Fall-risk-increasing adverse reactions-is there value in easily accessible drug information? A case-control study.

PURPOSE: The individual fall risk of a patient is often multifactorial. Polymedication contributes to an additional risk of fall-risk-increasing adverse reactions (FRIARs). Previous studies have not sufficiently investigated the complexity facing prescribers when balancing the therapeutic benefits of individual drugs against their potential fall risk. METHODS: An expert panel identified drugs with FRIARs based on the Summary of Product Characteristics (SmPC). These FRIARs and other parameters (such as the total number of drugs, dosage, dose adjustments, and drug changes) were then analyzed for their impact on falls in a case-control study using logistic regression. RESULTS: During a 1-year period, 112 (1%) of 11,481 hospital patients experienced at least one fall event. Complete data was available for evaluation from 87 of them (case group). We matched these patients to another 87 patients who had no fall events (control group). FRIAR drugs were more frequently prescribed in the case group (4.26 (Q25-Q75, 3.75-4.78) per patient; p = 0.033) than in the control group (3.48 (2.97-3.99)). Drugs with FRIARs (ß = 0.137; p = 0.035) and the total number of FRIARs (ß = 0.033; p = 0.031) increased the fall risk. The total number of drugs, dosage, dose adjustments, and drug changes showed no influence. CONCLUSIONS: FRIARs were associated with a higher number of falls. To consider FRIARs offers a chance to address the complexity of the individual medication. This data can support future computerized physician order entries with clinical decision support.

Quantitative determination of phenolic diterpenes in rosemary extracts. Aspects of accurate quantification.

Practical challenges related to accurate quantification of carnosic acid (CA), carnosol (CAR) and other phenolic diterpenes in extracts of rosemary leaves (Rosmarinus officinalis L.) are presented and discussed. Primary standard material of CA is isolated from rosemary extracts by preparative chromatography with a purity of 98% or higher. The response factors of CAR relative to CA, at 230 and 280 nm, have been estimated to be 0.92 and 1.36, respectively. The stability of pure CA and CAR, dissolved in methanol, dimethyl sulfoxide (DMSO), DMSO-acetonitrile (10:90) or ethyl acetate-acetonitrile (10:90) and stored at room temperature in the autosampler, is presented. Pure CA dissolved in DMSO is stable for several days, while CAR showed significant degradation within a few hours in all solvents tested. The lack of stability of standards results in practical difficulties with calculating reliable response factors. A correction procedure is presented and documented. A CAR calibration solution was analysed six times for purity during 30 h of storage, while the purity changed from 95 to 70%. Applying this correction procedure resulted in a relative standard deviation on the average response factor of 0.7% (n=6). CA has been dissolved in methanol and stored in clear and amber glass vials, respectively. The solution stored in amber vials degraded faster that in clear vials. The high content of Ti and Fe ions in amber glass seems to catalyse the degradation of CA. In contrast to solutions of pure CAR and CA, their stabilities in solutions of rosemary extracts are fine. A standard addition experiment, covering a time interval of 21 h, resulted in recoveries of CAR and CA of 100 and 96%, respectively.