Survey of prescriptions for triple whammy drug combinations with vitamin D as a possible fourth whammy.

IF 0.9 4区 医学 Q4 PHARMACOLOGY & PHARMACY International journal of clinical pharmacology and therapeutics Pub Date : 2023-01-01 DOI:10.5414/CP204234
Masami Narisue, Yuka Sugimoto, Fumi Hirano, Risa Nakatsukasa, Kenichi Miyazaki, Toshio Otsubo, Mikiro Nakashima, Sumio Hirata
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Abstract

Background: Improper prescriptions can cause adverse reactions in patients with chronic kidney disease (CKD).

Materials and methods: Hospital pharmacists investigated improper prescriptions, prerenal acute kidney injury (AKI) prescriptions, and adverse effects in AKI in 199 CKD patients at Kouseikai Hospital from July 2020 to June 2021, as well as combinations of "triple whammy" drugs (renin-angiotensin-system inhibitors, diuretics, and non-steroidal anti-inflammatory drugs) plus active vitamin D preparations. All participants (average age, 73.6 ± 16.2 years) were residents of Nagasaki City or its suburbs.

Results: Adverse reactions occurred in 38 of the 199 patients (19.1%). 13 patients had AKI, and 9 of these cases developed during the summer. A comparison of the 38 patients in the adverse reaction group and the 161 patients in the non-occurrence group showed that the former group was significantly older and had a lower body weight. In terms of renal function, estimated glomerular filtration rate (mL/min/1.73m2) was significantly lower, blood urea nitrogen/serum creatinine (BUN/S-Cr) was higher, dehydration was involved, and active vitamin D preparations were significantly more common in the adverse reaction group.

Conclusion: Our findings suggest that concomitant prescription of active vitamin D in combination with the drugs that constitute the triple whammy should be avoided. The absence of hypercalcemia should be confirmed and adequate fluid intake should be encouraged to prevent prerenal nephropathy.

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三重打击药物组合的处方调查,维生素D可能是第四种打击。
背景:慢性肾脏疾病(CKD)患者处方不当会引起不良反应。材料与方法:医院药剂师调查了2020年7月至2021年6月在Kouseikai医院的199例CKD患者的不当处方、AKI处方和AKI不良反应,以及“三联药”(肾素-血管紧张素系统抑制剂、利尿剂和非甾体抗炎药)加活性维生素D制剂的组合。所有参与者(平均年龄73.6±16.2岁)均为长崎市或其郊区居民。结果:199例患者中发生不良反应38例(19.1%)。13例患者有AKI,其中9例在夏季发病。不良反应组38例患者与未发生组161例患者比较,不良反应组年龄明显增大,体重明显下降。肾功能方面,不良反应组肾小球滤过率(mL/min/1.73m2)估测值明显降低,尿素氮/血清肌酐(BUN/S-Cr)升高,伴有脱水,活性维生素D制剂明显增多。结论:我们的研究结果表明,应避免活性维生素D与构成三重打击的药物合用。应确认没有高钙血症,并应鼓励充足的液体摄入,以预防肾前性肾病。
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来源期刊
CiteScore
1.70
自引率
12.50%
发文量
116
审稿时长
4-8 weeks
期刊介绍: The International Journal of Clinical Pharmacology and Therapeutics appears monthly and publishes manuscripts containing original material with emphasis on the following topics: Clinical trials, Pharmacoepidemiology - Pharmacovigilance, Pharmacodynamics, Drug disposition and Pharmacokinetics, Quality assurance, Pharmacogenetics, Biotechnological drugs such as cytokines and recombinant antibiotics. Case reports on adverse reactions are also of interest.
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