Assessing a therapeutic exchange protocol for second-generation antidepressants: clinical results.

OBJECTIVE: To design a therapeutic exchange protocol for antidepressants and clinically assess variables, such as: compliance level, frequency of cases with clinically significant increase on the Udvalg-für-Kliniske-Undersogelser (UKU) psychopharmacological scale, adverse effects analysis, overall analysis of UKU rating development and patients' level of acceptance. Secondary objectives were to correlate psychopharmacological treatment aspects with the pharmacological morbidity level, and evaluate the clinical impact of pharmacotherapeutic optimisation measures. METHOD: The protocol is designed in accordance with a bibliographical review, which was approved by the Pharmacy and Therapeutics Commission. Sequential study was carried out with a sample of 30 patients. Three measurements were taken (base line, at 48-72 hours and at 1-3 weeks) to calculate the pharmacotherapeutic morbidity with the UKU rating scale and the Global Clinical Impression. Pharmacotherapeutic optimisation measures were used for those patients with high pharmacotherapeutic morbidity levels. RESULTS: The compliance level was 73.3%. One patient experienced ≥25% increase on the UKU rating scale and another patient suffered from an adverse effect. The final UKU rating reached statistical significance compared with the measurements taken at 48-72 hours (P=.032) and with the base line measurement (P=.007). Patient acceptance was 90%. The impact of optimisation measurements on the pharmacotherapeutic morbidity level was clinically and statistically significant (P<.001). CONCLUSIONS: The proposed protocol has been widely accepted and it is quite certain that it is to be introduced in at a general hospital level.

Effectiveness of 100% autologous serum drops in ocular surface disorders.

OBJECTIVE: To evaluate the effectiveness of 100% autologous serum eye drops for the treatment of various ocular surface disorders. METHODS: A descriptive prospective observational study carried out from May 2005 to February 2009 which included patients with ocular surface disorders treated with single-dose autologous serum eye drops. Treatment effectiveness was evaluated by using a clinical questionnaire in order to assess symptoms experienced by patients at the beginning and end of treatment. RESULTS: A total of 15 patients (24 eyes) were evaluated. Clinical symptoms such as redness, burning, sharp pain and tired eyes improved in 100% of the patients, whereas dryness and sandy/gritty sensation improved in 92% of the patients. The overall improvement of clinical symptoms was worth the inconvenience of venipuncture according to 66.7% of the patients. Regarding tolerance for autologous serum eye drops, only one patient experienced some discomfort when using the single-dose eye drops. CONCLUSION: The treatment with 100% autologous serum eye drops improved ocular symptoms for most patients.

Analysing the stability of two oral carbamazepine suspensions.

OBJECTIVE: To assess the physical, chemical and microbiological stability of two oral suspensions of carbamazepine at concentrations of 2.5% and 5%. METHODS: Both oral suspensions were compounded from powdered carbamazepine and Ora-Sweet SF(®) and Ora-Plus(®) commercial compounding excipients. At the 2, 4 and a 6-month marks, different quality assays were performed, comprising physical (pH, state of the suspension, organoleptic properties), chemical (HPLC) and microbiological assays. RESULTS: The final concentration at 6 months for both the 2.5% and 5% carbamazapine suspensions was 22.9 and 45.9 mg/ml respectively, with calculated richness values between 90 and 110% fulfilling USP23 NF18 requirements. No changes in physical properties and no culture growth were observed during the study period. CONCLUSION: Both oral suspensions are physically, chemically and microbiologically stable for at least 6 months when preserved at room temperature in amber glass flasks.

Monitoring trough plasma concentrations of mycophenolate mofetil in patients with uveitis.

BACKGROUND: Mycophenolate mofetil (MMF) has been used successfully in patients with various forms of uveitis not responsive to other immunosuppressants. Nevertheless, for these patients neither recommendations for optimal dosage of MMF nor data concerning drug exposure of MMF are available. OBJECTIVE: To describe the results of the therapeutic drug monitoring (TDM) of MMF trough concentrations in a cohort of patients with uveitis, with the aim of optimizing the dosage of this drug, by maintaining a target concentration to achieve adequate immunosuppression with a minimal risk of therapeutic failure or toxicity. PATIENTS AND METHODS: This study describes the results of monitoring trough plasma concentrations of MMF in 12 patients with uveitis during a mean period of 21.4 months. Patients included one with Stevens-Johnson syndrome, one with Graves-Basedow's disease, one with Behcet's disease, one with idiopathic thrombocytopenic purpura and the rest with idiopathic uveitis. All patients were treated with steroids and additional therapy prior to treatment with MMF. RESULTS: Pharmacokinetic monitoring of mycophenolic acid (MPA) was performed with 108 trough plasma samples using an EMIT assay. Mean daily MMF dose was 24.5 +/- 6.3 mg/kg and mean trough MPA concentration was 2.9 +/- 1.9 microg/mL. Therapy was effective in 10 patients (83%). There were few side-effects: diarrhoea, excitement, agitation and cough that disappeared with daily dose reduction of MMF. CONCLUSIONS: MMF was effective in the majority of patients with uveitis with an acceptable profile of side-effects. TDM of MMF in patients with uveitis is clinically practicable and may help to optimize individual immunosuppressive therapy. We estimated that MMF dosages in the range of 0.5-1.5 g/day might be sufficient for treating uveitis and we recommend an initial target range of 2-4 microg/mL, which included 50% of our results. Randomized controlled trials are essential to confirm the efficacy of MMF in uveitis.

[Pharmacokinetic interaction between valproic acid and carbapenem-like antibiotics: a discussion of three cases]. / Interacción farmacocinética entre ácido valproico y antibióticos carbapenémicos: descripción de tres casos.

A number of literature references suggest that carbapenem-like antibiotics decrease plasma concentrations of valproic acid in epileptic patients. This interaction may result in a recurrence of epileptic seizures in these patients. To clarify the possible mechanism of such carbapenem-valproic acid interaction several experimental studies have been carried out in animals. However, the mechanism of this drug-drug interaction is as yet uncertain. in this article we report three new cases that were observed in our hospital within three months. One of these patients developed seizures. We also review the different mechanisms proposed, as well as cases published to this day. All these data demonstrate that care should be taken in using these potent antibiotics in patients receiving valproic acid.

[A study of the stability of lipid emulsions in mixtures for peripheral parenteral nutrition]. / Estudio de la estabilidad de emulsiones lipídicas en mezclas para nutrición parenteral por vía periférica.

This study is an attempt to contribute practical information on the stability of the mixtures of parenteral nutrition administered peripherally, using two different brands of lipids and amino acids for peripheral administration, with the addition of polivitamins and calcium. The tests performed included the determination of osmolarity, pH and size of lipidic globule using two methods: Coulter Counter and microscopic interference contrast method. The time factor and conservation temperature were taken into account in the stability of the mixtures.