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Biomedical subjects

M Martin-Facklam

Publications and source records attributed to M Martin-Facklam.

6 recordsLinked to original sources
PubMed2001

Drug dosage in patients with renal failure optimized by immediate concurrent feedback.

OBJECTIVE: To examine the impact of immediate concurrent feedback on dose adjustment in patients with renal failure. DESIGN: Prospective 12-month study in patients with various degrees of renal failure, with comparison to a retrospective control group. SETTING: A 39-bed unit of a university hospital providing primary and tertiary care. PATIENTS: Patients with renal failure (estimated creatinine clearance < or = 50 mL/min) receiving at least 1 pharmacologically active drug. INTERVENTIONS: Education of physicians and immediate concurrent feedback on the ward giving estimated creatinine clearance and dose recommendations for renally eliminated drugs adjusted to individual renal function. MEASUREMENTS AND MAIN RESULTS: The percentage of dosage regimens adjusted to renal function and cost assessment of drug therapy were calculated. Overall, 17% of the patients had at least 1 estimated creatinine clearance < or = 50 mL/min. In the intervention group, the dose of 81% of renally eliminated drugs was adjusted to renal function, compared with 33% in the control group ( P <.001). The mean difference in cost between standard and adjusted dose of renally eliminated drugs in the intervention and control groups was 5.3 +/- 12.3 and 0.75 +/- 2.8 Swiss francs (approximately US$3.5 and US$0.5), respectively ( P <.001), accounting for 16.5% and 2.8%, respectively, of daily medication costs of all drugs. CONCLUSIONS: The proportion of doses of renally eliminated drugs adjusted to renal function can be substantially increased by immediate concurrent feedback. This saves drug costs and has the potential to prevent adverse drug reactions.

Aged↗
PubMed2000

[Individualization of drug therapy in renal or liver insufficiency].

Individualisation of drug dosage in patients with renal or hepatic failure may prevent excessive drug accumulation and thus potentially reduce adverse drug reactions and costs. In renal failure, renal function may be estimated by combined evaluation of serum creatinine values and patient characteristics. Then individual elimination capacity of a given drug in the individual patient may be calculated and dosage accordingly adjusted. In severe liver cirrhosis, after peroral administration of drugs with a high extraction ratio each single dose has to be reduced because of increased bioavailability and decreased clearance. After i.v. administration and dosing of drugs with a low extraction ratio maintenance dose should be reduced either by prolonging the dosing interval or by decreasing each single dose.

Algorithms↗
PubMed2000

[Clinically relevant adverse drug interactions].

Drug interactions may lead to adverse drug effects or therapeutic failure. Many clinically relevant unwanted interactions are caused by a change in the activity of cytochrome P450 isoenzymes or the activity of active drug transport systems (e.g. p-glycoprotein). Most drug interactions may be anticipated and prevented by dose modification or using alternative drugs.

ATP Binding Cassette Transporter, Subfamily B↗
PubMed1999

[Anticonvulsant hypersensitivity syndrome. 2 case reports and an overview].

Anticonvulsants with aromatic ring structure such as phenytoine, carbamazepine, phenobarbital and lamotrigine can induce a drug hypersensitivity syndrome ("anticonvulsant hypersensitivity syndrome", AHS). Though the incidence of AHS is low, correct and early diagnosis are crucial to stop further progression by immediately withholding the causative drug. AHS usually starts within the first 2-8 weeks after initiation of therapy with fever, followed over the next 1-2 days by a cutaneous reaction and lymphadenopathy. The skin reaction is usually exanthematous but can also manifest itself as Stevens-Johnson or Lyell syndrome. AHS is commonly associated with symptomatic or asymptomatic internal organ involvement usually affecting the liver, although haematologic, renal or pulmonary impairment may also occur. We report two cases illustrating the clinical course and discuss theories about the potential pathogenesis and the treatment of AHS.

Adult↗