Evaluation of Gabapentin and Pregabalin Use in Hospitalized Patients With Decreased Kidney Function.

Background: Gabapentin and pregabalin are well-tolerated medications primarily cleared by the kidney. Patients receiving higher gabapentinoid doses with decreased kidney function may be at an increased risk of adverse effects (AEs), but limited evidence exists evaluating gabapentinoid dosing and AEs in this population. Objective: To determine whether patients with decreased creatinine clearance (CrCl) experienced increased frequency of AEs related to gabapentinoid dose at hospital admission. Methods: Single-center retrospective cohort study in adults with a gabapentinoid prescription and serum creatinine measurement documented on hospital admission. The primary outcome was the appropriateness of gabapentinoid prescription based on CrCl (stratified by CrCl ≥60 mL/min, <60 mL/min, 15-29 mL/min, and <15 mL/min) at admission. Secondary outcomes included the incidence of AEs related to gabapentinoids and concomitant opioid and psychiatric prescriptions. Results: A total of 286 patients were included in this study (gabapentin n = 234, pregabalin n = 52). Patients with a CrCl <60 mL/min and doses above the manufacturer's recommendation were prescribed gabapentin (34%) and pregabalin (22.7%). For patients with a CrCl of 15 to 29 mL/min and <15 mL/min groups, inappropriately high doses were prescribed for gabapentin (48.8%) and pregabalin (45%). A significant increase in recorded falls (P = 0.029) was identified in patients with a CrCl <60 mL/min. Concomitant opioid and psychiatric medications contributed to a higher prevalence of AEs regardless of CrCl. Conclusions: Patients with a CrCl <60 mL/min were frequently prescribed inappropriately high doses of gabapentinoids. The relationship between gabapentinoid dosing, kidney function, and the incidence of gabapentinoid-related AEs at hospital admission requires larger, multicentre studies.

Engaging community pharmacies in practice-based research: Lessons from opioid-focused research.

There is an established need to translate evidence-based practices into real-world practice. Community pharmacists and their corresponding pharmacies are well-positioned to be effective partners as researchers seek to study and implement practice-based research. Challenges exist when partnering with community pharmacies which can vary based on the study type, the nature of the community pharmacy, and stakeholder groups (i.e., patients, staff, leadership, physicians). This commentary seeks to describe these challenges and provide recommendations that can help mitigate and/or overcome these challenges. Recommendations are provided for team structure, communication, research tools/technology, motivational factors, workflow, and sustainability. These recommendations are based on the authors' experience in partnering with community pharmacy for opioid-related research in a variety of study types, states, and pharmacy environments.

Technology targeting immunocompromised patients for COVID-19 vaccine in community pharmacies.

BACKGROUND: Medication targeting by community pharmacists may assess medical history of patients for recommendation of clinical services through review of their prescription history. Previous studies have implemented medication targeting to identify patients eligible for vaccine recommendations. Targeting of immunosuppressing medications may impact the rate of third primary doses of COVID-19 vaccine administered to immunocompromised patients. OBJECTIVES: The primary objective was to determine the impact of medication targeting on the rate of third primary doses of COVID-19 vaccine given to immunocompromised patients. METHODS: This observational, retrospective cohort study occurred within one division of a large community pharmacy chain. Included patients were greater than 18 years of age with record of at least one immunosuppressing medication dispensed one year prior to study enrollment and 2 primary COVID-19 vaccine doses in the pharmacy dispensing software. An intervention for pharmacist recommendation of a third primary dose of COVID-19 vaccine was automatically loaded into their prescription profiles. The proportion of patients with completed interventions and confirmation of third dose administration was collected with demographic characteristics. RESULTS: The pharmacy dispensing software identified 1670 interventions through medication targeting, though 69 interventions met criteria for study inclusion. Baseline characteristics of the included population were a mean age of 51.8 years of primarily female sex (69.6%) and Caucasian race (78.3%). Third primary COVID-19 vaccine dose administration and completed pharmacist recommendation was recorded for 2 (2.9%) patients. CONCLUSION: Medication targeting identified immunocompromised patients for the recommendation of a third primary dose of COVID-19 vaccine. Improved specification for targeting of dosing regimen and route of administration may result in greater accuracy of appropriate recommendations identified.