Laliberté Marie-Claude, Normandeau Michelle, Lord Anne, Lamarre Diane, Cantin Isabelle, Berbiche Djamal, Corneille Louise, Prud'homme Louis, Lalonde Lyne
Sanofi-Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy, University of Montreal, Canada.
Am J Kidney Dis. 2007 Feb;49(2):245-56. doi: 10.1053/j.ajkd.2006.11.023.
Use of over-the-counter medications and natural products may be associated with drug-related problems among patients with chronic renal insufficiency. The aim of this study is to describe the use of nonprescription medications in patients attending a predialysis clinic and identify drug-related problems associated with the use of these products.
In a 6-month cluster randomized controlled trial, patients with moderate (n = 46) and severe (n = 41) chronic renal insufficiency were interviewed over the telephone at baseline by a community pharmacist to document their use of over-the-counter medications and natural products. The safety of each product was assessed, and drug-related problems were identified independently by 2 pharmacists.
Overall, 83% (95% confidence interval [CI], 72 to 94) of patients with moderate chronic renal insufficiency and 68% (95% CI, 54 to 83) with severe chronic renal insufficiency reported using at least 1 over-the-counter medication. Contraindicated over-the-counter medications were reported by 9% of patients. Natural products were used by 22% (95% CI, 10 to 34) and 29% (95% CI, 15 to 43) of patients with moderate and severe chronic renal insufficiency, respectively. Similarly, 3% of patients reported using at least 1 contraindicated natural product. Patients had consulted a health professional for 49% of over-the-counter medications and 19% of natural products. Overall, 65 drug-related problems were identified.
The use of over-the-counter medications and natural products is highly prevalent in patients with chronic renal insufficiency and often is associated with a drug-related problem. These results emphasize the importance for community pharmacists to closely monitor the use of these products in patients with chronic renal insufficiency.
非处方药和天然产品的使用可能与慢性肾功能不全患者的药物相关问题有关。本研究的目的是描述在接受透析前门诊治疗的患者中使用非处方药的情况，并确定与这些产品使用相关的药物相关问题。
在一项为期6个月的整群随机对照试验中，社区药剂师在基线时通过电话采访了中度（n = 46）和重度（n = 41）慢性肾功能不全患者，以记录他们使用非处方药和天然产品的情况。评估了每种产品的安全性，并由2名药剂师独立识别药物相关问题。
总体而言，中度慢性肾功能不全患者中有83%（95%置信区间[CI]，72至94）、重度慢性肾功能不全患者中有68%（95%CI，54至83）报告使用了至少1种非处方药。9%的患者报告使用了禁忌的非处方药。中度和重度慢性肾功能不全患者分别有22%（95%CI，10至34）和29%（95%CI，15至43）使用了天然产品。同样，3%的患者报告使用了至少1种禁忌的天然产品。患者就49%的非处方药和19%的天然产品咨询过医疗专业人员。总体共识别出65个药物相关问题。
非处方药和天然产品在慢性肾功能不全患者中的使用非常普遍，且常常与药物相关问题有关。这些结果强调了社区药剂师密切监测慢性肾功能不全患者使用这些产品的重要性。
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