Personalizing Medication Recommendation with a Graph-Based Approach

The broad adoption of electronic health records (EHRs) has led to vast amounts of data being accumulated on a patient’s history, diagnosis, prescriptions, and lab tests. Advances in recommender technologies have the potential to utilize this information to help doctors personalize the prescribed medications. However, existing medication recommendation systems have yet to make use of all these information sources in a seamless manner, and they do not provide a justification on why a particular medication is recommended. In this work, we design a two-stage personalized medication recommender system called PREMIER that incorporates information from the EHR. We utilize the various weights in the system to compute the contributions from the information sources for the recommended medications. Our system models the drug interaction from an external drug database and the drug co-occurrence from the EHR as graphs. Experiment results on MIMIC-III and a proprietary outpatient dataset show that PREMIER outperforms state-of-the-art medication recommendation systems while achieving the best tradeoff between accuracy and drug-drug interaction. Case studies demonstrate that the justifications provided by PREMIER are appropriate and aligned to clinical practices.

Case report: Medical cannabis—warfarin drug-drug interaction

Aim A case of an 85-year-old patient with concurrent use of warfarin and medical cannabis containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is described. Warfarin continues to be a cornerstone of anticoagulation treatment despite the recent addition of FDA-approved anticoagulant agents. It is well known that warfarin has numerous drug interactions; however, much remains unknown about its interaction with THC and CBD. A literature review was conducted to identify documented cases of possible interactions between cannabis and warfarin. The case reports we identified noted that cannabis may potentially increase warfarin’s effect. Therefore, we aimed to determine why an effect was not seen on our patient’s warfarin dose despite daily use of medical cannabis. Case This case report describes an 85-year-old patient who despite starting an oromucosal medical cannabis regimen of THC and CBD (which provided 0.3 mg of THC and 5.3 mg CBD once daily and an additional 0.625 mg of THC and 0.625 mg CBD once daily as needed) had minimal INR fluctuations from October 2018 to September 2019. Conclusion Despite the introduction and use of medical cannabis therapy, with both THC and CBD components, an elderly patient with concurrent warfarin use did not see major INR fluctuations, in contrast to published literature. The potential for warfarin and THC/CBD interactions may be dependent on route of administration and dose of the cannabis product.

Herbal Drug Interactions

Use of complementary and alternative medicines (CAM) for preventive and therapeutic purposes has increased tremendously in the last two decades internationally. The manufacturers of these products are not required to submit proof of safety or efficacy to the Food and Drug Administration. As a result, the adverse effects and drug interactions associated with them are largely unknown. In this chapter, the author presents interactions of herbal medicines with other medicines (herbal or non-herbal). A large number of herbal drugs, including from single drug to a variety of mixtures have been used to treat kidney disorders. Herb-herb or herb drug interaction has been reported intensively during last decade, therefore it becomes important to keep an eye on the use of combination herbal therapy in order to avoid serious results because of interactions with each other. Due to the growing awareness about the interactions and side effects of herbal drugs/supplements over the past few years, regulatory bodies are working on these issues and pharmacopoeias are being developed for reference.

Studi Interaksi Obat Antihiperlipidemia Pada Pasien Rawat Jalan RSUD Dr. M.M. Dunda Limboto

Hyperlipidemia is an abnormal lipid condition of metabolism which is characterized by increasing the level of blood lipid. Hyperlipidemia is often followed by other diseases. Therefore, the treatment of hyperlipidemia is often combined with other drugs and potentially increases the occurrence of drugsinteractions. This study aimed to identify the severity of antihyperlipidemic drugsinteractions to the outpatients at Dr. M.M Dunda Limboto Regional PublicHospital on January to March 2018.This research was included in the observation (survey) research, the type of research was the analytic survey and the data was obtained retrospectively. The type of data analysis was univariate analysis and the data was managed theoretically using the guidelines of Stockley Drug Interactionand drugs.com application review. Of the 170 prescription sheets that met the inclusion criteria, 67.65 % were potentially triggered the drugs interactions and 32.35 % had no drugs interactions. One of Antihyperlipidemic drug was often prescribed and mostly generated the interactions was simvastatin (64.12 %). Of the 170 prescriptions, 209 cases of severity of drugs interactions were found, with minor severity of 27.27 %, moderate severity of 47.85 % and major severity of 24.88 %. Hiperlipidemia merupakan suatu keadaan ketidaknormalan metabolisme lipid yang ditandai dengan adanya peningkatan kadar lipid dalam darah. Hiperlipidemiasering diikuti dengan penyakit lain. Sehingga pengobatan hiperlipidemia seringdikombinasikan bersama obat lain dan berpotensi meningkatkan terjadinyainteraksi obat. Penelitian ini bertujuan untuk mengidentifikasi tingkat keparahaninteraksi obat antihiperlipidemia pada pasien rawat jalan RSUD Dr. M.M DundaLimboto periode Januari sampai Maret 2018. Penelitian ini termasuk penelitian observasi (survei), jenis penelitian survei analitik dan data diambil secara retrospektif. Jenis analisis data adalah analisis univariat dan data dikelola secara teoritik menggunakan Stockley Drug Interaction dan review aplikasi drugs.com. Dari 170 lembar resep yang memenuhi kriteria inklusi, diperoleh 67,65 % berpotensi mengalami interaksi obat dan 32,35 % tidak mengalami interaksi obat. Antihiperlipidemia yang sering diresepkan dan paling besar menimbulkan interaksi obat adalah simvastatin (64,12 %). Dari 170 lembar resep, ditemukan 209 kasus tingkat keparahan interaksi obat, dengan tingkat keparahan minor sebesar 27,27 %, tingkat keparahan moderat sebesar 47,85% dan tingkat keparahan mayor sebesar 24,88 %.