Drug interactions with oral antineoplastic drugs: The role of the pharmacist.

The main objective of the study is to determine the pharmacist detection of drug-drug and drug-food interactions in patients receiving oral antineoplastic drugs (OADs). Descriptive, prospective study in a tertiary-care teaching hospital. The study population included patients who received OADs from the Outpatient Pharmacy of the hospital. The study population was attended by a pharmacist who checked potential interactions. The severity of interactions was evaluated using the summary of product characteristics of each drug and three different databases. We included 219 patients with a total of 736 concomitant medications. A total of 34 drug-drug or food-drug interactions were recorded. The most common interaction detected was between erlotinib and ranitidine (major interaction). In 19 of the 34 interactions detected in the experimental group, the pharmacist prevented them from reaching the patient. Interactions were resolved by drug suspensions, drug changes, or changes in schedules always according to the attending physician or the patient. In the remaining 15 interactions, the doctor was not contacted because the interactions were considered to be of little relevance or because they only required surveillance. Hospital pharmacist can improve the patient's safety and the efficiency of oral cytostatic treatment by detecting and preventing drug-drug and drug-food interactions.

[Recommendations from GESIDA/SEFH/PNS to improve adherence to antiviral treatment (2004)]. / Recomendaciones GESIDA/SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral en el año 2004.

Since the early days of antiretroviral therapy, adherence has emerged as the milestone of success; in fact, it is the most potent predictor of effectiveness. The main factors related to adherence include the complexity of the therapeutic regimen, adverse effects, psychological problems, alcoholism and active addiction to drugs, lack of social and family support and the patient's beliefs and attitudes about the treatment. Adherence monitoring should be part of the HIV patient's regular care, and should be done with feasible, easily applied methods adapted to the different clinical settings. The minimally acceptable measures should include use of a validated questionnaire, together with data from the Pharmacy Department's drug dispensation registry. All patients that begin HAART or undergo a change of treatment should participate in a treatment education program imparted by health professionals with knowledge and experience in the management of patients with HIV infection. The health team (doctors, pharmacists and nursing professionals) should offer maximum availability to solve the doubts and problems that may occur during treatment. When sub-optimal adherence is detected, intervention strategies based on psychological therapy, educational efforts and personal advice should be attempted, in order to adapt the treatment scheme to the patient's habits and provide solutions to the problem of non-compliance. In certain situations, co-morbid conditions will also require attention. Treatment adherence, being a multidimensional problem, needs a multidisciplinary team approach. The choice of therapy, only one aspect of the multidimensional problem of adherence, must be a careful and individualized decision; however, simpler regimens with regard to the number of pills and daily dose are desirable.

Recomendaciones GESIDA/SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral en el año 2004 / Recommendations from GESIDA/SEFH/PNS to improve adherence to antiviral treatment (2004)

El cumplimiento incorrecto del tratamiento antirretroviral(TAR) constituye el factor principal de fracaso terapéutico. Los factores que han demostrado estar relacionados con la adherencia de forma más relevante incluyen la complejidad del tratamiento, los efectos secundarios, los problemas psicológicos, la adicción activa a drogas y/o alcohol, la falta de soporte socio familiar y las actitudes y creencias del paciente acerca del tratamiento. La monitorización del cumplimiento debe formar parte de la atención habitual del paciente con infección por el virus de la inmunodeficiencia humana (VIH), deben utilizarse métodos factibles, adaptados a la realidad del hospital y lo más universalmente aplicables. Puede considerarse un mínimo aceptable la asociación de un cuestionario validado y el registro de dispensación del servicio de farmacia. Todo paciente que inicie o cambie el tipo de TAR debe realizar un programa de educación sanitaria sobre el tratamiento, a cargo de profesionales sanitarios con experiencia y conocimiento del manejo de pacientes con infección por VIH. Debe procurarse la máxima disponibilidad del equipo asistencial (médicos, farmacéuticos y profesionales de enfermería) para resolverlas dudas y problemas que se presenten a lo largo del tratamiento. En los pacientes en los que no se alcancen niveles de cumplimiento adecuados, se deben intentar estrategias de intervención, basadas en aspectos psico-educativos y de asesoramiento personal, con capacidad para adaptar el esquema del TAR a los hábitos de vida del paciente y proporcionando estrategias de resolución de problemas. En determinadas situaciones será necesario resolverla comorbilidad, por lo tanto el enfoque debe ser pluridisciplinar. Son aconsejables pautas más sencillas en cuanto a número de comprimidos y a dosis diarias (AU)

Since the early days of antiretroviral therapy, adherence has emerged as the milestone of success; in fact, it is the most potent predictor of effectiveness. The main factors related to adherence include the complexity of the therapeutic regimen, adverse effects, psychological problems, alcoholism and active addiction to drugs, lack of social and family support and the patient’s beliefs and attitudes about the treatment. Adherence monitoring should be part of the HIV patient’s regular care, and should be done with feasible, easily applied methods adapted to the different clinical settings. The minimally acceptable measures should include use of a validated questionnaire, together with data from the Pharmacy Department’s drug dispensation registry. All patients that begin HAART or under go a change of treatment should participate in a treatment education program imparted by health professionals with knowledge and experience in the management of patients with HIV infection. The health team (doctors, pharmacists and nursing professionals) should offer maximum availability to solve the doubts and problems that may occur during treatment. When sub-optimal adherence is detected, intervention strategies based on psychological therapy, educational efforts and personal advice should be attempted, in order to adapt the treatment scheme to the patient’s habits and provide solutions to the problem of non-compliance. In certain situations, co-morbid conditions will also require attention. Treatment adherence, being a multidimensional problem, needs a multidisciplinary team approach. The choice of therapy, only one aspect of the multidimensional problem of adherence, must be a careful and individualized decision; however, simpler regimens with regard to the number of pills and daily dose are desirable (AU)

[Characteristics of antiviral drugs]. / Características de los fármacos antivirales.

This article summarizes the principal characteristics of the drugs used to treat viral infections, with the exception of human immunodeficiency virus infection. It includes antiviral agents active against herpes virus, cytomegalovirus, hepatitis B and C virus, and respiratory viruses, such as influenza and respiratory syncytial virus. Dosage according to the indication, dose adjustment in the case of renal or hepatic insufficiency, significant pharmacokinetic characteristics, and the main adverse effects and interactions are described.

Características de los fármacos antivirales / Characteristics of antiviral drugs

En este artículo se resumen las principales características de los fármacos utilizados para tratar las infecciones virales, exceptuando la infección por el virus de la inmunodeficiencia humana (VIH). Se tratan los antivirales activos frente al virus del herpes, citomegalovirus (CMV), virus de la hepatitis B y C (VHB y VHC) y virus respiratorios como el de la gripe y el virus respiratorio sincitial (VRS). Se indica su dosificación en función de la indicación, el ajuste de dosis en caso de insuficiencia renal o hepática, sus características farmacocinéticas más relevantes, así como sus principales efectos secundarios e interacciones (AU)