Lamprecht Donald G, Todd Brittany A, Denham Anne M, Ruppe Leslie K, Stadler Sheila L
1 Kaiser Permanente Colorado, Aurora, CO, USA.
2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Ann Pharmacother. 2017 Feb;51(2):140-145. doi: 10.1177/1060028016675352. Epub 2016 Oct 25.
Against-label prescribing of statins with interacting drugs, such as cyclosporine, represents an important patient safety concern.
To implement and evaluate the effectiveness of a clinical pharmacist patient-safety initiative to minimize against-label prescribing of statins with cyclosporine.
Kaiser Permanente Colorado clinical pharmacists identified patients receiving both cyclosporine and against-label statin through prescription claims data. Academic detailing on this interaction was provided to health care providers. Clinical pharmacists collaborated with physicians to facilitate conversion to on-label statin. Conversion rates along with changes in low-density lipoprotein cholesterol (LDL-C) were assessed.
Of the 157 patients identified as taking cyclosporine, 48 were receiving concurrent statin therapy. Of these 48 patients, 33 (69%) were on an against-label statin regimen; 25 (76%) of these patients were converted to on-label statin. Overall, patients converted to on-label statin had a mean LDL-C prior to conversion of 82.9 (±26.4) mg/dL and mean LDL-C after conversion of 90.7 (±31.2) mg/dL ( P = 0.21). In all, 17 patients (68%) were switched to pravastatin 20 mg daily and 8 patients (32%) to rosuvastatin 5 mg daily. In patients converted to pravastatin 20 mg daily, the mean LDL-C was 13.5 mg/dL higher than prior to conversion ( P = 0.066). In patients converted to rosuvastatin 5 mg daily, the mean LDL-C was 3.8 mg/dL lower than prior to conversion ( P = 0.73).
Utilizing a patient-safety-centered approach, clinical pharmacists were able to reduce the number of patients on against-label statin with cyclosporine while maintaining a comparable level of LDL-C control.
他汀类药物与相互作用药物（如环孢素）的超说明书用药是一个重要的患者安全问题。
实施并评估一项临床药师患者安全倡议的有效性，以尽量减少他汀类药物与环孢素的超说明书用药情况。
科罗拉多州凯撒医疗机构的临床药师通过处方索赔数据识别出同时接受环孢素和超说明书他汀类药物治疗的患者。就这种相互作用向医疗服务提供者提供学术详述。临床药师与医生合作，促进向说明书规定的他汀类药物转换。评估转换率以及低密度脂蛋白胆固醇（LDL-C）的变化。
在157名被确定正在服用环孢素的患者中，48名同时接受他汀类药物治疗。在这48名患者中，33名（69%）采用超说明书他汀类药物治疗方案；其中25名（76%）患者转换为说明书规定的他汀类药物治疗。总体而言，转换为说明书规定的他汀类药物治疗的患者在转换前的平均LDL-C为82.9（±26.4）mg/dL，转换后的平均LDL-C为90.7（±31.2）mg/dL（P = 0.21）。共有17名患者（68%）改为每日服用20 mg普伐他汀，8名患者（32%）改为每日服用5 mg瑞舒伐他汀。改为每日服用20 mg普伐他汀的患者，其平均LDL-C比转换前高13.5 mg/dL（P = 0.066）。改为每日服用5 mg瑞舒伐他汀的患者，其平均LDL-C比转换前低3.8 mg/dL（P = 0.73）。
采用以患者安全为中心的方法，临床药师能够减少接受他汀类药物与环孢素超说明书用药治疗的患者数量，同时维持相当的LDL-C控制水平。
