A4 perpetrators on tegoprazan PK and PD changes, thus providing clinicians with the rationale for co-administration dosing adjustment.

Bacterial adaptation to antibiotic combinations depends on the joint inhibitory effects of the two drugs (drug interaction [DI]) and how resistance to one drug impacts resistance to the other (collateral effects [CE]). Here we model these evolutionary dynamics on two-dimensional phenotype spaces that leverage scaling relations between the drug-response surfaces of drug-sensitive (ancestral) and drug-resistant (mutant) populations. We show that evolved resistance to the component drugs – and in turn, the adaptation of growth rate – is governed by a Price equation whose covariance terms encode geometric features of both the two-drug-response surface (DI) in ancestral cells and the correlations between resistance levels to those drugs (CE). Within this framework, mean evolutionary trajectories reduce to a type of weighted gradient dynamics, with the drug interaction dictating the shape of the underlying landscape and the collateral effects constraining the motion on those landscapes. We also demonstrate how constraints on available mutational pathways can be incorporated into the framework, adding a third key driver of evolution. Our results clarify the complex relationship between drug interactions and collateral effects in multidrug environments and illustrate how specific dosage combinations can shift the weighting of these two effects, leading to different and temporally explicit selective outcomes.

ABSTRACT BACKGROUND: Older adults with a range of comorbidities are often prescribed multiple medications, which favors drug interactions. OBJECTIVES: To establish the frequency of potential drug interactions in prescriptions at hospital discharge among older adults and to identify the associated factors. DESIGN AND SETTING: Cross-sectional study conducted in a public hospital. METHODS: An initial face-to-face interview, data collection from the electronic medical records (covering sociodemographic, clinical, functional and drug therapy-related variables) and telephone follow-up after discharge were conducted to confirm the medication prescribed at discharge. Drug interactions were identified through the Micromedex DrugReax software, along with interactions that should be avoided among the elderly, as per the 2015 American Geriatric Society/Beers criteria. Multivariable logistic regression was performed. RESULTS: Potential for drug interactions was identified in the discharge drug therapy of 67.8% of the 255 older adults evaluated (n = 172), and 54.5% (n = 145) of the drug interactions were major. Among the drug interactions that should be avoided among older adults, those that increase the risk of falls were the most frequent. The drug interactions thus identified were independently associated with polypharmacy (odds ratio, OR = 12.62; 95% confidence interval, CI 6.25-25.50; P = 0.00), diabetes mellitus (OR = 2.16; 95% CI 1.05-4.44; P = 0.04), hypothyroidism (OR = 7.29; 95% CI 2.03-26.10; P = 0.00), chronic kidney disease (OR = 3.41; 95% CI 1.09-10.64; P = 0.03) and hospitalization in geriatric units (OR = 0.45; 95% CI 0.22-0.89; P = 0.02). CONCLUSION: The frequency of potential drug interactions in drug therapy prescribed at discharge for these older adults was high. Polypharmacy, diabetes mellitus, hypothyroidism and chronic kidney disease were positively associated with occurrences of drug interactions, while hospitalization in geriatric units showed an inverse association.

Objective(s): The primary cytotoxic effects of anticancer drugs like idarubicin, a chemotherapeutic agent, are not limited to neoplastic cells; they also produce similar effects in normal cells. In this study, we hypothesized that the combination of idarubicin-bromelain could make cancer cells more susceptible to cytotoxicity and genotoxicity.Materials and Methods: To test our hypothesis, the optimal concentrations of idarubicin and bromelain were combined and incubated in the HL-60 cancer cell line and normal human mononuclear leukocytes (PBMC) for 24, 48, and 72 hr. Cytotoxicity and genotoxicity were evaluated by measurement of ATP cell viability test, DNA damage, Caspase-3, Acridine orange/ethidium bromide (AO/EB), and DAPI fluorescent dyes in both cell types.Results: The combination of idarubicin-bromelain significantly reduced cell proliferation in the more potent HL-60 compared to PBMC in all incubation times (PP<0.05). The percentages of apoptotic images obtained by DAPI and AO / EB morphological examination were increased in both cells, depending on the combination dose. Conclusion: Based on these results, it can be concluded that idarubicin combined with bromelain produces more cytotoxic effects in low concentrations in comparison with when it was used per se in the HL-60 cells. Conversely, it was found that this combination in PBMC caused less cytotoxicity and less genotoxicity. Taken together, it can be said that this new combination makes cancer cells more sensitive to conventional therapy.

Context: Polypharmacy and inappropriate medication usage is one of the world's most important public health issues. Yet in rural India, where medications are readily available, little is known about polypharmacy. Aim: This study explores factors related to polypharmacy in rural India to inform the response. Settings and Design: A household survey was conducted by community health trainees, across 515 Indian villages collecting medication prescription and usage information for single illness in the past month. Methods and Material: Polypharmacy was defined as the concurrent usage of four or more medications for single illness. Data from 515 rural India villages were collected on medication usage for their last illness. Respondents who consulted one healthcare provider for this illness were included for analysis. Statistical Analysis Used: Bivariate logistic regression and multivariate generalized estimating equation analysis were used to explore associations with polypharmacy. Results: Prevalence of polypharmacy was 13% (n = 273) in the sample and ranges between 1% and 35% among Indian states. Polypharmacy was common among prescriptions for nonspecific symptoms (15%, N = 404). People aged over 61 years compared with people aged between 20 and 60 years (OR 1.11, 95% CI 1.03–1.19) and people with income of over 3,000 INR/month (OR 1.04, 95% CI 1.00–1.07) were more likely to be prescribed four or more medications. Conclusions: The study demonstrates high rates of polypharmacy, identifies vulnerable populations, and provides information to improve the response to polypharmacy in rural India.

Introduction:Drug-drug interactions (DDI) due to multiple drug use are the most important cause of adverse drug reactions. DDIs are among medication errors that can be prevented. The integrated computerized drug interaction checker programs, which medical professionals use in addition to their medical and practical knowledge, can help medical staff to reduce potential DDIs (PDDIs), although they are not sufficient alone. The aim of this study was to investigate the role of computerized drug interaction checker programs in the identification and prevention of PDDIs in clarithromycin prescribed pediatric outpatients.Methods:The study was a retrospective observational prescription analysis held in three community pharmacies operating in the province of Üsküdar-İstanbul during 12-month period. The prescriptions with oral clarithromycin medication were selected and PDDIs were analyzed using the RxMediaPharma® software on an active substance base.Results:During the 12-month period, 100 prescriptions containing 266 medicines were prescribed by 52 different physicians. The mean number of medicines per prescription was 2.66±1.11. Of the 16 PDDIs detected, five were clarithromycinrelated (31.25%) and 11 were non-clarithromycin-related (68.75%). When PDDIs were categorized by severity, 10 out of 16 (62.5%) were high-risk, two (12.5%) were moderate and four (25%) were low-risk. Clarithromycin interactions were moderate with lidocaine and low with both metronidazole and sultamicillin (ampicillin/sulbactam).Conclusion:Although evidence based computerized drug interaction checker programs that provide rapid access is not sufficient alone, they can help health care professionals in preventing PDDIs. The use of this program in the community pharmacies could minimize PDDIs during the dispensing of medicine.

Objective: The research evaluated point-of-care resources for scope, completeness, and consistency of information describing interactions between therapeutic drugs and drugs of abuse (DoA). Methods: A cross-sectional evaluation study was conducted focusing on seven resources: Clinical Pharmacology, Facts & Comparisons eAnswers, Lexicomp Online, Micromedex, Drug Interactions Analysis and Management, Drug Interaction Facts, and Stockley’s Drug Interactions. A sample of clinically relevant interactions was developed through review of tertiary literature and resources, and input was solicited from subject matter experts. Entries from each resource for each interaction were evaluated for scope (i.e., whether there was an entry for the interaction); completeness (i.e., whether there was information addressing mechanism; clinical effects, severity, course of action, and level of certainty, described as a median rating on a 5-point scale); and consistency (i.e., whether the information in the resource was similar to the majority) among resources with an entry. Results: Following review by subject matter experts, the final sample contained 159 interactions. Scope scores ranged from 0.6% (Drug Interactions Analysis and Management) to 43.4% (Lexicomp Online). Completeness scores ranged from 2 (interquartile range [IQR] 0 to 3, Stockley’s Drug Interactions) to 5 (IQR 5 to 5, Drug Interaction Facts, Micromedex, Facts & Comparisons eAnswers). Consistency scores ranged from 30.8% (Stockley’s Drug Interactions) to 87.1% (Clinical Pharmacology) for severity and from 15.4% (Facts & Comparisons eAnswers) to 71.4% (Drug Interaction Facts) for course of action. Conclusions: Although coverage of drug-DoA interactions was low and content was often inconsistent among resources, the provided information was generally complete.