Kasper Barbara, Erdel Angela, Tabaka Caitlynn, Edgar Borden
is a Clinical Assistant Professor; and and were Students at the time this article was written; all at the University of Missouri-Kansas City School of Pharmacy. and Barbara Kasper are Clinical Pharmacy Specialists at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri.
Fed Pract. 2020 Jun;37(6):268-275.
Statin drug interactions commonly increase the risk of muscle-related toxicities. The medical literature supports consultative pharmacist interventions to resolve drug interactions, but studies demonstrating autonomous pharmacist interventions are lacking.
To evaluate the complementary impact of using pharmacist-led protocols and pharmacists with prescriptive authority to resolve statin drug interactions.
Pharmacist-led protocols were developed to address gemfibrozil-statin and niacin-statin interactions. Pharmacists discontinued gemfibrozil and niacin by protocol or referred patients to the Patient Aligned Care Team (PACT) Pharmacy Clinic for individualized management. After all drug interactions were addressed, a retrospective quality improvement analysis was conducted. The primary outcome was to evaluate the impact of gemfibrozil and niacin discontinuation by protocol on patients' triglyceride (TG) laboratory results. The coprimary endpoints were the change in TGs and the percentage of patients with TGs ≥ 500 mg/dL, following pharmacist discontinuation by protocol. Secondary outcomes included the time required to resolve the interactions and a description of the PACT Clinical Pharmacy Specialists' (CPS) pharmacologic interventions.
The gemfibrozil and niacin protocols addressed 397 drug interactions. Seventy-six patients underwent gemfibrozil discontinuation by protocol and had TG laboratory results available. TG levels decreased or increased by < 100 mg/dL for 62 patients (82%), and 1 patient (1.3%) experienced TG elevation above the threshold of 500 mg/dL. Thirty-six patients had niacin discontinued by protocol and available laboratory results. The TG levels decreased or increased by < 100 mg/dL for 33 patients (91.7%), and no patients had TG levels increase above the threshold of 500 mg/dL. The mean time required to resolve both gemfibrozil and niacin drug interactions was 15.5 minutes per patient. A total of 129 patients were referred to the PACT Pharmacy Clinic to manage gemfibrozil and niacin drug interactions. TG laboratory results were available for 80 gemfibrozil patients (74.8%) and 16 niacin patients (72.7%). The PACT CPS made 171 pharmacologic interventions to address drug interactions and the median of 2 encounters per patient.
This single-site quality improvement analysis supports the complementary use of protocols and pharmacists with prescriptive authority to resolve statin drug interactions. These data support expanded roles for pharmacists, across settings, to mitigate select drug interactions.
他汀类药物相互作用通常会增加肌肉相关毒性的风险。医学文献支持咨询药师干预以解决药物相互作用，但缺乏证明自主药师干预的研究。
评估使用药师主导的方案和具有处方权的药师来解决他汀类药物相互作用的互补影响。
制定了药师主导的方案以解决吉非贝齐 - 他汀和烟酸 - 他汀相互作用。药师按照方案停用吉非贝齐和烟酸，或将患者转介至患者协调护理团队（PACT）药房诊所进行个体化管理。在所有药物相互作用得到解决后，进行了回顾性质量改进分析。主要结局是评估按照方案停用吉非贝齐和烟酸对患者甘油三酯（TG）实验室结果的影响。共同主要终点是按照方案药师停药后TG的变化以及TG≥500mg/dL的患者百分比。次要结局包括解决相互作用所需的时间以及PACT临床药学专家（CPS）的药物干预描述。
吉非贝齐和烟酸方案解决了397例药物相互作用。76例患者按照方案停用吉非贝齐并可获得TG实验室结果。62例患者（82%）的TG水平下降或升高<100mg/dL，1例患者（1.3%）的TG升高超过500mg/dL阈值。36例患者按照方案停用烟酸并可获得实验室结果。33例患者（91.7%）的TG水平下降或升高<100mg/dL，没有患者的TG水平升高超过500mg/dL阈值。解决吉非贝齐和烟酸药物相互作用平均每位患者需要15.5分钟。共有129例患者被转介至PACT药房诊所管理吉非贝齐和烟酸药物相互作用。80例吉非贝齐患者（74.8%）和16例烟酸患者（72.7%）可获得TG实验室结果。PACT CPS进行了171次药物干预以解决药物相互作用，每位患者平均会诊2次。
这项单中心质量改进分析支持联合使用方案和具有处方权的药师来解决他汀类药物相互作用。这些数据支持药师在不同环境中扩大作用以减轻特定药物相互作用。
