Relação entre benefício e risco em interações medicamentosas nas prescrições médicas de um hospital universitário no estado de São Paulo / Benefit-risk relationship in drug interactions in prescriptions from a university hospital in the state of São Paulo / Relación beneficio-riesgo en interacciones medicamentosas en prescripciones de un hospital universitario del estado de São Paulo

Objetivo: Avaliar interações medicamentosas (IM), em que os riscos se so- brepõem aos benefícios (nível I) ou os benefícios se sobrepõem aos riscos (nível II); a partir da análise retrospectiva de prescrições médicas em um Hospital Universitário no estado de São Paulo, Brasil. Métodos: Foram analisadas 19762 prescrições médicas des- tinadas à farmácia do hospital, de janeiro a setembro de 2009; com o auxílio de programas sobre IM, para categorizar IM de nível I e II. Resultados: Na análise 26,53% apresentaram IM, em que 23,64% foram classificadas em nível I e 76,35% em nível II. Dentre as IM com maior frequência no nível I, estavam: ácido acetilsalicílico (AAS) e clopidogrel, AAS e heparina, captopril e espironolactona, digoxina e hidroclorotiazida. Houve uma redução em percentual de IM de nível I, comparando janeiro representado por 26,5% e setembro representado por 18,4%. Já nas IM de nível II, tem-se as seguintes associações com maior frequência: AAS e propranolol, AAS e insulina regular humana, AAS e ate- nolol, AAS e enalapril, AAS e carvedilol. Conclusão: A atuação dos farmacêuticos cola- borou à redução de IM de nível I, devido à intervenção por meio de comunicação estabe- lecida com os prescritores; sinalizando a importância da equipe interprofissional em saúde.

Objective: To evaluate drug interactions (MI), in which risks outweigh the benefits (level I) or benefits outweigh the risks (level II); from the retrospective analysis of medical prescriptions in a University Hospital in the state of São Paulo, Brazil. Methods: 19,762 prescriptions destined to the hospital pharmacy were analyzed, from January to September 2009; with the help of programs on MI, to categorize level I and II MI. Results: In the analysis 26.53% presented MI, in which 23.64% were classified in level I and 76.35% in level II. Among the most frequent level I MI were: acetylsalicylic acid (ASA) and clopidogrel, ASA and heparin, captopril and spironolactone, digoxin and hydrochlorothiazide. There was a reduction in the percentage of level I MI, comparing January, which accounted for 26.5%, and September, which accounted for 18.4%. As for level II MI, the following associations were more frequent: ASA and propranolol, ASA and regular human insulin, ASA and atenolol, ASA and enalapril, ASA and carvedilol. Conclusion: The role of pharmacists collaborated to the reduction of level I MI, due to the intervention by means of communication established with the prescribers; signaling the importance of the interprofessional health team.

Objetivo: Evaluar las interacciones medicamentosas (IM), en las que los riesgos superan a los beneficios (nivel I) o los beneficios superan a los riesgos (nivel II); a partir del análisis retrospectivo de las prescripciones médicas en un Hospital Universitario del estado de São Paulo, Brasil. Métodos: Se analizaron 19.762 prescripciones destinadas a la farmacia del hospital, de enero a septiembre de 2009; con la ayuda de programas sobre IM, para categorizar los IM de nivel I y II. Resultados: En el análisis el 26,53% presentaron IM, en el que el 23,64% se clasificaron en nivel I y el 76,35% en nivel II. Entre los IM de nivel I más frecuentes estaban: ácido acetilsalicílico (AAS) y clopidogrel, AAS y heparina, captopril y espironolactona, digoxina e hidroclorotiazida. Hubo una reducción del porcentaje de IM de nivel I, comparando enero, que supuso el 26,5%, y septiembre, que supuso el 18,4%. En cuanto a los IM de nivel II, fueron más frecuentes las siguientes asociaciones: AAS y propranolol, AAS e insulina humana regular, AAS y atenolol, AAS y enalapril, AAS y carvedilol. Conclusiones: El papel de los farmacéuticos colaboró a la reducción de las IM de nivel I, debido a la intervención mediante la comunicación establecida con los prescriptores; señalando la importancia del equipo sanitario interprofesional.

[Translated Article] Disease-modifying treatments for patients with multiple sclerosis in Spain.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system and long-term disabling. Different disease-modifying treatments are available. These patients, despite being generally young, have high comorbidity and risk of polymedication due to their complex symptomatology and disability. OBJECTIVE PRIMARY: To determine the type of disease-modifying treatment in patients seen in Spanish hospital pharmacy departments. SECONDARY OBJECTIVES: to determine concomitant treatments, determine the prevalence of polypharmacy, identify the prevalence of interactions and analyze pharmacotherapeutic complexity. METHOD: Observational, cross-sectional, multicentre study. All patients with a diagnosis of multiple sclerosis and active disease-modifying treatment who were seen in outpatient clinics or day hospitals during the second week of February 2021 were included. Modifying treatment, comorbidities and concomitant treatments were collected to determine multimorbidity pattern, polypharmacy, pharmacotherapeutic complexity (Medication Regimen Complexity Index) and drug-drug interactions. RESULTS: 1407 patients from 57 centres in 15 autonomous communities were included. The most frequent form of disease presentation was the relapsing remitting form (89.3%). The most prescribed disease-modifying treatment was dimethyl fumarate (19.1%), followed by teriflunomide (14.0%). Of the parenteral disease-modifying treatments, the two most prescribed were glatiramer acetate and natalizumab with 11.1% and 10.8%. 24.7% of the patients had 1 comorbidity and 39.8% had at least 2 comorbidities. 13.3% belonged to at least one of the defined patterns of multimorbidity and 16.5% belonged to 2 or more patterns. The concomitant treatments prescribed were psychotropic drugs (35.5%); antiepileptic drugs (13.9%) and antihypertensive drugs and drugs for cardiovascular pathologies (12.4%). The presence of polypharmacy was 32.7% and extreme polypharmacy 8.1%. The prevalence of interactions was 14.8%. Median pharmacotherapeutic complexity was 8.0 (IQR: 3.3-15.0). CONCLUSIONS: We have described the disease-modifying treatment of patients with multiple sclerosis seen in Spanish pharmacy services and characterized concomitant treatments, the prevalence of polypharmacy, interactions, and their complexity.

Disease-modifying treatments for patients with multiple sclerosis in Spain. / Tratamientos modificadores de la enfermedad en pacientes con esclerosis múltiple en España.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system and long-term disabling. Different disease-modifying treatments are available. These patients, despite being generally young, have high comorbidity and risk of polymedication due to their complex symptomatology and disability. OBJECTIVE PRIMARY: To determine the type of disease-modifying treatment in patients seen in Spanish hospital pharmacy departments. SECONDARY OBJECTIVES: To determine concomitant treatments, determine the prevalence of polypharmacy, identify the prevalence of interactions and analyse pharmacotherapeutic complexity. METHOD: Observational, cross-sectional, multicentre study. All patients with a diagnosis of multiple sclerosis and active disease-modifying treatment who were seen in outpatient clinics or day hospitals during the second week of February 2021 were included. Modifying treatment, comorbidities and concomitant treatments were collected to determine multimorbidity pattern, polypharmacy, pharmacotherapeutic complexity (Medication Regimen Complexity Index) and drug-drug interactions. RESULTS: 1,407 patients from 57 centres in 15 autonomous communities were included. The most frequent form of disease presentation was the relapsing remitting form (89.3%). The most prescribed disease-modifying treatment was dimethyl fumarate (19.1%), followed by teriflunomide (14.0%). Of the parenteral disease-modifying treatments, the two most prescribed were glatiramer acetate and natalizumab with 11.1% and 10.8%. 24.7% of the patients had one comorbidity and 39.8% had at least 2 comorbidities. 13.3% belonged to at least one of the defined patterns of multimorbidity and 16.5% belonged to 2 or more patterns. The concomitant treatments prescribed were psychotropic drugs (35.5%); antiepileptic drugs (13.9%) and antihypertensive drugs and drugs for cardiovascular pathologies (12.4%). The presence of polypharmacy was 32.7% and extreme polypharmacy 8.1%. The prevalence of interactions was 14.8%. Median pharmacotherapeutic complexity was 8.0 (IQR: 3.3 -- 15.0). CONCLUSIONS: We have described the disease-modifying treatment of patients with multiple sclerosis seen in Spanish pharmacy services and characterised concomitant treatments, the prevalence of polypharmacy, interactions, and their complexity.

Reações adversas medicamentosas em pacientes em quimioterapia e estratégias de intervenções / Adverse drug reactions in chemotherapy patients and intervention strategies / Reacciones adversas a medicamentos en pacientes quimioterápicos y estrategias de intervención

A quimioterapia do câncer pode ocasionar reações adversas medicamentosas (RAM), podendo resultar de interações medicamentosas (IM) e impactar na adesão. O presente estudo relatou as RAM apresentadas por pacientes em quimioterapia (QT) e propôs estratégias de intervenções. Este trabalho foi aprovado em comité de ética (5.160.503), sendo incluídos 23 pacientes em quimioterapia (oral- VO e/ou endovenosa- EV) e todos foram entrevistados. Recebiam apenas o QTEV, 20 pacientes e 2 QTEV e VO, a maioria em tratamento paliativo (50%), predomínio de estadiamento IV, sendo as doenças mais presentes de pâncreas (27,3%), estômago (22,7%) e mama (18,2%) e esquema mais usado foi Carboplatina + Paclitaxel. As principais comorbidades foram diabetes e hipertensão arterial. As interações medicamentosas foram classificadas em graves (45%), moderadas (55%) e intencional (75%), sendo necessário introdução de medicamentos de suporte (61%). Houve RAM de maior gravidade, neutropenia, sendo necessário a suspensão temporária, e de menor gravidade náuseas. Houve um óbito relacionado a evolução de doença e, talvez, o tratamento possa ter contribuído. Ao final, foram feitas as intervenções para cada caso e validado o formulário para a consulta farmacêutica a pacientes oncológicos.

Cancer chemotherapy can cause adverse drug reactions (ADRs), which can result from drug interactions (IM) and impact adherence. The present study reported the ADRs presented by patients undergoing chemotherapy (CT) and proposed intervention strategies. This work was approved by the ethics committee (5,160,503), and 23 patients on chemotherapy (oral-VO and/or intravenous-IV) were included and all were interviewed. Only received CTIV, 20 patients and 2 CTIV and VO, most in palliative treatment (50%), predominance of stage IV, being the most common diseases of pancreas (27.3%), stomach (22.7%) and breast (18.2%) and the most used regimen was Carboplatin + Paclitaxel. The main comorbidities were diabetes and arterial hypertension. Drug interactions were classified as severe (45%), moderate (55%) and intentional (75%), requiring the introduction of supportive drugs (61%). There were more severe ADRs, neutropenia, requiring temporary suspension, and less severe nausea. There was one death related to the evolution of the disease and, perhaps, the treatment may have contributed. At the end, interventions were made for each case and the form for the pharmaceutical consultation to cancer patients was validated.

La quimioterapia contra el cáncer puede causar reacciones adversas a los medicamentos (RAM), que pueden ser consecuencia de interacciones farmacológicas (IM) y repercutir en la adherencia. El presente estudio reportó las RAM presentadas por pacientes en quimioterapia (QT) y propuso estrategias de intervención. Este trabajo fue aprobado en comité de ética (5.160.503), se incluyeron 23 pacientes en quimioterapia (oral- VO y/o endovenosa-EV) y todos fueron entrevistados. Recibieron sólo QTEV, 20 pacientes y 2 QTEV y VO, la mayoría en tratamiento paliativo (50%), predominio de estadiaje IV, siendo las enfermedades más presentes las de páncreas (27,3%), estómago (22,7%) y mama (18,2%) y el esquema más utilizado fue Carboplatino + Paclitaxel. Las principales comorbilidades fueron la diabetes y la hipertensión arterial. Las interacciones farmacológicas se clasificaron como graves (45%), moderadas (55%) e intencionadas (75%), requiriendo la introducción de fármacos de apoyo (61%). La RAM más grave fue la neutropenia, que requirió la suspensión temporal, y la menos grave las náuseas. Hubo una muerte relacionada con la evolución de la enfermedad y, tal vez, el tratamiento pudo haber contribuido. Al final, se realizaron intervenciones para cada caso y se validó el formulario de consulta farmacéutica a pacientes oncológicos.

Influence of polypharmacy in the simultaneous presence of high pharmacotherapeutic complexity, drug interactions and non-adherence to medication in patients with HIV infection. Project 3-HIT.

INTRODUCTION: The high pharmacotherapeutic complexity, drug interactions and lack of adherence to concomitant medication are circumstances with negative consequences in the clinical evolution of patients with HIV infection. The 3-HIT phenomenon refers to the simultaneous occurrence of these situations. The objective of the study is to determine the prevalence of the phenomenon 3-HIT in the polymedicated HIV population as well as to determine factors related to its occurrence. METHODS: Observational, retrospective and single-center study that included all elderly patients on active antiretroviral treatment in pharmacotherapeutic follow-up between January and March 2020. A logistic regression model was carried out to evaluate the factors associated with the occurrence of the 3-HIT concept with the variables significantly associated with this phenomenon and those considered clinically relevant. RESULTS: 428 patients were included, registering a prevalence of polypharmacy in 25.9% of the study sample. The 3-HIT phenomenon was detected in 6.3% of the patients. For each concomitant drug prescribed the risk of developing the phenomenon 3-HIT increases 1.5 times. CONCLUSION: Prevalence of the phenomenon 3-HIT is high in HIV patients with polymedication. A change in the pharmaceutical care model to a multidimensional setting is essential, together with pharmacotherapeutic optimization strategies to improve patient health outcomes.

Predictores de potenciales reacciones adversas e interacciones medicamentosas en pacientes post accidente cerebrovascular en Perú

Objetivo Identificar los predictores clínicos y farmacoterapéuticos asociados a los niveles de severidad de las reacciones adversas (RAM) e interacciones medicamentosas (IM) en pacientes hospitalizados post accidente cerebrovascular. Métodos Estudio analítico, predictivo y transversal mediante el modelo de regresión lineal múltiple. Los niveles de severidad de las potenciales reacciones adversas e interacciones medicamentosas se evaluaron mediante Drugs.com. Resultados De la evaluación de 992 prescripciones médicas de 55 (56,7%) pacientes mujeres y 42 (43,3%) varones post accidente cerebrovascular isquémico 62 (63,9%) y hemorrágico 35 (36,1%), se identificó un total de 11 790±46,8 potenciales reacciones adversas y 1 034±9,8 interacciones medicamentosas. La hipertensión arterial se asoció a las reacciones adversas graves y moderadas, en tanto que la neumonía intrahospitalaria y alcalosis metabólica a reacciones adversas leves y moderadas. La alcalosis metabólica se asoció a las interacciones medicamentosas moderadas y leves. Los predictores farmacoterapéuticos como la prescripción en polifarmacia y el uso de antibióticos se relacionaron con reacciones adversas graves, moderadas y leves; los antidiabéticos se relacionaron con interacciones medicamentosas graves, moderadas y los fármacos para terapia cardiaca con interacciones medicamentosas leves. Conclusiones Las variables clínicas como factores de riesgo cardiovascular, presencia de comorbilidades que exacerban las enfermedades crónicas no trasmisibles, los signos y síntomas de alarma, el mayor tiempo de estancia hospitalaria y la prescripción en polifarmacia fueron predictores de mayor frecuencia de reacciones adversas e interacciones medicamentosas graves y moderadas que requieren especial vigilancia y estudio individualizado.

Objective To identify clinical and pharmacotherapeutic predictors associated with severity levels of adverse reactions and drug-drug interactions in post-stroke hospita-lized patients. Methods Analytic, predictive, cross-sectional study using multiple linear regression modeling. Severity levels of potential adverse reactions and drug-drug interactions were assessed using Drugs.com. Results From the evaluation of 992 medical prescriptions of 55 (56.7%) female and 42 (43.3%) male patients post ischemic stroke 62(63.9%) and hemorrhagic stroke 35 (36.1%); a total of 11 790±46.8 potential adverse reactions and 1 034±9.8 drug-drug interactions were identified; arterial hypertension was associated with severe and moderate adverse reactions; while in-hospital pneumonia and metabolic alkalosis with mild and moderate adverse reactions. While metabolic alkalosis was associated with moderate and mild drug-drug interactions. Pharmacotherapeutic predictors such as polypharmacy prescription and antibiotic use were related to moderate and mild severe adverse reactions; antidiabetic drugs were related to moderate and severe drug-drug interactions and cardiac therapy drugs were related to mild drug-drug interactions. Conclusions Clinical variables such as cardiovascular risk factors, presence of comorbidities that exacerbate chronic noncommunicable diseases, alarm signs and symptoms, longer hospital stay, as well as polypharmacy prescriptions, were predictors of a higher frequency of severe and moderate adverse reactions and drug-drug interactions, which require special vigilance and individualized study.

Interacciones farmacológicas entre antivirales y plantas medicinales / Pharmacological interactions between antivirals and medicinal plants

Resumen: Objetivo: Identificar las plantas medicinales que presentan interacciones farmacológicas con los fármacos antivirales. Materiales y métodos: Se realizó una revisión bibliográfica mediante la recolección de artículos en las bases de datos PubMed, Scielo, Google académico. Se recuperó información de cada una de las plantas estudiadas hasta mayo de 2018. Se confeccionó una ficha instructiva a partir de la información obtenida, se tuvo en cuenta su utilidad y actualidad. Resultados: El 57.9% de la información fue recuperada de Google académico. El 47.9% del total de estudios revisados se referían a estudios clínicos y el 27% fueron investigaciones realizadas en Cuba. Allium sativum L. (19.7%), Hypericum perforatum (7.8%) y Panax quinquefolius (7.6%) fueron las plantas que presentaron mayor número de estudios concernientes a interacciones con antivirales. Las acciones sobre el citocromo P450 y la glicoproteína-P fueron las principales responsables de la ocurrencia de interacciones entre las plantas medicinales y los antivirales. La curcumina metabolito secundario de la Curcuma longa L. mostró potencial actividad antiviral ante virus de inmunodeficiencia humana tipo 1 sin obtenerse resultados concluyentes. Conclusiones: Podemos concluir que a pesar de que las interacciones farmacológicas entre antivirales y plantas medicinales son escasas, cuando se presentan lo hacen, en su mayoría, en forma de alteraciones farmacocinéticas. Los antirretrovirales fueron los fármacos de este grupo más involucrados en interacciones con plantas de uso común como el ajo. Los resultados encontrados fueron contradictorios en ocasiones y no todos estaban basados en evidencias clínicas.

Abstract: Objective: To identify medicinal plants that show pharmacological interactions with antiviral drugs. Materials and methods: A literature review carried out through the collection of articles in the PubMed, Scielo, Google academic databases. Information retrieved from each of the plants studied up to May 2018. An information sheet was prepared based on the information obtained and taking into account its usefulness and topicality. Results: 57.9% of the information was retrieved from academic Google. 47.9% of the total studies reviewed referred to clinical studies and 27% were investigations carried out in Cuba. Allium sativum L. (19.7%), Hypericum perforatum (7.8%) and Panax quinquefolius (7.6%) were the plants that presented the highest number of studies concerning interactions with antivirals. Actions on cytochrome P450 and P-glycoprotein were mainly responsible for the occurrence of interactions between medicinal plants and antivirals. The secondary metabolite curcumin of Curcuma longa L. showed potential antiviral activity against human immunodeficiency virus type 1 without obtaining conclusive results. Conclusions: We can conclude that although the interactions between antivirals and medicinal plants are rather rare when they occur, they do so mostly in the form of pharmacokinetic alterations. Antiretroviral drugs are the drugs of this group most involved in interactions with commonly used plants such as garlic. The results found are not all base on clinical evidence and sometime they were contradictories.

A farmacoterapia intra-hospitalar e as potenciais interações medicamentosas em pacientes geriátricos com fraturas

Objetivo: analisar o perfil da farmacoterapia intra-hospitalar quanto à ocorrência de polifarmácia, potenciais interações medicamentosas e prescrição de medicamentos potencialmente inapropriados em idosos hospitalizados por fraturas ósseas. No período de janeiro de 2019 a janeiro de 2020, com pacientes idosos internados por fraturas em qualquer segmento corporal, candidatos ao tratamento cirúrgico, que se encontravam em terapia farmacológica no Hospital Municipal de Imperatriz (HMI), Maranhão. Metodologia: as prescrições foram analisadas por meio do banco de dados Lexi-Interact® para identificar possíveis interações medicamentosas em potencial e os critérios de Beers atualizados em 2019 pela American Geriatrics Society para classificar os medicamentos potencialmente inapropriados. Para verificação de associações foram utilizados o teste de Qui-Quadrado e o teste exato de Fisher. Resultados: o estudo incluiu 29 participantes. A polifarmácia ocorreu em 75,8% dos pacientes. 25 pacientes (86,2%) faziam uso de pelo menos um medicamento potencialmente inapropriado para idosos. 45,3% das 115 potenciais interações medicamentosas possuíam ação deletéria sob a condição clínica do paciente. Conclusão: o perfil da farmacoterapia se caracterizou pela elevada taxa de polifar-mácia, prescrição de medicamentos potencialmente inapropriados pertencentes às classes farmacológicas dos AINEs, analgésico, antibiótico e protetor gástrico, que as potenciais interações medicamentosas foram de grande risco clínico em idosos com fraturas ósseas, cujo predomínio foi de fêmur. Espera-se contribuir para tomada de medidas em consenso para as prescrições de idosos e que outras pesquisas nessa abordagem sejam realizadas para endossar esses achados.

SUMMARY Aim: To evaluate the drug profile concerning occurrence of the polypharmacy, potential drug-drug interactions and potentially inappropriate medication prescribed to aging adults admitted for bone fractures. Cross-sectional, quantitative and analytical study, conducted in January 2019 to January of 2020 with patients attended for bone fractures in any body segment, candidates for surgical treatment, under drug therapy in the Hospital Municipal de Imperatriz (HMI), Maranhão. Methodology: The prescriptions were analyzed with the assistance of Lexi-Interact" database to verification potential drug-drug interactions and the Beers criteria updated in 2019 by the American Geriatrics Society to classify potentially inappropriate medications. The chi-square test and Fisher's exact test were used to verify associations. Results: A total of 29 geriatric patients were included in this study. The prevalence of polypharmacy was 75.8%. 25 patients (86.2%) used at least one medication potentially inappropriate for the aging adults. Of the 115 potential drug-drug interactions, 45.3% had a deleterious effect on the patient clinical condition. Conclusion: The frequency of polypharmacy, potential drug interactions with deleterious action on clinical condition, and prescription of potentially inappropriate medications for geriatric patients during hospitalization was high. The most prevalent pharmacological classes were NSAIDs, analgesic, antibiotic, and gastric protector. Proximal femur fractures were the most prevalent in this research. Thus, it is hoped to contribute to taking consensus measures for prescribing in this population.

Objetivo: analizar el perfil de la farmacoterapia intrahospitalaria en cuanto a la ocurrencia de polifarmacia, posibles interacciones medicamentosas y prescripción de medicamentos potencialmente inapropiados en ancianos hospitalizados por fracturas óseas. De enero de 2019 a enero de 2020, con ancianos hospitalizados por fracturas en cualquier segmento del cuerpo, candidatos a tratamiento quirúrgico, que estaban en tratamiento farmacológico en el Hospital Municipal de Imperatriz (HMI), Maranhão. Metodología: las recetas se analizaron utilizando la base de datos Lexi-Interact " para identificar posibles interacciones farmacológicas y los criterios de Beers actualizados en 2019 por la Sociedad Estadounidense de Geriatria para clasificar los fármacos potencialmente inapropiados. Para verificar las asociaciones se utilizó la prueba Chi-Cuadrado y la prueba exacta de Fisher. Resultados: el estudio incluyó a 29 participantes. La polifarmacia se presentó en el 75,8% de los pacientes. 25 (86,2%) pacientes utilizaban al menos un fármaco potencialmente inapropiado para ancianos. El 45,3% de las 115 posibles interacciones medicamentosas tuvo un efecto deletéreo sobre el estado clínico del paciente. Conclusión: el perfil farmaco-terapéutico se caracterizó por la alta tasa de polifarmacia, prescripción de medicamentos potencialmente inapropiados pertenecientes a las clases farmacológicas de los AINEs, analgésicos, antibióticos y protectores gástricos, las potenciales interacciones medicamentosas resultaron de gran riesgo clínico en ancianos con fracturas óseas. Las fracturas de fémur proximal fueron las más prevalentes en esta investigación. Se espera contribuir a la toma de medidas en consenso para las prescripciones de los ancianos y que se realicen más investigaciones en este enfoque para avalar estos hallazgos.

Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients.

INTRODUCTION: Aging of people living with HIV could be related to potentially inappropiate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS: Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS: Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropiate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION: The prevalence of PIMDINAC criteria in elderly HIV patients is high.

Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients. / Prevalencia y factores asociados con la presencia de criterios PIMDINAC en pacientes VIH de edad avanzada.

INTRODUCTION: Aging of people living with HIV could be related to potentially inappropriate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS: Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS: Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropriate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION: The prevalence of PIMDINAC criteria in elderly HIV patients is high.

Consistency between anticholinergic burden scales in patients with Sjögren's syndrome / Consistencia entre escalas de carga anticolinérgica en pacientes con síndrome de Sjögren

ABSTRACT Introduction: Sjögren's syndrome is the second most frequent autoimmune rheumatic disease and is characterized by exocrine gland involvement manifesting as sicca symptoms. The objective of this study was to estimate the degree of agreement between three anticholinergic burden scales related to the prescriptions of patients diagnosed with Sjögren's syndrome in Colombia. Materials and methods: An analytical concordance study was conducted. The weighted kappa coefficient with quadratic weights was used to identify consistency between the Anticholinergic Drug Scale (ADS), Anticholinergic Cognitive Burden Scale (ACB) and Anticholinergic Risk Scale (ARS), which address the prescriptions used for 3 months by patients with Sjögren s syndrome, in a population database. Results: A total of 15,696 patients with Sjögren's syndrome were identified, with a mean age of 65.4 ± 13.9 years, and 74.2% were women. A total of 94.1% of the patients received at least one topical lubricant, with carboxymethyl cellulose being the most commonly prescribed (22.9%), while oral pilocarpine was prescribed to 3.5% of patients. The ACB was the tool identified more antimuscarinic prescriptions (37.5%), followed by the ADS (35.3%) and ARS (25.2%). The greatest degree of agreement was found between the ADS and ACB (kappa 0.6520; confidence interval (CI): 0.6393-0.6648). Conclusions: Except for the ADS and ACB, little agreement was found between the three scales gauging the anticholinergic burden. Additional studies are needed to determine how these differences can impact the clinical outcomes of patients.

RESUMEN Introducción: El síndrome de Sjögren es la segunda enfermedad reumática autoinmune más frecuente, caracterizada especialmente por el compromiso de glándulas exocrinas manifestándose con síntomas sicca. El objetivo fue estimar el grado de acuerdo de 3 escalas de carga anticolinérgica en las prescripciones de pacientes con diagnóstico de síndrome de Sjögren en Colombia. Materiales y métodos: Estudio analítico de concordancia. Se empleó el coeficiente Kappa con ponderación cuadrática para identificar la consistencia entre los instrumentos Anticholin-ergic Drug Scale (ADS), Anticholinergic Cognitive Burden Scale (ACB) y Anticholinergic Risk Scale (ARS) de las prescripciones utilizadas durante 3 meses por pacientes con síndrome de Sjögren, a partir de una base de datos poblacional. Resultados: Se identificaron 15.696 pacientes con síndrome de Sjögren, con una edad media de 65,4 ±13,9 anos y el 74,2% de mujeres. El 94,1% recibieron por lo menos un lubricante tópico siendo el más prescrito la carboximetilcelulosa (22,9%), mientras que la pilocarpina oral se formuló en el 3,5% de ellos. La escala ACB fue la herramienta que más prescripciones anti-muscarínicas identificó (37,5%) seguida de la ADS (35,3%) y ARS (25,2%). El mayor grado de acuerdo se presentó entre las escalas ADS-ACB (Kappa: 0,6520; IC: 0,6393-0,6648). Conclusiones: Con excepción de las escalas ADS-ACB, hubo poco acuerdo al comparar las 3 escalas de carga anticolinérgica. Se requieren estudios adicionales para determinar cómo estas diferencias pueden impactar en la validez de los desenlaces clínicos de los pacientes.

[Potential drug-drug interactions in COVID 19 patients in treatment with lopinavir/ritonavir]. / Interacciones medicamentosas potenciales en pacientes COVID 19 en tratamiento con lopinavir/ritonavir.

OBJECTIVES: To determine the prevalence of potential interactions in COVID-19 patients receiving lopinavir/ritonavir (LPV/r). The secondary objective was to develop recommendations and identify the risk factors associated with presenting potential interactions with LPV/r. SUBJECTS AND METHODS: Cross-sectional and multicenter study with the participation of 2 hospitals. COVID-19 patients over 18 years of age, admitted to hospital and under treatment with LPV/r were included. A screening of potential interactions related to LPV/r and home and hospital medication was carried out. Lexicomp® (Uptodate), HIV-drug interactions and COVID-drug interactions were used as the query database. RESULTS: 361 patients with a mean age of 62.77 ± 14.64 years were included, where 59.6% (n = 215) were men. 62.3% (n = 225) had 1 or more potential interactions and 26, 87% (n = 97) 2 or more. The independent variables associated with presenting ≥1 potential interactions were age (> 65) (OR 1.95; 95% CI 1.06-3.59, P =.033), ICU admission (OR 9.22; CI 95% 1.98-42.93; P =.005), previous respiratory pathology (OR 2.90; 95% CI 1.15-7.36; P =.024), psychiatric (OR 4.14; 95 CI % 1.36-12.61; P =.013), dyslipidemia (OR 3.21; 95% CI 1.63-6.35; P =.001) and the number of drugs prescribed (OR 4.33; 95% CI 2.40-7.81; P =.000). CONCLUSION: The prevalence of potential interactions in COVD-19 patient undergoing treatment with LPV/r is high, with age (> 65), ICU admission, previous respiratory and psychiatric pathology, dyslipidemia and the number of prescribed drugs acting as risk factors.

High Doses of Drugs Extensively Metabolized by CYP3A4 Were Needed to Reach Therapeutic Concentrations in Two Patients Taking Inducers / Dos pacientes que tomaban inductores necesitaron dosis altas de medicamentos metabolizados en gran medida por el CYP3A4 para alcanzar concentraciones terapéuticas

ABSTRACT Introduction: In the last 20 years of clinical practice, the senior author has identified these 2 rare cases in which the patients needed extremely high doses of drugs metabolized by CYP3A4 to reach and maintain serum therapeutic concentrations. Methods: The high metabolic ability of these 2 patients was demonstrated by the low concentration-to-dose ratios (C/D ratios) of several drugs metabolized by CYP3A4. Results: Case 1 was characterized by a history of high carbamazepine doses (up to 2,000 mg/day) and needed 170 mg/day of diazepam in 2 days to cooperate with dental cleaning. The high activity of the CYP3A4 isoenzyme was manifested by fast metabolism for quetiapine and diazepam, which took more than 1 year to normalize after the inducer, phenytoin, was stopped. Case 2 was also very sensitive to CYP3A4 inducers as indicated by very low C/D ratios for carbamazepine, risperidone and paliperidone. The carbamazepine (2,800 mg/day) and risperidone (20 mg/day) dosages for this second patient are the highest doses ever seen for these drugs by the senior author. Risperidone induction appeared to last for many months and metabolism was definitively normal 3 years after stopping carbamazepine. On the other hand, olanzapine C/D ratios were normal for induction. Conclusions: The literature has never described similar cases of very high doses of drugs metabolized by CYP3A4. We speculate that these 2 patients may have unusual genetic profiles at the nuclear receptor levels; these receptors regulate induction of drugs.

RESUMEN Introducción: Durante sus últimos 20 años de práctica, el último autor ha identificado estos 2 infrecuentes casos que necesitaban dosis extremadamente altas de medicaciones metabolizadas por el CYP3A4 para alcanzar y mantener concentraciones séricas terapéuticas. Métodos: La gran capacidad metabólica de estos 2 pacientes se demostró por los bajos cocientes entre concentración y dosis (C/D) de varias medicaciones metabolizadas por el CYP3A4. Resultados: El caso 1 se caracterizaba por una historia de altas dosis de carbamazepina (1.500 mg/día) y la necesidad de tomar 170 mg de diazepam en 2 días para facilitar una limpieza dental. La gran actividad de la isoenzima CYP3A4 se manifestó por una gran capacidad metabólica de quetiapina y diazepam, cuya normalización tardó más de 1 año tras la toma de un inductor, fenitoína. El caso 2 tambien era muy sensible a la inducción, lo cual se demuestra por los bajos cocientes C/D de carbamazepina, risperidona y paliperidona. Las dosis de carbamazepina (2.800 mg/día) y risperidona (20 mg/día) de este segundo paciente son las más altas nunca vistas por el último autor. La inducción de risperidona duró muchos meses y su metabolismo era normal 3 años después de interrumpir la carbamazepina. El cociente C/D de olanzapina era normal para la inducción. Conclusiones: Nunca se habían descrito casos similares de dosis tan altas de medicaciones metabolizadas por el CYP3A4. Se especula con que estos pacientes podrían tener unos perfiles genéticos inusuales en los receptores nucleares que regulan la inducción de medicamentos.

High Doses of Drugs Extensively Metabolized by CYP3A4 Were Needed to Reach Therapeutic Concentrations in Two Patients Taking Inducers.

INTRODUCTION: In the last 20 years of clinical practice, the senior author has identified these 2 rare cases in which the patients needed extremely high doses of drugs metabolized by CYP3A4 to reach and maintain serum therapeutic concentrations. METHODS: The high metabolic ability of these 2 patients was demonstrated by the low concentration-to-dose ratios (C/D ratios) of several drugs metabolized by CYP3A4. RESULTS: Case 1 was characterized by a history of high carbamazepine doses (up to 2,000mg/day) and needed 170 mg/day of diazepam in 2 days to cooperate with dental cleaning. The high activity of the CYP3A4 isoenzyme was manifested by fast metabolism for quetiapine and diazepam, which took more than 1 year to normalize after the inducer, phenytoin, was stopped. Case 2 was also very sensitive to CYP3A4 inducers as indicated by very low C/D ratios for carbamazepine, risperidone and paliperidone. The carbamazepine (2,800 mg/day) and risperidone (20 mg/day) dosages for this second patient are the highest doses ever seen for these drugs by the senior author. Risperidone induction appeared to last for many months and metabolism was definitively normal 3 years after stopping carbamazepine. On the other hand, olanzapine C/D ratios were normal for induction. CONCLUSIONS: The literature has never described similar cases of very high doses of drugs metabolized by CYP3A4. We speculate that these 2 patients may have unusual genetic profiles at the nuclear receptor levels; these receptors regulate induction of drugs.

Interacciones medicamentosas como un problema de salud imperceptible en la población / Drug Interactions as an Imperceptible Health Concern among the Population

Introducción: El consumo elevado de medicamentos se asocia a factores que propician su uso inadecuado y posibles consecuencias en el objetivo terapéutico, el control de la enfermedad. Objetivo: Caracterizar las posibles interacciones medicamentosas como un problema de salud para la población general y los prescriptores del sistema. Métodos: Estudio descriptivo y transversal, serie de casos de consecuencias prácticas con elementos de esquema terapéutico. Población de 214 individuos consumidores de medicamentos, entre 18 y 89 años, seleccionados al azar por muestreo probabilístico estratificado. Escenario: consultorios de la Atención Primaria (9, 10) y consultas de medicina interna de instituciones hospitalarias en Cienfuegos, Cuba. Período: primer trimestre, año 2017. Variables investigadas: sociodemográficas, tipo de prescripción, grupos farmacológicos y posibles interacciones medicamentosas. Resultados: La media de consumo fue de 10,5 en mujeres de la tercera edad. De 365 prescripciones el 54,2 por ciento fueron posibles interacciones medicamentosas, predominaron las de tipo farmacocinéticas (95,4 por ciento), y de ellas las relacionadas con el metabolismo por automedicación (34,3 por ciento), así como el consumo de omeprazol u otra sustancia no farmacológica inhibidores del CYP-450, como el jugo de toronja y el consumo de alcohol crónico. El tabaco fue el inductor que más se identificó 25 (58,1 por ciento), propiciando posibles fallas terapéuticas. Conclusión: Las posibles interacciones medicamentosas se presentaron como problema de salud imperceptible para la población sana y enferma. Los prescriptores de salud generalmente no las tienen en cuenta, donde las de mayor riesgo se relacionan con inhibidores del metabolismo oxidativo, lo cual propicia posibles daños a la salud del ser humano(AU)

Introduction: The high consumption of medicines is associated with factors that favor their inappropriate use and possible consequences in the therapeutic objective, the control of the disease. Objective: To characterize possible drug interactions as a health concern for the general population and the healthcare system prescribers. Methods: Descriptive and cross-sectional study. Series of cases of practical consequences with elements of a therapeutic scheme. Population of 214 individuals consuming drugs, aged 18-89 years, randomly selected by stratified probabilistic sampling. The setting was the primary care clinics (9 and 10) and internal medicine consultations of hospital institutions in Cienfuegos, Cuba. The period was the first trimester of the year 2017. The variables investigated were the sociodemographic ones, type of prescription, pharmacological groups, and possible drug interactions. Results: The average consumption was 10.5 among elderly women. Out of 365 prescriptions, 54.2 percent were possible drug interactions, while those of the pharmacokinetic type (95.4 percent) predominated, together with those related to the metabolism of self-medication (34.3 percent), as well as the consumption of omeprazole or other nonpharmacological substance inhibitors of CYP-450, such as grapefruit juice and chronic alcohol consumption. Tobacco was the inducer that most identified (25, 58.1 percent), leading to possible therapeutic failures. Conclusion: Possible drug interactions were presented as an imperceptible health concern for the healthy and sick population. Healthcare prescribers generally do not take them into account, for which those at highest risk are related to oxidative metabolism inhibitors, which leads to possible damage to human health(AU)

Interactions of cobicistat and ritonavir in patients with HIV and its clinical consequences. / Interacciones de cobicistat y ritonavir en pacientes con VIH y sus consecuencias clínicas.

INTRODUCTION: The prescription of antiretroviral treatment (ART) that contains pharmacokinetic enhancers such as ritonavir and cobicistat is frequent. The objective of this stdy was to analyze the potential interactions of ART that include these molecules in their formulation with the patient's home medication, as well as the clinical management of those potentially serious. METHODS: Prospective study conducted in the pharmacy care clinic of a third level hospital between January and December of 2018. Those HIV+patients with an ART containing cobicistat or ritonavir were included in the study. Potential interactions between ART and concomitant medication were analysed in three databases (Micromedex®, Drugs.com and Liverpool), the interventions carried out were detailed, and adverse drug reactions analysed. RESULTS: 968 patients were included with a total of 2,148 prescriptions (274 different medications). A total of 86 interventions were performed regarding potential interactions in patients. The most frequent were substitutions of corticoid treatments, treatment suspensions and closer monitoring of treatments. A total of possible adverse drug reactions were analysed. The degree of agreement in the severity classification of the interactions for cobicistat and ritonavir was good among the three databases. It was remarkable Micromedex® as the most complete because it has more registered medications. CONCLUSION: The interactions between ART with pharmacokinetic enhancers in its composition and concomitant medication is frequent and requires a significant variety of interventions. The check of interactions in different databases is recommended since they can cause adverse drug reactions.

Drug safety among institutionalized elderly people: potential interactions / Seguridad medicamentosa en ajustes institucionalizados: potencial interacciones / Segurança medicamentosa em idosos institucionalizados: potenciais interações

ABSTRACT Objective: to identify the drug interactions among institutionalized elderly. Method: retrospective and documentary study with a quantitative approach developed in two Long Stay Institutions for Elderly, located in northeastern Brazil. Drug interactions were identified by using Drug-Reax® software from the Micromedex database, and they were classified by severity, start time, and documentation. Result: in the 286 analyzed prescriptions, 136 drug interactions were detected in both institutions, most of them classified as severe. The average number of drugs prescribed by the elderly was 4.5. In the analysis of Pearson's correlation, the number of drug interactions showed a statistically significant correlation with the time of institutionalization and with the amount of drugs administered on the day. Conclusion and implications for practice: the high consumption of drugs and serious drug interactions detected with significant clinical repercussions was evidenced in the study. Knowledge of these interactions is essential for the establishment of preventive safety measures in pharmacotherapy.

RESUMEN Objetivo: Identificar las posibles interacciones medicamentosas en ancianos institucionalizados. Metodo: Estudio documental, retrospectivo, con abordaje cuantitativo, desarrollado en dos Instituciones de Larga Permanencia para Ancianos, ubicada en el nordeste de Brasil. Las posibles interacciones medicamentosas, del tipo fármaco-fármaco, fueron identificadas utilizándose el software Drug-Reax® de la base de datos Micromedex, y clasificadas según la gravedad, el tiempo de inicio y la documentación. Resultados: En las 286 prescripciones, se detectaron 136 interacciones medicamentosas en las dos instituciones, siendo la mayoría clasificada como severidad grave. La media de medicamentos prescritos por los ancianos fue 4,5. El número de interacciones medicamentosas presentó correlación estadísticamente significativa con el tiempo de institucionalización y con la cantidad de medicamentos administrados en el día. Conclusión e implicaciones para la práctica: Se evidenció un alto consumo de fármacos y de potenciales interacciones medicamentosas graves con respuestas clínicas significativas. El conocimiento de estas interacciones es esencial para el establecimiento de medidas preventivas de seguridad en la farmacoterapia para esa población.

RESUMO Objetivo: Identificar as potenciais interações medicamentosas em idosos institucionalizados. Método: Estudo documental, retrospectivo, com abordagem quantitativa, desenvolvida em duas Instituições de Longa Permanência para Idosos, localizada no nordeste do Brasil. As potenciais interações medicamentosas, do tipo fármaco-fármaco, foram identificadas utilizando o software Drug-Reax® da base de dados Micromedex, e classificadas segundo a gravidade, ao tempo de início e a documentação. Resultados: Nas 286 prescrições, foram detectadas 136 interações medicamentosas nas duas instituições, sendo a maioria classificada como severidade grave. A média de medicamentos prescritos por idosos foi de 4,5. O número de interações medicamentosas apresentou correlação estatisticamente significativa com o tempo de institucionalização e com a quantidade de medicações administradas no dia. Conclusão e implicações para a prática: Foi evidenciado um alto consumo de fármacos e de potenciais interações medicamentosas graves com respostas clínicas significantes. O conhecimento dessas interações é essencial para o estabelecimento de medidas preventivas de segurança na farmacoterapia para essa população.

Incidencia de los problemas relacionados con los medicamentos antirretrovirales para el tratamiento de la infección por HIV en pacientes hospitalizados en el Hospital Santa Clara de Bogotá / Incidence of antiretroviral drug-related problems in the treatment of HIV among hospitalized patients in the Hospital Santa Clara, Bogotá

Resumen Introducción. El tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana (HIV) se ha relacionado con diversos problemas de los medicamentos que causan o pueden causar la aparición de resultados negativos. En este contexto, es importante determinar su incidencia, caracterizarlos y clasificarlos para diseñar estrategias que minimicen su impacto. Objetivo. Estimar la incidencia global y de cada uno de los problemas relacionados con los medicamentos antirretrovirales utilizados en el tratamiento del HIV en una cohorte de pacientes hospitalizados en una institución de tercer nivel de Bogotá. Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo de cohorte en pacientes de 18 años o más de edad con diagnóstico de infección por el HIV y en tratamiento antirretroviral, hospitalizados entre el 1° enero de 2015 y el 31 de diciembre de 2016 en el Hospital Santa Clara de Bogotá. Resultados. La incidencia global de los problemas relacionados con los medicamentos antirretrovirales fue de 0,90 (IC95% 0,85-0,93). La incidencia de las interacciones medicamentosas fue de 0,85 (IC95% 0,80-0,90), la de las reacciones adversas de 0,28 (IC95% 0,22-0,35) y la del error de prescripción de 0,12 (IC95% 0,08-0,17). Conclusión. Los problemas relacionados con los medicamentos deben estudiarse, diagnosticarse, prevenirse y tratarse para que el personal de salud pueda anticiparse a su aparición, disminuir su incidencia, implementar planes de manejo del riesgo y optimizar el cumplimiento del tratamiento antirretroviral.

Abstract Introduction: The antiretroviral therapy for the treatment of the human immunodeficiency virus (HIV) is a therapeutic strategy linked to drug-related problems that cause or can cause the appearance of negative results associated with the medication. It is important, therefore, to identify their incidence, characterize them, and classify them to design strategies to minimize their impact. Objective: To estimate the overall incidence and the incidence of each one of the antiretroviral drugs-related problems in the treatment of the HIV infection in a cohort of hospitalized patients in Bogotá, Colombia. Materials and methods: We conducted a descriptive, retrospective cohort study in patients aged 18 years or more diagnosed with HIV infection and under antiretroviral treatment hospitalized between January 1st, 2015, and December 31st, 2016, in the Hospital Santa Clara, Bogotá. Results: The overall incidence of antiretroviral drug-related problems was 0.90 (95% CI: 0.85-0.93). The incidence of drug-drug interactions was 0.85 (95% CI: 0.80-0.90), 0.28 (95% CI: 0.22-0.35) for adverse reactions, and 0.12 (CI 95%: 0.08-0.17) for prescription errors. Conclusion: Drug-related problems should be studied, diagnosed, prevented, and treated. Their knowledge can enable health care professionals to anticipate their emergence, reduce their incidence, implement risk management plans, and optimize adherence to antiretroviral treatment.

Polypharmacy among HIV infected people aged 50 years or older / Polifarmacia en pacientes mayores de 50 años con infección por el VIH

Abstract Introduction: Although HAART cannot eradicate HIV, it suppresses viral replication, resulting in a progressive reduction in HIV-related morbidity and mortality. The increase in life expectancy for HIV-infected patients has turned this disease into a chronic disease and, therefore, to the appearance of comorbidities. At the same time there is an increase in the use of concomitant medication, making HIV-infected patient a polymedicated patient. Objective: To determine the degree of polypharmacy and to describe clinically relevant drug interactions, as well as the comorbidities and adherence to HAART in HIV + patients over 50 years. Methods: Observational, transversal study. Patients ≥50 years on HAART ambulatory were included. The variables were collected: aged, sex, VL, CD4, comorbidities, ARV, concomitant medication, herbal products and adherence. Patients who did not sign informed consent were excluded. Results: Were included 154 patients ≥50 years on HAART. The presence of polypharmacy, defined as the use of 5 or more medications including HAART, was 40.3%. 73.4% of the patients had concomitant medication: lipid-lowering agents (33.8%), anxiolytics / sedatives (28.6%), proton-pump inhibitors (26.0%) antihypertensive agents (23.4%). 102 relevant interactions were recorded, finding statistically significant differences in relation to the presence of polypharmacy and pharmacologic drugs classes (p <0.001). Conclusion: The prevalence of polypharmacy among HIV+ patients ≥50 years is high. Comorbidities, interactions and drugs associated were similar to those described in the literature. It is necessary to establish priorities in relation to drug interactions with polypharmacy and a correct approach to the pathologies that may develop.

Resumen Introducción: El HAART, si bien no puede erradicar la infección por el VIH, mantiene suprimida la replicación viral obteniendo una progresiva reducción de la morbimortalidad. El aumento de la esperanza de vida ha convertido a esta enfermedad en una patología crónica y por tanto, a la aparición de comorbilidades. Paralelamente, se produce un incremento en el uso de medicamentos que califican al paciente VIH como polimedicado. Objetivos: Determinar el grado de polifarmacia, describir las interacciones relevantes, así como conocer las comorbilidades y la adherencia al HAART en pacientes VIH+ ≥50 años. Métodos: Estudio descriptivo, transversal. Se incluyeron pacientes ≥50 años VIH + con terapia HAART ambulatoria. Se recogieron las variables: edad, sexo, carga viral, CD4, comorbilidades, tratamiento antirretroviral, medicación concomitante, productos de herboristería y adherencia. Resultados: Se incluyeron 154 pacientes ≥50 años con HAART. La polifarmacia, definida como la presencia de 5 o más principios activos incluido el HAART, se presentaron en el 40.3% de los pacientes. El 73.4% tenía medicación concomitante: hipolipemiantes (33.8%), ansiolíticos/sedantes (28.6%), inhibidores de la bomba de protones (26.0%), antihipertensivos (23.4%). Se registraron 102 interacciones relevantes encontrándose diferencias estadísticamente significativas en relación a la presencia de polifarmacia y al grupo farmacológico antirretroviral (p <0.001). Conclusiones: Existe una alta prevalencia de polifarmacia en pacientes VIH+ ≥50 años. Las comorbilidades, las interacciones identificadas y la medicación concomitante fueron similares a las descritas en la literatura. Es necesario establecer prioridades en relación a las interacciones farmacológicas con la polifarmacia y un correcto abordaje de las patologías que se puedan desarrollar.

Prevalence of the potential drug-drug interactions between pangenotypic direct-acting antivirals and the concomitant medications associated with patients with chronic hepatitis C virus infection in Spain. / Prevalencia de las potenciales interacciones medicamentosas entre los antivirales de acción directa pangenotípicos y la medicación concomitante asociada a los pacientes con infección del virus de la hepatitis C crónica en España.

OBJECTIVE: To determine the comorbidity and potential for drug-drug interactions (DDIs) among pangenotypic direct-acting-antivirals (pDAAs) and the concomitant medications associated with chronic hepatitis C (CHC) patients in routine clinical practice in Spain. METHODS: Retrospective observational study. Included patients were ≥18 years, diagnosed with CHC, on antiviral treatment and required medical attention during 2017. Two groups were differentiated according to age ranges (<50 and ≥50 years). The variables collected were: age, gender, general/specific comorbidity, concomitant medication and potential DDIs (www.hep-druginteractions.org). The pDAAs analysed were: a) Sofosbuvir/Velpatasvir (SOF/VEL), b) Glecaprevir/Pibrentasvir (GLE/PIB) and c) Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX). Bivariate statistical analysis, P<.05. RESULTS: 3,430 patients with a mean age of 56.9 years and 60.3% males were enrolled. The average Charlson index was 0.8. Age range distribution: 18-49 years (28.9%) and ≥50 years (71.1%). The average number of medications per patient/year was 3.1 (SD 2.6). The total percentage of potential DDIs was: 8.6% minor DDIs, 40.5% clinically significant DDIs and 10.0% contraindicated medication. These DDIs were greater in patients ≥50 years (8.6%, 43.8% and 12.4%, respectively, P<.001). For all ages, SOF/VEL showed a lower percentage of: minor interactions (1.3% vs. 6.6% and 5.9%, P<.001); clinically significant interactions (53.4%, vs. 77.4% and 66.3%, P<.001) and contraindicated medication (1.7% vs. 8.3% and 10.7%, P<.001) compared to GLE/PIB and SOF/VEL/VOX, respectively. CONCLUSIONS: Patients with CHC present high comorbidity and concomitant medication use, particularly elderly patients, thus implying a greater exposure to potential DDIs. Although the DDI rate was considerable with the three combinations analysed, SOF/VEL showed a lower number of clinically significant interactions.