Potential drug interactions in cancer therapy: a prevalence study using an advanced screening method.

BACKGROUND: In cancer patients, drug interactions may intensify adverse events or reduce antitumour effects. We assessed the prevalence of potential drug interactions (PDIs) among ambulatory cancer patients on i.v. treatment using an advanced screening method. PATIENTS AND METHODS: Data on drugs used for comorbidities, anticancer agents, over-the-counter (OTC) drugs, and comorbidities were collected by means of a structured interview among the patients and review of medical charts. PDIs were identified using electronic (Drug Interaction Facts software, version 4.0) and manual screening methods (peer-reviewed reports). RESULTS: In this study, 278 patients were enrolled. We identified 348 PDIs. Of all patients, 161 (58%) had at least one PDI. Of all PDIs, 34% was classified as major and 60% as moderate. Coumarins, quinolones, antiepileptics, and hydrochlorothiazide were frequently part of a PDI. Interactions that potentially cause QT interval prolongation, gastrointestinal toxicity, and central nervous system depression were also common. In multivariate analysis, an increasing number of drugs [odds ratio (OR) = 1.4, confidence interval (CI) 1.23-1.52; P < 0.001] and the use of an OTC drug (OR = 0.56, CI 0.32-0.97; P = 0.045) were risk factors. CONCLUSIONS: PDIs are common in patients treated for an (haemato-) oncological disease. Screening for potential interactions should take place routinely before administering chemotherapy.

[Non-oral routes of administration of psychotropic agents]. / Niet-orale toedieningsvormen van psychofarmaca.

For patients not able to take oral medication, a psychotropic agent may be selected not only according to its therapeutic and side effects but also to the optional alternative routes of administration. Partly because of the various options of routes of administration haloperidol is the first choice 'classic' antipsychotic medication. As to 'atypical' antipsychotics, the preparation of an ill-tasting clozapine liquid is possible. Lorazepam, clorazepate and diazepam injections (oil in water emulsion) or diazepam per rectiole are non-oral anxiolytics of first choice. Clomipramine and amitriptyline are the only parenteral antidepressants available in the Netherlands. Lithium tablets without controlled release may be administered as a suspension via a catheter. Carbamazepine or valproate may serve as a parenteral alternative for lithium. In case of extrapyramidal side effects of antipsychotics, biperiden or promethazine may be administered parenterally.

Antimicrobial drug use in hospitals in The Netherlands, Germany and Belgium.

Data on the use of antimicrobial drugs was collected by means of an inquiry to 30 hospitals in Belgium (15 in Dutch sectors and 15 in the French sectors), 21 hospitals in Germany and 20 hospitals in the Netherlands. The use of these drugs was expressed as the number of defined daily doses (DDD) per 100 bed days by the anatomical therapeutical chemical classification system. The total use of antimicrobial agents was significantly (p < 0.001) higher in both parts of Belgium (55.6 and 52.0 DDD per 100 bed days) than in Germany (37.9 DDD) or the Netherlands (34.1 DDD). In particular, amoxicillin-clavulanic acid, the first- and second-generation cephalosporins, aminoglycosides and fluoroquinolones were used more in Belgium than in either of the other countries. At least part of the differences observed in antimicrobial drug use could be explained by differences in written antibiotic policy.