Finks Shannon W, Rogers Kelly C, Manguso Amy H
The University of Tennessee College of Pharmacy, Memphis Campus, Tennessee 38163, USA.
Int J Pharm Pract. 2011 Aug;19(4):281-6. doi: 10.1111/j.2042-7174.2011.00094.x. Epub 2011 Mar 15.
Due to risk of serious adverse drug events (ADEs) sotalol use is limited in renal insufficiency and heart failure. To reduce potential life-threatening ADEs, medication safety initiatives that ensure appropriate dosing of sotalol are necessary. Pharmacist-managed renal dosing assessment programmes ensure appropriate dosing of renally eliminated medications. A prospective medication safety evaluation was conducted to assess the need to include sotalol in an existing renal dosing assessment programme as well as the impact of clinical pharmacist assessment on sotalol prescribing.
Patients in a 736-bed community hospital, receiving sotalol during a 6-week period, were prospectively evaluated. Information was collected on indication, dosing, concomitant disease states and medications, renal function, QTc length, symptoms of toxicity and readmissions. Pharmacist recommendations were made when necessary and were followed to determine acceptance rate and patient outcomes.
Thirty-six patients were prescribed sotalol for atrial tachyarrhythmias. Thirty-two (89%) were dosed inappropriately with respect to renal function. Twenty (56%) had left-ventricular dysfunction as defined by an ejection fraction of ≤ 40%. At time of initial assessment, 15 (42%) were exhibiting signs of potential sotalol toxicity. Pharmacists provided recommendations regarding discontinuation or dosage adjustment on 32 patients with a 38% full and a 12% partial acceptance rate. All-cause readmission rates for patients receiving appropriate therapy, including those after pharmacist recommendations were accepted (Group A; n=16), were compared to those remaining on inappropriate therapy (Group B; n=20). Readmission rates within 6 months differed between groups (31% for Group A, 55% for Group B; P=0.095, odds ratio 3.7).
This medication safety evaluation suggests the need for pharmacist assessment in patients receiving sotalol. Dosage adjustment or avoidance in patients with renal insufficiency, heart failure and other relative contraindications is often necessary to avoid toxicity. Sotalol was inappropriately prescribed in the majority of patients secondary to renal insufficiency. Based on this evaluation, it was recommended to add sotalol to the institution's pharmacist-managed renal dosing adjustment programme. Ensuring clinical pharmacist assessment when sotalol is prescribed can help reduce potential life-threatening ADEs and hospital readmissions.
由于存在严重药物不良事件（ADEs）风险，索他洛尔在肾功能不全和心力衰竭患者中的使用受到限制。为减少潜在的危及生命的ADEs，必须采取确保索他洛尔合理给药的药物安全措施。由药剂师管理的肾脏给药剂量评估计划可确保经肾脏排泄药物的合理给药。开展了一项前瞻性药物安全评估，以评估将索他洛尔纳入现有肾脏给药剂量评估计划的必要性，以及临床药剂师评估对索他洛尔处方的影响。
对一家拥有736张床位的社区医院中在6周内接受索他洛尔治疗的患者进行前瞻性评估。收集了有关适应证、给药剂量、伴随疾病状态和用药情况、肾功能、QTc间期、毒性症状和再次入院情况的信息。必要时由药剂师提出建议，并跟踪建议的接受率和患者结局。
36例患者因房性快速性心律失常而开具索他洛尔处方。其中32例（89%）肾功能给药剂量不当。20例（56%）的射血分数≤40%，定义为左心室功能不全。在初次评估时，15例（42%）出现潜在索他洛尔毒性迹象。药剂师为32例患者提供了停药或调整剂量的建议，完全接受率为38%，部分接受率为12%。将接受适当治疗的患者（包括药剂师建议被接受后的患者，A组；n = 16）与仍接受不当治疗的患者（B组；n = 20）的全因再入院率进行比较。两组6个月内的再入院率存在差异（A组为31%，B组为55%；P = 0.095，比值比为3.7）。
这项药物安全评估表明，接受索他洛尔治疗的患者需要药剂师进行评估。对于肾功能不全、心力衰竭和其他相对禁忌证的患者，通常需要调整剂量或避免用药以避免毒性。大多数患者因肾功能不全而索他洛尔处方不当。基于该评估，建议将索他洛尔纳入该机构由药剂师管理的肾脏给药剂量调整计划。开具索他洛尔处方时确保临床药剂师评估有助于减少潜在的危及生命的ADEs和住院再入院情况。
