Paralysis of the external popliteal sciatic nerve associated with daptomycin administration.

WHAT IS KNOWN AND OBJECTIVE: Peripheral neuropathy has been associated with the administration of certain drugs. Few reports have described the association of daptomycin with the development of peripheral neuropathy, none of them with peroneal nerve involvement. CASE SUMMARY: We report a case of a 62-year-old man who developed external popliteal sciatic nerve paralysis after 22 days of therapy with daptomycin. WHAT IS NEW AND CONCLUSION: We present an uncommon and not previously reported adverse event. We have also analysed a possible alteration in a metabolic pathway (ABCB1 gene polymorphisms) that, in some patients, could explain certain drug adverse events. WHAT IS NEW AND CONCLUSION: We present an uncommon and not previously reported adverse event. We have also analysed a possible alteration in a metabolic pathway (ABCB1 gene polymorphisms) that, in some patients, could explain certain drug adverse events.

[Specific considerations on the prescription and therapeutic interchange of statins]. / Consideraciones específicas en la prescripción e intercambio terapéutico de estatinas.

OBJECTIVE: The pharmaceutical industry currently offers six different statins in Spain and there is one more soon to be available. Choosing the most appropriate drug and dose is determined by the therapeutic target (reduction in LDL-C levels). Statin doses that decrease LDL-C at the same percentage are considered equivalent. Evaluating the pharmacokinetic characteristics of each statin can be useful when setting selection criteria, helping to determine which statin may be more appropriate for a patient based on their individual characteristics and on the other co-administered drugs. METHODS: We reviewed the pharmacokinetics properties of each statin and its possible involvement in drug interactions. RESULTS: CYP3A4 was responsible for the metabolism of lovastatin, simvastatin and atorvastatin; fluvastatin depends on CYP2C9; P-glycoprotein is responsible for decreased atorvastatin, pravastatin, simvastatin and lovastatin concentrations. The OATPA1B1 transporter involved in all statins' access to the hepatocyte, except for fluvastatin, is essential for rosuvastatin and pravastatin. These circumstances cause those drugs inhibiting or inducing isoenzymes or transporters' activity not to have the same effect on the different statins. CONCLUSION: The pharmacokinetics is important when choosing the best statin and could be a limitation in the use of interchange therapeutic programmes when other drugs are present.

Review of use of drugs for conditions not included in product characteristics.

Off-label use of medication is common in hospital clinical practice and should be applied together with follow-up of a healthcare treatment protocol and in compliance with a procedure which ensures that the patient is informed and that he or she provides informed consent. A review of the literature on controlling 310 disorders showed that off-label use was indicated for 69 of them (22.3%) with the minimum required scientific evidence. It would be useful for the Pharmacy and Therapeutics Committee to have a list of the disorders that can be controlled using off-label drugs, providing a reference to those disorders which must follow a healthcare treatment protocol. A list of the mentioned characteristics is also useful for the hospital pharmacist for validating prescriptions, as it would provide a reference for assessing prescriptions which at first sight could seem questionable. Finally, this list would be very useful if a search index of all the drugs by disorder were to be included in the Pharmacotherapeutic Guide. It would complement the usual indices which include active ingredients and specialties.