Pharmacokinetic changes of psychotropic drugs in patients with liver disease: implications for dose adaptation.

Dose adjustment of psychotropic drugs in patients with liver cirrhosis may be important as most of these drugs are predominantly eliminated by the liver and many of them are associated with dose-dependent adverse reactions. As no surrogate parameter is available to predict hepatic metabolism of drugs, dose adjustment according to pharmacokinetic properties of the drugs is proposed. Psychotropic drugs (antiepileptics, antiparkinsonian drugs, psycholeptics such as antipsychotics, anxiolytics, sedatives and hypnosedatives, and psychoanaleptics such as antidepressants, psychostimulants and antidementia drugs) marketed in Switzerland in 2006 were therefore classified according to their hepatic extraction and/or bioavailability to predict their kinetic behaviour in patients with cirrhosis.

Age-related differences in the prevalence of potential drug-drug interactions in ambulatory dyslipidaemic patients treated with statins.

Background And Objective: Elderly patients may be at higher risk of drug-drug interactions (DDIs) because of polypharmacy. This study evaluated age-specific differences in the prevalence of clinically relevant potential DDIs (pDDIs) in ambulatory dyslipidaemic patients treated with an HMG-CoA reductase inhibitor (statin). We hypothesised that elderly patients are at higher risk for pDDIs because of the presence of more drugs and drugs with a higher potential for DDIs in this age group.

Prevalence of potentially inappropriate medication use in elderly patients: comparison between general medical and geriatric wards.

Background And Objective: Inappropriate drug use is one of the risk factors for adverse drug reactions in the elderly. We hypothesised that, in elderly patients, geriatricians are more aware of potentially inappropriate medications (PIMs) and may replace or stop PIMs more frequently compared with internists. We therefore evaluated and compared the prevalence of PIMs as well as anticholinergic drug use throughout hospital stay in elderly patients admitted to a medical or geriatric ward.

Lichenoid eruption associated with the use of nebivolol.

Objective: To report a case of lichenoid drug eruption (LDE) after starting antihypertensive treatment with nebivolol, a cardioselective beta-blocker.

Case Summary: Five weeks after starting treatment with nebivolol, a 62-year-old woman presented with erythematous papules on both extremities and skin lesions spreading over the back. She was not being treated with any other drugs.

[Dealing with adverse drug reactions in dentistry. Procedures on encountering adverse drug reactions and goal of the Swiss Pharmacovigilance system].

Dentists may be confronted with adverse drug reactions (ADRs) in their dental practice, and are--like other health professionals--obliged to report certain ADRs. The aim of this article is to sensitise dentists for this topic, to show how to proceed in case of a supposed ADR, and to emphasise the importance of spontaneous reporting of ADRs. ADRs may not always be clearly distinguished from symptoms of underlying diseases, and in cases of polypharmacy multiple drugs may be responsible for the reaction.

Life-threatening hemorrhage after dalteparin therapy in a patient with impaired renal function.

Dalteparin and other low-molecular-weight heparins are frequently used for the treatment of deep vein thrombosis and for other indications. Unlike unfractionated heparin (UFH), dalteparin is mainly cleared through the kidney; therefore, it can accumulate in patients with impaired renal function, increasing the risk of hemorrhage. An 84-year-old woman with chronic renal failure was hospitalized because of stenosis of a femorofibular bypass in her right leg.

Lithium intoxication as a result of an interaction with rofecoxib.

Objective: To report the occurrence of lithium intoxication in a patient with bipolar disorder after adding rofecoxib to the medication regimen.

Case Summary: A 68-year-old woman with bipolar disorder under long-term treatment with lithium, carbamazepine, pipamperon, and mirtazapine was prescribed rofecoxib 25 mg twice daily for the treatment of leg pain. Within one week, she showed progressive hypokinesia and tremor, which was treated with propranolol.

Potential drug-drug interactions in the medication of medical patients at hospital discharge.

Objective: Information on the frequency of drug combinations with the potential to induce dangerous drug-drug interactions (DDIs) in patients discharged from the hospital is scarce. With the present study, we assessed the frequency and potential clinical significance of DDIs in the prescriptions of discharged medical patients.

Methods: We retrospectively screened the medication for potential DDIs of 500 patients consecutively discharged with at least two prescriptions using a computerised drug-interaction program.