Effectiveness of Repaglinide-Gemfibrozil Interaction Alert in a Medical Center
| Autor: | Yi-Yen Chen, 陳怡晏 |
|---|---|
| Rok vydání: | 2016 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 104 Background: Drug-drug interaction (DDI) is defined as the change of pharmacodynamics or pharmacokinetics of a drug by prior administration or coadministration of another drug. DDI may cause adverse drug events (ADEs). The computerized drug-interaction alert system (DIAS) may reduce the occurrence of DDIs. Contraindicated repaglinide and gemfibrozil interaction alert was implemented in DIAS at a medical center since 2004. When physicians issued the prescriptions with both repaglinide and gemfibrozil, the alert automatically popped out the warning details: “gemfibrozil inhibits metabolism of repaglinide and obviously enhances the blood glucose-lowering effect, resulting in severe hypoglycemia.” The first part of the study was to investigate the effectiveness of repaglinide-gemfibrozil interaction alert and to analyze the alert rate, overridden rate and physicians’ responses to alert. The second part was to follow up the ADEs of hypoglycemia among patients with concomitant use repaglinide and gemfibrozil. Method: We conducted a retrospective descriptive study to investigate the effectiveness of repaglinide-gemfibrozil interaction alert. The ambulatory prescriptions including repaglinide or gemfibrozil from computerized physician order entry system and the prescriptions with repaglinide-gemfibrozil interaction alert from DIAS were collected at a medical center from January 1 2007 to December 31 2014. Furthermore, we conducted a case series study based on reviews of charts. We collected blood glucose levels and related information of ambulatory patients who concomitant used repaglinide and gemfibrozil at the same medical center from January 1 2007 to September 30 2015. Result: During the 8-year study period, 101,422 prescriptions involving repaglinide or gemfibrozil were prescribed for 9,197 patients. A total of 61 patients (0.66%, 61/9197) received 332 prescriptions with repaglinide-gemfibrozil interaction alert. Of these, 310 alerts for 44 patients (72.1%, 44/61) were overridden. In respond to alerts, dose or frequency of gemfibrozil was reduced in 2 prescriptions (0.64%, 2/310) with overridden alert. Among the 22 prescriptions with accepted alert, gemfibrozil was shifted to another lipid-lower drug in 9 (40.9%, 9/22), repaglinide was shifted to another oral antidiabetic drugs in 8 (36.4%, 8/22) and gemfibrozil or repaglinide was canceled in 5 (22.7%, 5/22). A total of 48 patients used repaglinide and gemfibrozil concomitantly. Over the entire 14,198-day observation time, 8 patients with 20 hypoglycemic events were detected. The incidence of hypoglycemia owing to concomitant use repaglinide and gemfibrozil was 1.41 events/1,000 patient-days (20/14,198). Conclusion: Repaglinide-gemfibrozil interaction-induced hypoglycemic events certainly existed in clinical practice. To ensure drug safety, concomitant use of repaglinide and gemfibrozil should be avoided. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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