RESUMO
Propofol (2,6-diisopropylphenol) is the most widely used drug for endoscopic procedures under deep sedation. We present the clinical case of an 83-year-old man who underwent a colonoscopy under sedation with propofol, observing a green discolouration of the urine during the procedure.
Assuntos
Anestesia , Sedação Profunda , Propofol , Masculino , Humanos , Idoso de 80 Anos ou mais , Propofol/efeitos adversos , Colonoscopia/métodos , Sedação Consciente/métodos , Sedação Profunda/efeitos adversos , Sedação Profunda/métodos , Hipnóticos e Sedativos/efeitos adversosRESUMO
INTRODUCTION: Combination therapy with an alpha blocker (AB) plus an antimuscarinic (AM) is recommended for men with moderate-to-severe mixed lower urinary tract symptoms (LUTS) when monotherapy is not effective in relieving storage symptoms. This study compared treatment persistence and adherence with an AB plus AM fixed-dose combination (FDC) vs an AB plus AM free-dose combination in men with LUTS in Spain. METHODS: Retrospective study using the Spanish IQVIA Cegedim Electronic Medical Records database. Men prescribed AB plus AM combination therapy were included in an FDC or free-dose combination cohort based on their index treatment. Treatment persistence was the time from index date to first discontinuation of ≥1 of the two index drugs over 12 months. Adherence was measured using the fixed medication possession ratio (MPR). RESULTS: Of 3114 patients identified, 999 were included (FDC, n = 790; free-dose combination, n = 209). Median (95% CI) persistence was longer in the FDC (125 [109-151] days) than in the free-dose combination (31 [31-36] days) cohort (hazard ratio [HR], 2.9; 95% CI, 2.4-3.4; P < .0001). The 12-month persistence rates were 31.1% (FDC cohort) and 8.9% (free-dose cohort). The mean (SD) fixed MPR was higher in the FDC cohort (48.8 [37.2]) compared with the free-dose cohort (23.1 [28.4]); more patients in the FDC cohort (34.2%) than in the free-dose cohort (10.0%) were adherent (MPR ≥ 80%). The probability of treatment persistence and adherence increased with age (>80 vs <65 years, persistence HR, 0.7 [95% CI, 0.5-0.9]; MPR difference, 12.5), polypharmacy (persistence HR, 0.7 [95% CI, 0.6-0.9]; MPR difference, 10.7) and previous use of AB (persistence HR, 0.8 [95% CI, 0.7-1.0]; MPR difference, 5.7) or AB/AM combinations (persistence HR, 0.7 [95% CI, 0.5-0.9]; MPR difference, 11.1). CONCLUSIONS: Treatment with an AB/AM FDC is associated with better persistence and adherence vs a free-dose combination in men with LUTS in Spain.
Assuntos
Sintomas do Trato Urinário Inferior , Antagonistas Muscarínicos , Idoso , Quimioterapia Combinada , Humanos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Masculino , Adesão à Medicação , Antagonistas Muscarínicos/uso terapêutico , Estudos Retrospectivos , EspanhaRESUMO
Sr Director:Desde que la FDA (Food and Drug Administration) aprobó el uso de los nuevos fármacos anticoagulantes orales (NACOs) para la fibrilación auricular en octubre de 2010, ha habido un aumento exponencial en la prescripción de estos medicamentos, de forma que gradualmente están reemplazando a los tradicionales antagonistas de la vitamina K (AVK) como un nuevo estándar enanticoagulación oral (1).
Sr Director:Desde que la FDA (Food and Drug Administration) aprobó el uso de los nuevos fármacos anticoagulantes orales (NACOs) para la fibrilación auricular en octubre de 2010, ha habido un aumento exponencial en la prescripción de estos medicamentos, de forma que gradualmente están reemplazando a los tradicionales antagonistas de la vitamina K (AVK) como un nuevo estándar enanticoagulación oral (1).