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Bir üniversite hastanesinde yatan, digoksin ile tedavi edilen hastalarda omeprazol kullanımı: 2011-2015 yılları arasındaki veri analizi

Year 2018, Volume 32, Issue 1, 1 - 8, 18.05.2018
https://doi.org/10.5505/deutfd.2018.07088

Abstract

Giriş: Proton pompa inhibitörleri (PPİ) Türkiye’de en çok reçetelenen ilaçların başında gelmektedir. Güvenli bir ilaç olarak kabul edilmesi, bu kadar fazla reçetelenmesinde en büyük etkendir. Ancak bu ilaç grubu içerisinde yer alan omeprazol birçok ilaç ile etkileşim gösterebildiği için ilaç-ilaç etkileşimi açısından önem taşımaktadır. Bu çalışmada digoksin kullanan olgulardan oluşan bir veri tabanında omeprazol kullanım sıklığının, kullanım uygunluğunun ve hastaların kullandığı diğer ilaçlar ile etkileşim olasılığının araştırılması planlanmıştır.

Gereç ve Yöntem: Üniversite hastanesi elektronik hasta kayıtlarının incelendiği tanımlayıcı ve kesitsel türde bir çalışmadır. Ocak 2011- Aralık 2015 tarihleri arasında kardiyoloji servisinde yatan, oral yol digoksin ile tedavi edilen hastaların verileri tanımlayıcı istatistik, ki-kare ve t-testi ile değerlendirildi. Omeprazol kullanım endikasyon uygunluğu literatür kriterlerine göre belirlendi. Omeprazol ile etkileşim olasılığı olan ilaç listesi Micromedex® İlaç Bilgi Kaynağından elde edildi. Kanıt düzeyi çok iyi ve iyi düzeyde olan orta ve ciddi düzeyde etkileşime neden olabilecek ilaçlar değerlendirmeye alındı.

Bulgu: Toplam 1580 hastanın %69,4’ünde omeprazol kullanılmaktaydı. Bu hastaların yaş ortalaması kullanılmayan gruba göre daha yüksekti (p<0,001). Omeprazol kullanım endikasyonu, hastaların %67,4’ünde uygun bulundu. Omeprazol kullanım sıklığı 2014 yılında en azdı (%48,9). Ancak endikasyon olmadan kullanım sıklığının bu yılda en fazla (%50,6) olduğu görüldü. Seçilen örneklem nedeniyle omeprazol kullanan hastaların hepsi digoksin ile tedavi edilmekte olan hastalardı. Omeprazol ile digoksinin birlikte kullanımı için orta düzeyde etkileşim tanımlanmıştır. Orta düzeyde etkileşime neden olabilecek diğer ilaçlar arasında en çok kullanılan (%41,5) varfarin idi. Ciddi etkileşime girebilecek ilaçlar arasında ise en çok kullanılan ilacın klopidogrel (%27) olduğu bulundu.

Sonuçlar: Digoksin kullanan kardiyoloji servis hastalarında omeprazol kullanımı oldukça sıktır. Omeprazol kullanım endikasyonu bu hasta grubunun çoğunda uygun olsa da ilaç-ilaç etkileşimi açısından dikkatli olunması ve etkileşim riski daha düşük olan diğer PPİ’lerinin seçilmesi önerilir.

References

  • Uygun A. Uzun süre proton pompa inhibitörleri (PPI) kullanılacaksa, hangi PPI tercih edilmelidir? Nelere dikkat edilmelidir? Güncel Gastroenteroloji 2013;17:45-58.
  • Forte JG, Zhu L. Apical recycling of the gastric parietal cell H,K-ATPase. Annu Rev Physiol 2010;72:273-96.
  • Niklasson A, Bajora A, Bergendal L, M. Simren, H. Strid H. Bjornsson E. Overuse of acid suppressive therapy in hospitalized patients with pulmonary diseases. Respir Med 2003; 97:1143–1150.
  • Akram F, Huang Y, Lim V, Huggan PJ, Merchant RA. Proton pump inhibitors: Are we still prescribing them without valid indications? AMJ 2014;7:465–470.
  • Nardino RJ, Vender RJ, Herbert PN. Overuse of acid suppressive therapy in hospitalized patients. Am J Gastroenterol 2000;95:3118-22.
  • Nousheen, Tadvi NA, Shareef SM. Use of proton pump ınhibitors ın general practice: Is it rationale? Int J Med Res Health Sci 2014;3:37-42.
  • Ksiądzyna D, Szeląg A, Paradowski L. Overuse of proton pump inhibitors. Pol Arch Med Wewn 2015;125:289-98.
  • Gelal A. Yaşlılarda akılcı ilaç kullanımı. Turkiye Klinikleri J Pharmacol-Special Topics 2015;3:57-64.
  • Sutfin T, Balmer K, Boström H, et al. Stereoselective interaction of omeprazole with warfarin in healthy men. Ther Drug Monit 1989;11:176184.
  • Kiley CA, Cragin DJ, Roth BJ. Omeprazole associated digoxin toxicity. South Med J 2007;100:400402.
  • Oosterhuis B, Jonkman JH, Anderson T, et al. Minor effect of multiple dose omeprazole on the pharmacokinetics of digoxin after a single oral dose. B J Clin Pharmacol 1991;32:569572.
  • ACCF/ACG/AHA 2010 Expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: A focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. J Am Coll Cardiol 2010;56:2051–66.
  • Parente F et al. Hospital use of acid‐suppressive medications and its fall‐out on prescribing in general practice: a 1‐month survey. Aliment Pharmacol Ther 2003;17:1503-1506.
  • Gürsoy MO, Yıldız M. Akut koroner sendromda tienopiridin ve proton pompa inhibitörü kullanımı. Koşuyolu Heart Journal 2016;19:37-39.
  • Johnson DA, Chilton R, Liker HR. Proton-pump inhibitors in patients requiring antiplatelet therapy: new FDA labeling. Postgrad Med 2014;126:239-45.
  • Thomson Reuters Healthcare Web site. URL: www. micromedex. com/products/hcs. Erişim: Haziran 2017
  • Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali, WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288-1294.
  • Villamanan E, Ruano M, Lara C, et al. Reasons for initiation of proton pump inhibitor therapy for hospitalised patients and its impact on outpatient prescription in primary care. Rev Esp Enferm Dig 2015;107:652-658. doi:10.17235/ reed.2015.3882/2015.
  • Nachnani JS, Bulchandani D, Moormeier J, Foxworth J. Patient and physician predictors of inappropriate acid-suppressive therapy (AST) use in hospitalized patients. J Hosp Med 2009;4:E10-E14. doi:10.1002/jhm.492.
  • De Rijdt T et al. Appropriateness of acid suppression therapy. Ann Pharmacother 2017;51:125-134.
  • Up ToDate 2017. URL: https://www.uptodate.com/contents/stress-ulcer-prophylaxis-in-the-intensive-care-unit Erişim tarihi: 28.06.2017
  • Oncu S, Gelal A, Aslan O, Ucku RS. Appropriateness of digoxin measurement in hospitalized patients. Biochem Med (Zagreb) 2018;28:010901. https://doi.org/ 10.11613/BM.2018.010901
  • Agewall S et al. Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy. Eur Heart J 2013;34:1708-1713.
  • US Food and Drug Administration 2009. URL: https://www.fda.gov/Drugs/DrugSafety/Postmarket
  • DrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm079520.htm Erişim tarihi: 03.07.2017.
  • Gilard M et al. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin. J Am Coll Cardiol 2008;51:256-260.
  • O'Donoghue ML, Braunwald E, Antman EM, Murphy SA et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. The Lancet 2009;374(9694): 989-997.
  • Craig DGN, Thimappa R, Anand V, Sebastian S. Inappropriate utilization of intravenous proton pump inhibitors in hospital practice—a prospective study of the extent of the problem and predictive factors. QJM 2010;103:327–35.
  • Ament PW, Dicola DB, James ME. Reducing adverse effects of proton pump inhibitors. Am Fam Physician 2012;86:66-70.
  • Atkins AM, Chandra Sekar M. Proton pump inhibitors: Their misuse, overuse and abuse. IOSR J Pharm 2013;3:25-9.

USE OF OMEPRAZOLE IN PATIENTS HOSPITALİZED IN A UNIVERSITY HOSPITAL AND TREATED WITH DIGOXİN: DATA ANALYSIS BETWEEN 2011-2015

Year 2018, Volume 32, Issue 1, 1 - 8, 18.05.2018
https://doi.org/10.5505/deutfd.2018.07088

Abstract

Objective: Proton pump inhibitors (PPI) are among the most frequently prescribed drugs in Turkey. The main reason for the frequent prescription of this drug is that it is regarded to be safe. However, omeprazole, which is in this group, is important for drug-drug interactions as it can interact with many drugs. We planned to investigate the frequency and appropriateness of omeprazole usage as well as its probable interactions with other drugs in a data setting of digoxin users. 

Material and Method: This is a descriptive and cross sectional study in which electronic patient data in a university hospital were reviewed. The data of the patients hospitalized between January 2011-December 2015 in the cardiology service and treated with oral digoxin were evaluated in accordance with literature criteria. Data were analyzed using descriptive statistics, chi-square and t-test. The drugs with potential interaction risk with omeprazole were selected from the Micromedex® Pharmaceutical Knowledge. Major and moderate interactions with excellent and good evidence were evaluated.

Results: Omeprazole was used in 69.4% of the total of 1580 patients. Mean age of patients who used omeprazole was higher than those who did not (p<0.001). In 67.4% of the patients, omeprazole was used on appropriate indication. It was found that in 2014 the frequency of omeprazole use was lowest (48.9%); whereas its use without indication was highest (50.6%). All of the patients using omeprazole were being treated with digoxin due to selected sample of patients. Moderate interaction is defined for the combined use of omeprazole and digoxin. Among the other drugs that may cause moderate interactions, the most commonly used one was warfarin (41.5%). Among the drugs that could cause major interaction, the most frequently used drug was clopidogrel (27%).

Conclusion: Use of omeprazole was frequent in cardiology inpatients taking digoxin. Although omeprazole was used with appropriate indication in the majority of this group, one should beware of drug-drug interactions and prefer other PPIs with lower risk of interaction. 

References

  • Uygun A. Uzun süre proton pompa inhibitörleri (PPI) kullanılacaksa, hangi PPI tercih edilmelidir? Nelere dikkat edilmelidir? Güncel Gastroenteroloji 2013;17:45-58.
  • Forte JG, Zhu L. Apical recycling of the gastric parietal cell H,K-ATPase. Annu Rev Physiol 2010;72:273-96.
  • Niklasson A, Bajora A, Bergendal L, M. Simren, H. Strid H. Bjornsson E. Overuse of acid suppressive therapy in hospitalized patients with pulmonary diseases. Respir Med 2003; 97:1143–1150.
  • Akram F, Huang Y, Lim V, Huggan PJ, Merchant RA. Proton pump inhibitors: Are we still prescribing them without valid indications? AMJ 2014;7:465–470.
  • Nardino RJ, Vender RJ, Herbert PN. Overuse of acid suppressive therapy in hospitalized patients. Am J Gastroenterol 2000;95:3118-22.
  • Nousheen, Tadvi NA, Shareef SM. Use of proton pump ınhibitors ın general practice: Is it rationale? Int J Med Res Health Sci 2014;3:37-42.
  • Ksiądzyna D, Szeląg A, Paradowski L. Overuse of proton pump inhibitors. Pol Arch Med Wewn 2015;125:289-98.
  • Gelal A. Yaşlılarda akılcı ilaç kullanımı. Turkiye Klinikleri J Pharmacol-Special Topics 2015;3:57-64.
  • Sutfin T, Balmer K, Boström H, et al. Stereoselective interaction of omeprazole with warfarin in healthy men. Ther Drug Monit 1989;11:176184.
  • Kiley CA, Cragin DJ, Roth BJ. Omeprazole associated digoxin toxicity. South Med J 2007;100:400402.
  • Oosterhuis B, Jonkman JH, Anderson T, et al. Minor effect of multiple dose omeprazole on the pharmacokinetics of digoxin after a single oral dose. B J Clin Pharmacol 1991;32:569572.
  • ACCF/ACG/AHA 2010 Expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: A focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. J Am Coll Cardiol 2010;56:2051–66.
  • Parente F et al. Hospital use of acid‐suppressive medications and its fall‐out on prescribing in general practice: a 1‐month survey. Aliment Pharmacol Ther 2003;17:1503-1506.
  • Gürsoy MO, Yıldız M. Akut koroner sendromda tienopiridin ve proton pompa inhibitörü kullanımı. Koşuyolu Heart Journal 2016;19:37-39.
  • Johnson DA, Chilton R, Liker HR. Proton-pump inhibitors in patients requiring antiplatelet therapy: new FDA labeling. Postgrad Med 2014;126:239-45.
  • Thomson Reuters Healthcare Web site. URL: www. micromedex. com/products/hcs. Erişim: Haziran 2017
  • Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali, WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288-1294.
  • Villamanan E, Ruano M, Lara C, et al. Reasons for initiation of proton pump inhibitor therapy for hospitalised patients and its impact on outpatient prescription in primary care. Rev Esp Enferm Dig 2015;107:652-658. doi:10.17235/ reed.2015.3882/2015.
  • Nachnani JS, Bulchandani D, Moormeier J, Foxworth J. Patient and physician predictors of inappropriate acid-suppressive therapy (AST) use in hospitalized patients. J Hosp Med 2009;4:E10-E14. doi:10.1002/jhm.492.
  • De Rijdt T et al. Appropriateness of acid suppression therapy. Ann Pharmacother 2017;51:125-134.
  • Up ToDate 2017. URL: https://www.uptodate.com/contents/stress-ulcer-prophylaxis-in-the-intensive-care-unit Erişim tarihi: 28.06.2017
  • Oncu S, Gelal A, Aslan O, Ucku RS. Appropriateness of digoxin measurement in hospitalized patients. Biochem Med (Zagreb) 2018;28:010901. https://doi.org/ 10.11613/BM.2018.010901
  • Agewall S et al. Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy. Eur Heart J 2013;34:1708-1713.
  • US Food and Drug Administration 2009. URL: https://www.fda.gov/Drugs/DrugSafety/Postmarket
  • DrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm079520.htm Erişim tarihi: 03.07.2017.
  • Gilard M et al. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin. J Am Coll Cardiol 2008;51:256-260.
  • O'Donoghue ML, Braunwald E, Antman EM, Murphy SA et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. The Lancet 2009;374(9694): 989-997.
  • Craig DGN, Thimappa R, Anand V, Sebastian S. Inappropriate utilization of intravenous proton pump inhibitors in hospital practice—a prospective study of the extent of the problem and predictive factors. QJM 2010;103:327–35.
  • Ament PW, Dicola DB, James ME. Reducing adverse effects of proton pump inhibitors. Am Fam Physician 2012;86:66-70.
  • Atkins AM, Chandra Sekar M. Proton pump inhibitors: Their misuse, overuse and abuse. IOSR J Pharm 2013;3:25-9.

Details

Primary Language Turkish
Subjects Health Care Sciences and Services
Journal Section Articles
Authors

Şeyma ÖNCÜ This is me
DOKUZ EYLÜL ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, TIBBİ FARMAKOLOJİ ANABİLİM DALI
Türkiye


Ayşe GELAL This is me (Primary Author)
DOKUZ EYLÜL ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, TIBBİ FARMAKOLOJİ ANABİLİM DALI
0000-0003-1910-7847
Türkiye


Özgür ASLAN
DOKUZ EYLÜL ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI
Türkiye


Reyhan UÇKU
DOKUZ EYLÜL ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, HALK SAĞLIĞI ANABİLİM DALI
Türkiye

Publication Date May 18, 2018
Application Date July 13, 2017
Acceptance Date November 27, 2017
Published in Issue Year 2018, Volume 32, Issue 1

Cite

Vancouver Öncü Ş. , Gelal A. , Aslan Ö. , Uçku R. Bir üniversite hastanesinde yatan, digoksin ile tedavi edilen hastalarda omeprazol kullanımı: 2011-2015 yılları arasındaki veri analizi. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi. 2018; 32(1): 1-8.



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