Drug-drug Interactions between COVID-19 Treatments and Antidepressants, Mood Stabilizers/Anticonvulsants, and Benzodiazepines: Integrated Evidence from 3 Databases

2021 ◽  
Author(s):  
Beatriz Oda Plasencia-García ◽  
María Isabel Rico-Rangel ◽  
Gonzalo Rodríguez-Menéndez ◽  
Ana Rubio-García ◽  
Jaime Torelló-Iserte ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Treatment Options ◽  
Mood Stabilizers ◽  
Evidence Based ◽  
Ecg Monitoring ◽  
Ensure Patient Safety ◽  
Coronavirus Infection ◽  
Based Medicine ◽  
Potential Interactions

Abstract Introduction The SARS-CoV-2 pandemic with psychiatric comorbidities leads to a scenario in which the use of psychotropic drugs may be required. This requires the support of evidence-based medicine to take into account possible interactions between antidepressants, mood stabilizers, benzodiazepines, and coronavirus infection treatments. Methods Three databases were consulted: (a) Lexicomp Drug Interactions, (b) Micromedex Solutions Drugs Interactions, (c)Liverpool Drug Interaction Group for COVID-19 therapies. The CredibleMeds QTDrugs List was also queried. Hydroxychloroquine, chloroquine, azithromycin, lopinavir-ritonavir, remdesivir, favipiravir, tocilizumab, baricitinib, anakinra, and dexamethasone – drugs used for SARS-CoV-2 – were analyzed, and consensus recommendations are made. Results The potential interactions of agomelatine, desvenlafaxine, duloxetine, milnacipran, and vortioxetine with COVID-19 treatments shall be considered less risky. Antidepressant interactions with hydroxychloroquine, chloroquine, and azithromycin enhance the risk of QT prolongation, and ECG monitoring is advised for most antidepressants. Antidepressants with lopinavir/ritonavir involve multiple CYP enzyme interactions (except with milnacipran). Gabapentin, oxcarbazepine, pregabalin, topiramate, and zonisamide are safe treatment options that have no significant interactions with COVID-19 treatments. Lithium is contraindicated with hydroxychloroquine, chloroquine, and azithromycin. Precaution should be taken in using valproic acid with lopinavir-ritonavir. The use of benzodiazepines does not present a risk of drug interaction with COVID-19 treatments, except lopinavir/ritonavir. Conclusions Clinicians prescribing antidepressants, mood stabilizers/anticonvulsants, and benzodiazepines, should be aware of the probable risk of drug-drug interaction with COVID-19 medications and may benefit from heeding these recommendations for use to ensure patient safety.

scholarly journals ANALYSIS OF EFFICACY OF USING PLATELET-RICH PLASMA AND BETAMETHAZONE IN THE TREEATMENT OF ALOPECIA AREATA

2020 ◽  
Vol 20 (4) ◽  
pp. 4-10
Author(s):  
M. A. Aljabali ◽  
L. V. Kuts
Keyword(s):  
Alopecia Areata ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Venous Blood ◽  
Smoking Habit ◽  
Diagnostic Errors ◽  
Statistical Processing ◽  
Evidence Based ◽  
Based Medicine ◽  
Instrumental Methods

In the era of evidence-based medicine, confirming a disease by using various instrumental methods is one of the important tasks. This enables to reduce the number of diagnostic errors and to prescribe the appropriate treatment in accordance with the current views on the problem of alopecia areata in each case. Moreover, monitoring the course of the disease, data recording and their statistical processing opens up the prospect for obtaining evidence-based treatment methods. Studying the effectiveness of various treatment options and approaches including the registration of results obtained and their statistical processing is of great clinical significance. The aim of this study is to compare the efficiency of monotherapy with betamethasone injections, with platelet-rich plasma, and their combination. The venous blood of 104 patients aged (35.7 ± 8.9 years with alopecia areata was used in the study. All patients were randomly divided to three groups. The group І received intradermal injections of betamethasone (4 sessions per month). The group ІІ received intradermal injections of platelet-rich plasma once every 2 weeks for 16 weeks. The group ІІІ received 4 sessions of betamethasone which were alternated with 4 sessions of platelet-rich plasma treatment at interval of 2 weeks. The patients were examined before the treatment and in 3, 6 and 17 months. The following factors as the age, sex, smoking habit, the presence of alopecia in relatives, the duration, shape and stage of the disease, the index of the severity of alopecia and hair growth, the presence of "yellow and black dots", "conical" and terminal hair were considered in the study. Statistical analysis was performed using SPSS (version 22.0.). The results have shown the combination therapy allows us to obtain the best result, especially in long follow-up period.

New coronavirus infection, hemostasis and heparin dosing problems: It is important to say now

2020 ◽  
Author(s):  
А.Ю. Буланов ◽  
Е.В. Ройтман
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight ◽  
Evidence Based ◽  
Low Molecular Weight Heparins ◽  
Heparin Resistance ◽  
Hospital Patients ◽  
Expert’S Opinion ◽  
Coronavirus Infection ◽  
Based Medicine ◽  
D Dimer

В отсутствие достаточной базы доказательной медицины самым ценным становится мнение экспертов, опирающихся на свой опыт и опыт коллег. COVID-19-ассоциированная коагулопатия имеет характер тромбовоспаления. Назначение гепаринов — нефракционированного или, главным образом, низкомолекулярного (НМГ) призвано преодолеть его, поскольку гепарин обладает не только антикоагулянтным эффектом, но и оказывает непрямое и прямое противовоспалительное дейст вие. Поэтому назначение НМГ как минимум в профилактических дозах показано всем госпитализированным пациентам. Система гемостаза у пациентов с COVID-19, прежде всего у тяжелых, требует лабораторной оценки количества тромбоцитов, содержания Д-димера, протромбинового отношения или процентов протромбина по Квику и концентрации фибриногена. Анализ данных показал, что своеобразие коронавирусного гемостаза формирует гиперфибриногенемия, которая становится явным фактором гепаринорезистентности. Для преодоления последней назначение увеличенных (промежуточных или лечебных) доз НМГ выглядит перспективным решением. Достаточность назначения уместно определить либо по анти- Ха активности или (как экспресс-оценка) по тромбоэластрограмме. In the absence of a suffi cient base of evidence-based medicine, the most valuable becomes the expert’s opinion as a mirror of both personal and collegial experience. COVID-19-associated coagulopathy has a character of a thromboinfl ammation. The heparins — unfractionated or mainly low molecular weight heparins (LMWH) are intended to overcome it, since heparins have not only an anticoagulant effect but both an indirect and direct anti-infl ammatory effects as well. So that LMWH are indicated for all in-hospital patients. Patients with COVID-19, especially in severe cases, require laboratory testing of platelet count, D-dimer, prothrombin ratio or prothrombin percents by Quick and fi brinogen. Data analysis showed that a feature of coronavirus hemostasis is hyperfibrinogenemia that becomes an overt factor for heparin resistance. To overcome the latter, an adjusting doses of LMWH toward intermediate or therapeutic looks like a promising way. The suffi ciency of the adjusted LMWH dose is appropriate determining either with anti- Xa activity or thromboelastographically as express testing. Key words: hemostasis, COVID-19-associated coagulopathy, fibrinogen, low molecular weight heparins

The Fall of Psychopharmacology

2021 ◽  
pp. 305-322
Author(s):  
Edward Shorter
Keyword(s):  
New Zealand ◽  
Pharmaceutical Industry ◽  
Medical School ◽  
Evidence Based Medicine ◽  
Mood Stabilizers ◽  
Scientific Concept ◽  
Evidence Based ◽  
Clinical Neuroscience ◽  
Based Medicine

In 2012, Mickey Nardo forecast the end of an era during the height of the Age of Psychopharmacology and Clinical Neuroscience. Skeptical observers like Nardo asked the disquieting question of why SSRI/SNRIs, SGAs, and mood stabilizers were needed when psychiatrists were just prescribing ineffective drugs for non-existent conditions. Susanna Every-Palmer, a psychiatrist at the Otago Medical School in New Zealand, argued that evidence-based medicine in general was being discredited by the invasion of the pharmaceutical industry. Psychopharmacology was doomed as a scientific concept when it became a vehicle for promoting the pharmaceutical industry. Psychopharmacology’s scientific concept died when it became a trope for selling drugs.

Inequalities of health insurance guidelines for the treatment of symptomatic varicose veins

2013 ◽  
Vol 29 (4) ◽  
pp. 236-246 ◽  
Author(s):  
M W Schul ◽  
T King ◽  
L S Kabnick
Keyword(s):  
Evidence Based Medicine ◽  
Varicose Veins ◽  
Treatment Options ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Standards Of Care ◽  
Evidence Based ◽  
Treatment Providers ◽  
Based Medicine ◽  
Vein Disease

Objectives The emerging model of US healthcare delivery is aimed at reducing costs, standardizing care, and improving outcomes. Although it is necessary for healthcare providers and insurance carriers to work together to achieve those goals, insurers have the added duty of assuring physicians and patients that they comprehend the medical evidence and, based on that understanding, construct policies. Are US insurers meeting that responsibility or are they simply creating policies to serve their own needs? Methods The medical policies of several US health insurers were analysed. The goal was to see whether it could readily be determined if these carriers used evidence-based medicine consistently to create uniform policies for the treatment of patients with symptomatic varicose veins. The literature was also reviewed to determine whether increased insurance documentation requirements have affected cost reduction, standardization of care and/or improvement of outcomes related to chronic vein disease management. Results There is a dramatic lack of uniformity among the insurance policies reviewed. Insurers appear to not choose important papers to create policy but use carefully chosen articles to reinforce what they want their policies to say. In so doing, conflicting policy criteria are being created. Complicating this inconsistency, rules for medical necessity are modified frequently, raising frustration levels among vein providers and their patients. What is clear is that costs are not being lowered, care is not being standardized and little is being done to prevent potential complications resulting from chronic vein disease. Conclusions Patients and physicians are increasingly ill-served by, and frustrated with, the clear lack of consistency in the medical policy criteria being created by US insurance carriers in covering the treatment of patients with symptomatic varicose veins. The contradictory coverage requirements, seemingly based on no understanding of evidence-based medicine guidelines, and total variability in reimbursement for various types of treatment options is particularly worrisome. Collaboration between venous treatment providers and insurance carriers, to create evidence-based standards of care, would be timely and beneficial in creating guidelines for optimal patient care.

The prevalence of potentially beneficial and harmful drug-drug interactions in intensive care units

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Hossein Ali Mehralian ◽  
Jafar Moghaddasi ◽  
Hossein Rafiei
Keyword(s):  
Intensive Care ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Intensive Care Units ◽  
Medical Records ◽  
Potential Ddis ◽  
Cross Sectional ◽  
Text Book ◽  
The Mean ◽  
Potential Interactions

Abstract Background The present study was conducted with the aim of investigating the prevalence of potentially beneficial and harmful drug-drug interactions (DDIs) in intensive care units (ICUs). Methods The present cross-sectional prospective study was conducted in two ICUs in Shahr-e Kord city, Iran. The study sample was consisted of 300 patients. The Drug Interaction Facts reference text book [Tatro DS. Drug interaction facts. St Louis, MO: Walters Kluwer Health, 2010.] was used to determine the type and the frequency of the DDIs. Results The participants consisted of 189 patients men and 111 women. The mean age of patients was 44.2 ± 24.6 years. Totally, 60.5% of patients had at least one drug-drug interaction in their profile. The total number of DDIs found was 663 (the mean of the total number of drug-drug interactions was 2.4 interactions per patient). Of all the 663 interactions, 574 were harmful and others were beneficial. In terms of starting time, 98 of the potential interactions were rapid and 565 of them were delayed. In terms of severity, 511 of the potential interactions were moderate. Some of the drugs in the patients’ medical records including phenytoin, dopamine, ranitidine, corticosteroid, dopamine, heparin, midazolam, aspirin, magnesium, calcium gluconate, and antibiotics, the type of ventilation, the type of nutrition and the duration of hospital stay were among the factors that were associated with high risk of potential DDIs (p < 0.05). Conclusions The prevalence of potentially beneficial and harmful DDIs, especially harmful drug-drug interactions, is high in ICUs and it is necessary to reduce these interactions by implementing appropriate programs and interventions.

Comparatively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine

2020 ◽  
Vol 45 (5) ◽  
pp. 787-800
Author(s):  
Eric M. Patashnik
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Treatment Options ◽  
Cultural Barriers ◽  
Health Care Spending ◽  
Evidence Based ◽  
Medical Evidence ◽  
Patient Centered ◽  
The Us ◽  
Based Medicine

Abstract The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the Affordable Care Act to promote research on the comparative effectiveness of treatment options. Advocates hoped this information would help reduce wasteful spending by identifying low-value treatments, but many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: overcoming the controversy of its birth and escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system. The growing attention among policymakers and researchers to provider prices (rather than utilization) as the driver of health care spending could be helpful to the political prospects of the evidence-based medicine project by making it appear to be less as rationing driven by costs and more as an effort to improve quality and uphold medical professionalism.

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

scholarly journals A Minimal Information Model for Potential Drug-Drug Interactions

2021 ◽  
Vol 11 ◽  
Author(s):  
Harry Hochheiser ◽  
Xia Jing ◽  
Elizabeth A. Garcia ◽  
Serkan Ayvaz ◽  
Ratnesh Sahay ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Best Practice ◽  
Task Force ◽  
Information Model ◽  
Potential Drug ◽  
Community Group ◽  
Drug Drug Interaction ◽  
Potential Interactions ◽  
Minimal Information

Despite the significant health impacts of adverse events associated with drug-drug interactions, no standard models exist for managing and sharing evidence describing potential interactions between medications. Minimal information models have been used in other communities to establish community consensus around simple models capable of communicating useful information. This paper reports on a new minimal information model for describing potential drug-drug interactions. A task force of the Semantic Web in Health Care and Life Sciences Community Group of the World-Wide Web consortium engaged informaticians and drug-drug interaction experts in in-depth examination of recent literature and specific potential interactions. A consensus set of information items was identified, along with example descriptions of selected potential drug-drug interactions (PDDIs). User profiles and use cases were developed to demonstrate the applicability of the model. Ten core information items were identified: drugs involved, clinical consequences, seriousness, operational classification statement, recommended action, mechanism of interaction, contextual information/modifying factors, evidence about a suspected drug-drug interaction, frequency of exposure, and frequency of harm to exposed persons. Eight best practice recommendations suggest how PDDI knowledge artifact creators can best use the 10 information items when synthesizing drug interaction evidence into artifacts intended to aid clinicians. This model has been included in a proposed implementation guide developed by the HL7 Clinical Decision Support Workgroup and in PDDIs published in the CDS Connect repository. The complete description of the model can be found at https://w3id.org/hclscg/pddi.

Postmastectomy Neuropathic Pain

2018 ◽  
Author(s):  
Heena Pranav ◽  
Dalia H. Elmofty
Keyword(s):  
Neuropathic Pain ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Interventional Treatment ◽  
Evidence Based ◽  
Detailed History ◽  
Multiple Domains ◽  
Based Medicine ◽  
Pharmacologic Agents

Neuropathic pain can burden patients in multiple domains. It is a complex pain syndrome that remains difficult to treat. Detailed history and physical examination would reveal patients with neuropathic conditions complaining of burning, shocklike pain. There are a variety of neuropathic pain conditions that can be considered in a differential diagnosis. Because patients with neuropathic pain fail to obtain satisfactory relief from pharmacologic agents alone, a multidisciplinary approach that includes preventative and interventional options is recommended. Interventional treatment options may offer relief to patients with refractory neuropathic pain. Success in the treatment of neuropathic pain depends on evidence-based medicine and individualized patient care.

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