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Drug interactions in the elderly

Elizabeth G Rhee, Matthew L Rizk, Nicole Calder, Marcela Nefliu, Steven J Warrington, Michael S Schwartz, Eric Mangin, Keith Boundy, Pratik Bhagunde, Francheska Colon-Gonzalez, Patricia Jumes, Yang Liu, Joan R Butterton
Relebactam is a novel class A and C β-lactamase inhibitor that is being developed in combination with imipenem/cilastatin for the treatment of serious gram-negative bacterial infections. Here we report on 2 phase 1 randomized, double-blind, placebo-controlled, pharmacokinetics, safety, and tolerability studies of relebactam administered with or without imipenem/cilastatin in healthy participants: 1) a single dose (25 to 1150 mg) and multiple dose (50 to 625 mg every 6 hours [q6h] for 7 to 14 days) escalation study in men and 2) a single dose (125 mg) study in women and elderly...
June 18, 2018: Antimicrobial Agents and Chemotherapy
Davide Liborio Vetrano, Emanuele Rocco Villani, Giulia Grande, Silvia Giovannini, Maria Camilla Cipriani, Ester Manes-Gravina, Roberto Bernabei, Graziano Onder
OBJECTIVES: To test the association between polypharmacy and 1-year change in physical and cognitive function among nursing home (NH) residents. DESIGN: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. SETTING: NH in Europe (n = 50) and Israel (n = 7). PARTICIPANTS: 3234 NH older residents. MEASUREMENTS: Participants were assessed through the interRAI long-term care facility instrument...
May 31, 2018: Journal of the American Medical Directors Association
Q F Zhang, D Z Zhang
Chronic hepatitis C (CHC) has a prevalence rate of 0.43% in China and approximately 10 million chronically infected people are in urgent need of treatment. Since the beginning of 2013, pan-genotypic sofosbuvir (SOF) with its potent antiviral activity, minimal drug resistance, less drug-drug interactions and good safety has created a new era in HCV treatment. Its combination with ribavirin, in single tablet regimen with either ledipasvir or velpatasvir has been widely used in about 1.6 million patients worldwide...
March 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
Hojjat Borna, Kasim Assadoulahei, Gholamhossein Riazi, Asghar Beigi Harchegani, Alireza Shahriary
Neurodegenrative diseases are among the most widespread life-threatening disorders around the world in elderly ages. The common feature of a group of neurodegenerative disorders, called tauopathies, is accumulation of microtubule associated protein tau inside the neurons. The exact mechanism underlying tauopathies is not well-understood but several factors such as traumatic brain injuries and genetics are considered as potential risk factors. Although tau protein is well-known for its key role in stabilizing and organization of axonal microtubule network, it bears a broad range of functions including DNA protection and participation in signaling pathways...
May 24, 2018: CNS & Neurological Disorders Drug Targets
Amza Ali
Epilepsy is a frequently misunderstood and highly stigmatized condition. Major treatment gaps exist across the world, most so in areas of financial constraint. Classification permits the best approaches to treatment and to ascertaining prognosis. The International League Against Epilepsy's new classification system emphasizes clinical aspects and utilizes all available resources to determine whether it is a focal or generalized epilepsy. The most important tools are a careful history, clinical examination, electroencephalography, and appropriate neuroimaging...
April 2018: Seminars in Neurology
Georgios Schoretsanitis, Edoardo Spina, Christoph Hiemke, Jose de Leon
This article includes a combined analysis of therapeutic drug monitoring (TDM) studies and a review of the marketer's data on pharmacological mechanisms. Areas covered: An article search led to the inclusion of 21 paliperidone studies in the systematic review plus 2 case reports. Paliperidone clearance was calculated from: 1) steady-state studies using concentration/dose (C/D) ratios, and 2) single-dose studies describing 24-hour area under the curve calculations. The marketed extended-release formulation has 28% bioavailability...
May 18, 2018: Expert Review of Clinical Pharmacology
Ileana L Piña, Katherine E Di Palo, Hector O Ventura
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions...
May 22, 2018: Journal of the American College of Cardiology
Benedetto Caroleo, Lidia Colangelo, Maria Perticone, Giovambattista De Sarro, Luca Gallelli
Chronic hepatitis C virus (HCV) infection represents a global public health challenge, and new drugs have been authorized for its treatment. In this study, we evaluated both the clinical efficacy and safety of elbasvir-grazoprevir fixed-dose combination in HCV patients. We performed a prospective single-blind study on patients admitted to the Regional Center for HCV Treatment of the University of Catanzaro from March 1, 2017, to December 31, 2017, in patients >30 years old with a history of chronic HCV infection...
May 10, 2018: Journal of Clinical Pharmacology
Stephanie N Hicks, Supranee Chaiwatpongsakorn, Heather M Costello, Jason S McLellan, William Ray, Mark E Peeples
The respiratory syncytial virus (RSV) fusion (F) protein is a trimeric, membrane-anchored glycoprotein capable of mediating both viral-target cell membrane fusion to initiate infection and cell-cell fusion, even in the absence of the attachment glycoprotein. The F protein is initially expressed in a precursor form, whose functional capabilities are activated by proteolysis at two sites between the F1 and F2 subunits. This cleavage results in expression of the metastable and high-energy prefusion conformation...
May 9, 2018: Journal of Virology
Silvia Ognibene, Natale Vazzana, Claudio Giumelli, Luisa Savoldi, Luca Braglia, Giuseppe Chesi
BACKGROUND AND AIMS: Adverse drug reaction (ADRs) is a leading but underrecognized cause of illness particularly in frail subjects with multiple comorbidities. We aimed to investigate the frequency, patterns and outcomes of ADRs as a cause of hospitalization in elderly patients admitted to an internal medicine ward. METHODS: We performed a retrospective observational study including every patient aged over 65 years who was admitted to our Department during a 12-month period...
May 9, 2018: Internal Medicine Journal
Katharina Luise Schneider, Kathrin Kastenmüller, Klaus Weckbecker, Markus Bleckwenn, Miriam Böhme, Julia Carolin Stingl
INTRODUCTION: Drug-drug interactions (DDIs) are an important risk factor for adverse drug reactions. Older, polymedicated patients are particularly affected. Although antithrombotics have been detected as high-risk drugs for DDIs, data on older patients exposed to them are scarce. METHODS: Baseline data of 365 IDrug study outpatients (≥ 60 years, use of an antithrombotic and one or more additional long-term drug) were analyzed regarding potential drug-drug interactions (pDDIs) with a clinical decision support system...
May 8, 2018: Drugs & Aging
Katsunori Yamaura, Naoko Hayashi, Yoshihiro Imazu, Yoshitaka Yoneta, Emiko Uchida, Junko Suzuki
 There is an urgent need to promote home medical care in Japan because of the country's superaging society. Community pharmacists are expected to play an important role as part of home medical care teams. The prevalence of nail ringworm is high among home-care patients and can cause decreases in the quality of life, including difficulty in walking due to pain caused by nail deformation and inflammation around infected nails. Nail ringworm is typically treated with oral medication. However, the condition is left untreated in many elderly patients because of the risk of drug-drug interactions or concerns about severe liver damage...
2018: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
Chi Chiu Mok
Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects all age groups, but the prevalence appears to increase with age. Elderly-onset RA (after the age of 60 years) has distinct clinical patterns. Treatment of RA in older individuals is confounded by the presence of medical comorbidities, concurrent medications, drug interactions, and the altered pharmacokinetics and pharmacodynamics related to aging and organ dysfunction. Patients with RA commonly experience morning stiffness, which is associated with reduced quality of life and work disability...
June 2018: Drugs & Aging
Meng Chen, Shu-Yi Zhou, Erlinda Fabriaga, Pian-Hong Zhang, Quan Zhou
This review addressed drug interactions precipitated by fruit juices other than grapefruit juice based on randomized controlled trials (RCTs). Literature was identified by searching PubMed, Cochrane Library, Scopus and Web of Science till December 30 2017. Among 46 finally included RCTs, six RCTs simply addressed pharmacodynamic interactions and 33 RCTs studied pharmacokinetic interactions, whereas seven RCTs investigated both pharmacokinetic and pharmacodynamic interactions. Twenty-two juice-drug combinations showed potential clinical relevance...
April 2018: Journal of Food and Drug Analysis
Concetta Di Giorgio, Alessio Provenzani, Piera Polidori
BACKGROUND: Management of therapy in elderly patients is a critical issue in primary care. The physiopathological status is usually complex, and the prescription of multiple drugs is typically required, with a consequent higher risk of adverse effects. Many tools have been developed to cope with this problem, and identify drugs that are inappropriate in the elderly. The objective of the study was to evaluate the appropriateness of therapies in the elderly according to implicit criteria...
April 2018: Recenti Progressi in Medicina
V Ramos-Sesma, M Górgolas-Hernández Mora, J M Ramos-Rincón
Improved living conditions and advances in medicine have extended life expectancy and quality of life, resulting in an increasing number of elderly travellers. Pathophysiological changes and treatments can reduce the efficacy of vaccines and facilitate drug interactions. Elderly travellers have various characteristics that should be considered when offering pre-trip counselling, which should include proper management of chronic diseases that are susceptible to worsening during the trip, as well as an appropriate study and follow-up after the trip...
April 20, 2018: Revista Clínica Española
Ikuo Saito, Kazuomi Kario, Toshio Kushiro, Satoshi Teramukai, Mai Yaginuma, Natsuko Zenimura, Yoshihiro Mori, Yasuyuki Okuda, Kazuyuki Shimada
The appropriate target blood pressure (BP) in elderly patients with hypertension remains uncertain. We investigated the relationship between morning home systolic blood pressure (MHSBP) during follow-up and cardiovascular (CV) risk in outpatients receiving olmesartan-based treatment aged <75 years (n = 16799) and ≥75 years (n = 4792) in the HONEST study. In the follow-up period (mean 2.02 years), the risk for major CV events was significantly higher in patients with MHSBP ≥155 mmHg compared with <125 mmHg in both age groups in Cox proportional hazards model adjusted for other risk factors and there was no significant difference in trend between the two groups (interaction P = 0...
2018: Clinical and Experimental Hypertension: CHE
Tom Marcelissen, Tina Rashid, Tiago Antunes Lopes, Nicolas Barry Delongchamps, Bogdan Geavlete, Malte Rieken, Jean-Nicolas Cornu, Mohammad Sajjad Rahnama'i
Overactive bladder syndrome (OAB) is a prevalent disorder with a significant impact on quality of life. Despite this high prevalence, there is significant underdiagnosis and undertreatment due to several barriers, including embarrassment, poor communication and low patient adherence. Currently, various antimuscarinic are available in the treatment of OAB. The introduction of mirabegron has broadened the therapeutic approach and combination therapy of both agents can be valuable in clinical practice. Yet, patient adherence to most drugs for OAB is still relatively poor...
April 4, 2018: European Urology Focus
Kevin T Bain, Emily J Schwartz, Orsula V Knowlton, Calvin H Knowlton, Jacques Turgeon
OBJECTIVES: To determine the feasibility of implementing a pharmacist-led pharmacogenomics (PGx) service for the Program of All-Inclusive Care for the Elderly (PACE). SETTING: A national centralized pharmacy providing PGx services to community-based PACE centers. PRACTICE DESCRIPTION: Individuals 55 years of age and older enrolled in PACE who underwent PGx testing as part of their medical care (n = 296). PRACTICE INNOVATION: Pharmacist-led PGx testing, interpreting, and consulting...
May 2018: Journal of the American Pharmacists Association: JAPhA
Heather L Forbes, Thomas M Polasek
Background: To determine the prevalence and nature of potential drug-drug interactions (DDIs) with direct oral anticoagulants (DOACs) in elderly hospitalized patients. Methods: This was a retrospective observational study. Inclusion criteria were: aged over 65 years; taking apixaban, rivaroxaban or dabigatran; and admitted to the Repatriation General Hospital between April 2014 and July 2015. A list of clinically relevant 'perpetrator' drugs was compiled from product information, the Australian Medicines Handbook, the Australian National Prescribing Service resources, and local health network guidelines...
October 2017: Therapeutic Advances in Drug Safety
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