Pharmacy Division Ramathibodi Hospital


Interesting Articles in 2002 Oct - Dec

American Journal of Health-System Pharmacy
October 1, 2002 (Volume 59, Number 19)

Cost-Efficacy Analysis of Ondansetron Regimens for Control of Emesis Induced by Noncisplatin, Moderately Emetogenic Chemotherapy

Lachaine J, Laurier C
American Journal of Health-System Pharmacy. 2002;59(19):1837-1846

Most of the available literature surrounding optimal dosing and cost-effectiveness of ondansetron therapy highlights the use of highly emetogenic chemotherapy. In this study, clinical efficacy and cost data for controlling emesis associated with noncisplatin, moderately emetogenic chemotherapy were compiled and analyzed. The authors accessed MEDLINE and retrieved clinical efficacy results from the literature available between January 1966 and December 2000. Only direct antiemetic treatment costs were considered.

A total of 30 articles were identified from the primary literature as meeting the needs of this analysis from a potential of 436. Twenty-two different ondansetron-based antiemetic regimens were identified. The efficacy of the regimens ranged from 24.2% to 90.4%, and costs ranged from $20 (Canadian) to $413 (Canadian). The authors conclude, from their review of the literature, that a regimen that includes a corticosteroid and twice daily administration of ondansetron is supported by both clinical and cost-effectiveness data. Treatment with ondansetron should be limited to 4 days.

Editor's Comment

Managing the adverse effects of chemotherapy is important to patient satisfaction with therapy. Treatment options are often costly and varied, as noted by the 22 different regimens identified in this analysis. Most of the accepted data is based on highly emetogenic chemotherapy regimens. This data analysis is valuable to patients and caregivers who are being treated with moderately emetogenic chemotherapy. The authors were unable to determine a single regimen that was most effective clinically and with regard to cost, but the treatment parameters that were identified as most effective can be translated into clinical practice.


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The Annals of Pharmacotherapy
October 2002 (Volume 36, Number 10)

Effect of Number of Medications on Cardiovascular Therapy Adherence

Shalansky SJ, Levy AR
The Annals of Pharmacotherapy. 2002;36(10):1532-1539

Potential participants in this retrospective study were identified from acute care wards and 2 clinics at a large hospital in Canada. Potential participants must have received either a 3-month prescription for an angiotensin-converting enzyme inhibitor or lipid-lowering therapy or both during a 2-year period. A total of 888 patients were approached to participate; 367 met inclusion criteria after the database review. Patients were surveyed by means of phone or in person. The survey was designed to identify patient characteristics that would potentially influence adherence and included all drug use, use of compliance aids, perceived need for the medication, perceived health, living situation, and adverse drug reactions, as well as demographic information. Manual review of patient profiles in the prescription claims database was done, and information was used to calculate adherence.

In this study, 12% of patients (n = 45) were categorized as nonadherent. These patients took fewer regularly scheduled medications per day (4.1 ± 2.7 vs 5.9 ± 3.4, P < .001). They also took fewer pills per day (5.3 ± 3.6 vs 9.2 ± 7.1, P < .001). In addition, patients categorized as nonadherent had fewer administration times per day (1.8 ± 0.7 vs 2.4 ± 0.9, P = .001).

Editor's Comment

Prior information regarding the link between adherence and the complexity of the drug regimen has been contradictory. These data suggest that there is not a link between drug regimen complexity and adherence, at least for patients with cardiovascular diseases. Pharmacists can use this information in discussions with prescribers who might be reluctant to add additional therapies to patients with cardiovascular disease.


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Journal of the American Pharmaceutical Association
September/October 2002 (Volume 42, Number 5)

Clinical Pharmacy Services in the Home: Canadian Case Studies

MacKeigan LD, Marshman JA, Kruk-Romanus D, et al.
Journal of the American Pharmaceutical Association. 2002;42(5):735-742

In Canada, the elderly are the primary consumers of both home healthcare services and medications. Access to clinical pharmacy services has traditionally not been provided as a home health service, despite that the homebound elderly person is frequently on a large number of medications and has little contact with a pharmacist. Using a case study approach, the authors of this study set out to describe homecare services being provided by pharmacists.

As defined in this study, a clinical homecare practice must include pharmacist home visits conducted for clinical purposes beyond routine prescription counseling, at least 1 home visit was conducted per week, and documentation of services provided. Practices were identified, and 20 case descriptions were selected for inclusion that allowed for a description of diverse services representative of many regions.

A total of 16 practices were included in the final analysis; unwillingness to participate (n = 3) and lack of permission from the homecare agency (n = 1) were cited as reasons for nonparticipation. Reasons for home visits included visual or hearing impairment, adverse drug reaction, repeat hospitalizations/emergency visits, cognitive impairment, living alone, complex medication regimen, noncompliance, and various others. Marketing of these services included the Internet, brochure, and physician office visits.

Editor's Comment

Despite the limitations of a purely descriptive case-study approach, this report offers some insight into the potential benefits of clinical pharmacy service provision to consumers of healthcare along with identification of some of the barriers. As healthcare continues to be provided outside of the traditional inpatient environment, it will be important for pharmacy services to continue to evolve so that all patients can benefit from them.


Journal of Clinical Pharmacology
October 2002 (Volume 42, Number 10)

Lack of Correlation Between the Steady-State Plasma Concentrations of Haloperidol and Risperidone

Yasui-Furukori N, Kondo T, Mihara K, et al.
Journal of Clinical Pharmacology. 2002;42(10):1083-1088

Haloperidol and risperidone are used in the treatment of schizophrenia. The efficacy of risperidone is equal to or greater than that of haloperidol. Patients who do not respond adequately to haloperidol may be switched to risperidone. This study was conducted to determine the correlation between steady-state plasma concentrations of haloperidol and risperidone with the effects of CYP2D6 status on the plasma concentrations of both drugs.

Twenty-two patients with a diagnosis of schizophrenia who were otherwise healthy adults were included in the study. Eleven patients received risperidone 6 mg/day and were then switched to haloperidol 12 mg/day. The remaining 11 patients received the medications in an opposite sequence. A 2- to 8-month interval occurred between the 2 treatments. Patients were switched to the second drug over a 4-week period. Study drugs were given in 2 equally divided doses 12 hours apart. Blood samples were collected at least 2 weeks after the initiation of each drug. CYP2D6 genotyping was done on each patient.

There was no significant correlation between the steady-state plasma concentrations of haloperidol, risperidone, or the active moiety of risperidone.

Editor's Comment

This study, in a small population of patients with schizophrenia indicates that the plasma concentrations of haloperidol cannot be used to estimate the plasma concentration of risperidone in the same individual. Metabolism by CYP2D6 may play a role in the differences in plasma concentration. The efficacy of risperidone has not been tied to plasma concentrations, although the plasma concentration of the active metabolite of risperidone has been linked to parkinsonian symptoms.


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