Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pha... more Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage. In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.
The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharm... more The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.
Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pha... more Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage. In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.
ABSTRACT In a multiple dose cross-over experiment in 18 healthy male volunteers the sustained rel... more ABSTRACT In a multiple dose cross-over experiment in 18 healthy male volunteers the sustained release properties and relative bioavailability of new once daily Euphylong 375 mg capsules (= A) were studied using twice daily Theo-Dur (= B) as reference. Theophylline was given over a period of 8 days: A once daily as a 750 mg dose at 20.00 h (with placebo at 08.00 h) and B twice daily as a 400 mg dose at 08.00 and 20.00 h. Plasma concentration-time profiles were evaluated on days and . Theophylline in plasma was measure by high-performance liquid chromatography (HPLC). Considerable sustained release properties for A were indicated by an extended shape of the plateau phase on days and , resulting in high T75% values (11.0 h and 10.6 h). As to be expected, peak-to-trough fluctuations (defined as %PTF= 100 (max − Cmin)/Cav) on the two steady-state days with once daily A (%PTF: 104% and 108%) were significantly larger than fluctuations with twice daily B (52% and 53%). The two products were found to be bioequivalent although bioavailability of A was slightly lower on both days (85% and 90%). In conclusion, A was found to be of good sustained release quality. In once daily dosing it may occasionally (e.g. in fast metabolizers) be difficult to keep theophylline plasma concentrations within the therapeutic range during the 24-h dosing interval, although in asthmatic patients, who generally have slower elimination than healthy young adults, smaller peak-trough fluctuations can be anticipated.
Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pha... more Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage. In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.
To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) afte... more To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. To assess the effect of different types of bariatric surgery in patients with T2DM on diabetes remission compared with matched control patients, and the effect of the type of bariatric surgery on improvement of glycemic control and related clinical parameters. A retrospective cohort study conducted from May 2013 to May 2014 within the Clinical Practice Research Datalink involving 2978 patients with a record of bariatric surgery (2005-2012) and a body mass index (calculated as weight in kilograms divided by height in meters squared) of 35 or greater. We identified 569 patients with T2DM and matched them to 1881 patients with diabetes without bariatric surgery. Data on the use of medication and laboratory results were evaluated. Bariatric surgery, stratified by type of surgery (gastric band...
Magnesium research : official organ of the International Society for the Development of Research on Magnesium, 2009
The bronchodilating potency of magnesium sulphate (MgSO₄) has been shown in acute asthma exacerba... more The bronchodilating potency of magnesium sulphate (MgSO₄) has been shown in acute asthma exacerbations. We hypothesized that smooth muscle cell relaxation by magnesium might also be beneficial in chronic severe asthma with persistent airflow limitation. To investigate whether nebulised magnesium, administered according to a dosing scheme shown to be effective in acute asthma, induces bronchodilation in stable asthma patients with persistent airflow limitation. In a placebo-controlled, cross-over study, 13 severe asthma patients with postbronchodilator FEV₁ < 75% predicted received either 2.5 mL MgSO₄ 6.4% or placebo in 3 nebulisations at 30 minute intervals. Before the first and 30 minutes after the last inhalation FEV₁, exhaled nitric oxide (NO) in dyspnoea (Borg) were measured. After MgSO₄ treatment no improvement in FEV₁ occurred (56.2 ± 16.8 to 55.4 ± 17.4% predicted [p = 0.5]), neither was a change in exhaled NO or Borg observed (p > 0.1). The changes in FEV₁, NO or Borg ...
Valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar ... more Valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar affective disorders, schizoaffective disorders, schizophrenia and migraine prophylaxis. We describe two case reports involving valproic acid intoxication with ingestion of ethanol. One patient was treated by supportive care, one patient received haemodialysis. From analysis of plasma concentrations before and during haemodialysis (pre- and post-filter) it is shown that valproic acid can be effectively eliminated by haemodialysis when plasma levels are way above 100 microg/ml. In the literature, plasma protein binding is reported to be around 90% for levels within the therapeutic range. In our patient plasma protein binding was around 50% after treatment with haemodialysis. These findings make haemodialysis in valproic acid intoxication a sensible therapeutic option with increasing efficiency when plasma concentration is high. Furthermore our findings suggest that lowering valproic acid c...
A three-way crossover study with seven healthy male volunteers was conducted to determine the rel... more A three-way crossover study with seven healthy male volunteers was conducted to determine the relative bioavailability of phenobarbital after single dose administration of 100 mg of phenobarbital as oral solution in Myvacet 9-08, and as a suspension, compared with a 100 mg phenobarbital tablet. At 4-week intervals each subject received the solution in Myvacet 9-08, the suspension and the tablet in randomized order. Blood samples were collected for 48 h after each dose for analysis of phenobarbital. From the individual serum concentration-versus-time curves Cmax and Tmax were determined and AUC0-48 was calculated. All three oral dosage forms of phenobarbital are bioequivalent. No significant differences in Tmax were observed. The oral solution in Myvacet 9-08, and the suspension of phenobarbital proved to be bioequivalent to a tablet.
Selective Digestive Tract Decontamination in Intensive Care Medicine: a Practical Guide to Controlling Infection, 2008
ABSTRACT To assess the effect of selective decontamination of the digestive tract on respiratory ... more ABSTRACT To assess the effect of selective decontamination of the digestive tract on respiratory tract infections and survival of patients treated in an intensive care unit, meta-analyses of clinical studies comparing patients treated with selective decontamination and untreated controls have been carried out. Analyses of these studies have shown a protective effect of selective decontamination on infections. On the other hand, the mortality benefit has been shown only recently [1]. Earlier studies with historical controls and randomised trials showed that mortality was not significantly different between treatment and control patients. The evidence from these studies is consistent with an effect of selective decontamination of the digestive tract on survival of patients in the intensive care unit, in addition to a clear preventive effect on the occurrence of respiratory tract infections [2]–[12].
The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharm... more The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.
Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pha... more Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage. In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.
The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharm... more The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.
Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pha... more Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage. In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.
ABSTRACT In a multiple dose cross-over experiment in 18 healthy male volunteers the sustained rel... more ABSTRACT In a multiple dose cross-over experiment in 18 healthy male volunteers the sustained release properties and relative bioavailability of new once daily Euphylong 375 mg capsules (= A) were studied using twice daily Theo-Dur (= B) as reference. Theophylline was given over a period of 8 days: A once daily as a 750 mg dose at 20.00 h (with placebo at 08.00 h) and B twice daily as a 400 mg dose at 08.00 and 20.00 h. Plasma concentration-time profiles were evaluated on days and . Theophylline in plasma was measure by high-performance liquid chromatography (HPLC). Considerable sustained release properties for A were indicated by an extended shape of the plateau phase on days and , resulting in high T75% values (11.0 h and 10.6 h). As to be expected, peak-to-trough fluctuations (defined as %PTF= 100 (max − Cmin)/Cav) on the two steady-state days with once daily A (%PTF: 104% and 108%) were significantly larger than fluctuations with twice daily B (52% and 53%). The two products were found to be bioequivalent although bioavailability of A was slightly lower on both days (85% and 90%). In conclusion, A was found to be of good sustained release quality. In once daily dosing it may occasionally (e.g. in fast metabolizers) be difficult to keep theophylline plasma concentrations within the therapeutic range during the 24-h dosing interval, although in asthmatic patients, who generally have slower elimination than healthy young adults, smaller peak-trough fluctuations can be anticipated.
Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pha... more Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage. In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.
To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) afte... more To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. To assess the effect of different types of bariatric surgery in patients with T2DM on diabetes remission compared with matched control patients, and the effect of the type of bariatric surgery on improvement of glycemic control and related clinical parameters. A retrospective cohort study conducted from May 2013 to May 2014 within the Clinical Practice Research Datalink involving 2978 patients with a record of bariatric surgery (2005-2012) and a body mass index (calculated as weight in kilograms divided by height in meters squared) of 35 or greater. We identified 569 patients with T2DM and matched them to 1881 patients with diabetes without bariatric surgery. Data on the use of medication and laboratory results were evaluated. Bariatric surgery, stratified by type of surgery (gastric band...
Magnesium research : official organ of the International Society for the Development of Research on Magnesium, 2009
The bronchodilating potency of magnesium sulphate (MgSO₄) has been shown in acute asthma exacerba... more The bronchodilating potency of magnesium sulphate (MgSO₄) has been shown in acute asthma exacerbations. We hypothesized that smooth muscle cell relaxation by magnesium might also be beneficial in chronic severe asthma with persistent airflow limitation. To investigate whether nebulised magnesium, administered according to a dosing scheme shown to be effective in acute asthma, induces bronchodilation in stable asthma patients with persistent airflow limitation. In a placebo-controlled, cross-over study, 13 severe asthma patients with postbronchodilator FEV₁ < 75% predicted received either 2.5 mL MgSO₄ 6.4% or placebo in 3 nebulisations at 30 minute intervals. Before the first and 30 minutes after the last inhalation FEV₁, exhaled nitric oxide (NO) in dyspnoea (Borg) were measured. After MgSO₄ treatment no improvement in FEV₁ occurred (56.2 ± 16.8 to 55.4 ± 17.4% predicted [p = 0.5]), neither was a change in exhaled NO or Borg observed (p > 0.1). The changes in FEV₁, NO or Borg ...
Valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar ... more Valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar affective disorders, schizoaffective disorders, schizophrenia and migraine prophylaxis. We describe two case reports involving valproic acid intoxication with ingestion of ethanol. One patient was treated by supportive care, one patient received haemodialysis. From analysis of plasma concentrations before and during haemodialysis (pre- and post-filter) it is shown that valproic acid can be effectively eliminated by haemodialysis when plasma levels are way above 100 microg/ml. In the literature, plasma protein binding is reported to be around 90% for levels within the therapeutic range. In our patient plasma protein binding was around 50% after treatment with haemodialysis. These findings make haemodialysis in valproic acid intoxication a sensible therapeutic option with increasing efficiency when plasma concentration is high. Furthermore our findings suggest that lowering valproic acid c...
A three-way crossover study with seven healthy male volunteers was conducted to determine the rel... more A three-way crossover study with seven healthy male volunteers was conducted to determine the relative bioavailability of phenobarbital after single dose administration of 100 mg of phenobarbital as oral solution in Myvacet 9-08, and as a suspension, compared with a 100 mg phenobarbital tablet. At 4-week intervals each subject received the solution in Myvacet 9-08, the suspension and the tablet in randomized order. Blood samples were collected for 48 h after each dose for analysis of phenobarbital. From the individual serum concentration-versus-time curves Cmax and Tmax were determined and AUC0-48 was calculated. All three oral dosage forms of phenobarbital are bioequivalent. No significant differences in Tmax were observed. The oral solution in Myvacet 9-08, and the suspension of phenobarbital proved to be bioequivalent to a tablet.
Selective Digestive Tract Decontamination in Intensive Care Medicine: a Practical Guide to Controlling Infection, 2008
ABSTRACT To assess the effect of selective decontamination of the digestive tract on respiratory ... more ABSTRACT To assess the effect of selective decontamination of the digestive tract on respiratory tract infections and survival of patients treated in an intensive care unit, meta-analyses of clinical studies comparing patients treated with selective decontamination and untreated controls have been carried out. Analyses of these studies have shown a protective effect of selective decontamination on infections. On the other hand, the mortality benefit has been shown only recently [1]. Earlier studies with historical controls and randomised trials showed that mortality was not significantly different between treatment and control patients. The evidence from these studies is consistent with an effect of selective decontamination of the digestive tract on survival of patients in the intensive care unit, in addition to a clear preventive effect on the occurrence of respiratory tract infections [2]–[12].
The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharm... more The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.
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