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Adverse Drug Reactions

Potential adverse effects of a low-dose aspirin-diuretic combination on kidney function

W.M. Sweileh

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Volume 45 p. 601 - 605

Abstract

W.M. Sweileh

Clinical Pharmacology, College of Pharmacy, Clinical Pharmacy Graduate Program, An-Najah National University, Nablus, Palestine
Objective: Low-dose aspirin and diuretics are commonly co-utilized in patients with cardiovascular diseases. The objective of this study was to investigate the effects of a low-dose aspirin-diuretic drug combination on renal function. Methods: In this cross-sectional retrospective study, all patients, excluding those on renal dialysis, admitted to the Internal Medicine Department of the Al-Watani Hospital, Nablus, Palestine, were included in the study. Medical data were obtained from patients’ medical files. Estimation of creatinine clearance was carried out using the Cockcroft-Gault equation. Patients on the target drug combination were compared with patients who were not receiving the target drug combination. An independent paired t-test and 1-way ANOVA were used to test for significance between groups. Statistics were carried out using the Statistical Package for Social Sciences (SPSS), version 13. Results: A total of 340 subjects (54.4% men) were included in the study. There were 90 patients on the target drug combination and designated as the study group. Of the remaining 250 patients comprising the control group, 114 received none of the target drugs and 136 received only one target medication. There was a significant (p < 0.001) difference in the levels of creatinine clearance between the two groups. Patients on the target drug combination had significantly lower creatinine clearance levels than those in the control group. Men in the study group had lower creatinine clearances than men in the control group and similar results were found for women. Patients in the study group with >= 2 chronic diseases, had lower creatinine clearances than patients in the control group with >= 2 chronic diseases. Similar results were found in patients with < 2 chronic diseases. Conclusion: Administration of a low-dose aspirin-diuretic drug combination was associated with significantly lower creatinine clearance levels. This finding was independent of gender and the number of chronic diseases present. Monitoring kidney function in patients receiving this drug combination is recommended.Correspondence to:
W.M. Sweileh, PhD, Associate Professor, Clinical Pharmacology, Dean, College of Pharmacy, Chairman, Clinical Pharmacy Graduate Program, An-Najah National University, Nablus, Palestine
Email: [email protected]

Therapeutics

Predictors of in-hospital mortality after acute stroke: impact of renal dysfunction

W.M. Sweileh

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Volume 46 p. 637 - 643

Abstract

W.M. Sweileh

Clinical Pharmacology, College of Pharmacy, Clinical Pharmacy Graduate Program, An-Najah National University Nablus, Palestine
Objective: The objective of this 1-year, hospital-based study was to identify the impact of renal dysfunction on in-hospital mortality after acute stroke. Methodology: All patients admitted to Al-Watani governmental hospital and diagnosed with acute stroke from September 2006 to August 2007 were included in the study. Data were obtained from patients’ medical files. Creatinine clearance (CrCl) was calculated using Cockcroft-Gault equation. Patients with CrCl < 60 ml/min were designated as Group 1 while those with CrCl >= 60 ml/min were designated as Group 2. The main outcome measure in this study was vital status at discharge. Pearson chi² and independent Student’s t test were used in the univariate analysis while multiple logistic regression analysis was used to identify independent predictors of in-hospital mortality. Statistical testing and graphics were carried out using SPSS 15. Results: A total of 186 acute stroke cases were included. Hypertension (HTN) (69.9%) and diabetes mellitus (DM) (45.2%) were the most prevalent risk factors. Patients in Group 1 were significantly older than those in Group 2 (74.11 ± 9.46 versus 66.53 ± 10.74 years). Thirty nine (21%) of the stroke patients died during their hospital stay. In the total stroke patients, three predictors of in-hospital mortality were identified: CrCl (p = 0.004), number of post-stroke complications (p = 0.001), and type of stroke (p = 0.034). In Group 1, CrCl (p = 0.012) was the only independent predictor of mortality, with patients who died having significantly lower CrCl than those who survived. However, in Group 2, CrCl level was not a predictor of mortality and was not significantly different (p = 0.26) between those who died and those who survived. In Group 2, no predictors of mortality were identified. Conclusion: Screening and better control of renal dysfunction is required to decrease the risk of in-hospital mortality among patients after acute stroke. Our study also shows that the lower the CrCl, the greater is the risk of in-hospital mortality after acute attack. This finding needs to be considered in preventive and therapeutic strategies of acute stroke.Correspondence to:
W.M. Sweileh, PhD; Associate Professor
Clinical Pharmacology, Dean, College of Pharmacy, An-Najah National University, Nablus, Palestine
Email: [email protected]

Original Research

Target blood pressure attainment in diabetic hypertensive patients: need for more diuretics?

W.M. Sweileh

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Volume 47 p. 434 - 438

Abstract

W.M. Sweileh

College of Pharmacy, An-Najah National University, Palestine
Objective: To determine target blood pressure attainment and to evaluate blood pressure control relative to type of therapy among diabetic hypertensive patients. Methodology: An observational retrospective study of all diabetic hypertensive patients visiting Al-Watani governmental medical center from August 01, 2006 until August 01, 2007. The blood pressure (BP) measurement made during the patient’s recent visit and documented in the medical files was used in the study. Controlled BP values for hypertensive patients with diabetes mellitus were defined per JNC 7 guidelines: 130/80 mmHg or lower. Proportions of use of 5 different antihypertensive drug classes were compared between patients with controlled and uncontrolled BP. Results: Of the 311 patients, 79 (25.4%) had their BP controlled. No significant differences in age, gender, body weight, duration of hypertension or diabetes, renal function, average number of anti-hypertensive medications and doses of most commonly reported antihypertensive medications were found between controlled and uncontrolled BP groups. ACE-I/ARB was the most commonly used drug class in both groups. Overall, the use of ACE-I/ARB, beta-blockers, calcium channel blockers, alpha-blockers and multi drug regimens were also not significantly different between the controlled and uncontrolled groups. However, overall use of diuretics was significantly higher in controlled group than uncontrolled group (59.5% versus 45.7%, p < 0.001). Conclusion: Despite the common use of ACE-I/ ARB as recommended per JNC 7th report, the majority of the patients had uncontrolled BP. Diuretics is an important drug class in attaining target BP. Use of diuretics in combination with ACE-I as well as drug compliance needs to be emphasized and encouraged.Correspondence to:
W.M. Sweileh, PhD, Associate Professor
Clinical Pharmacology, College of Pharmacy
An-Najah National University, Palestine
Email: [email protected]

Original Research

Storage, utilization and cost of drug products in Palestinian households

W.M. Sweileh, A.F. Sawalha, S.H. Zyoud, S.W. Al-Jabi, F.F. Bani Shamseh and H.S. Khalaf

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Volume 48 p. 59 - 67

Abstract

W.M. Sweileh¹, A.F. Sawalha¹,², S.H. Zyoud², S.W. Al-Jabi¹, F.F. Bani Shamseh² and H.S. Khalaf²

¹College of Pharmacy and ²Poison Control and Drug Information Center (PCDIC), An-Najah National University, Nablus, Palestine
Background and objective: Appropriate storage and use of medications in households may decrease drug wastage and unnecessary hazard. The objective of this study was to investigate storage, utilization habits and cost of medications in households in Palestine. Methods: This is a cross sectional, anonymous, questionnaire-based study of 465 households in northern Palestine. The drug product inventory in the surveyed households was investigated and family members were interviewed. Results: A total of 465 households were assessed, 50 were excluded. The total number of drug products in the 415 households was 5,505; the mean ± SD was 13.3 ± 7.8. Level of father’s education, presence of chronic disease and insurance coverage were the variables that showed a significant relationship with the amount of drug products found in the households. Most of the drug products (43.4%) were stored in relatively unsafe places in the house within the reach of children. Approximately one third (32.5%) of the drug products were not in their original container. The percentages of unused drug products, expired, or those with no clear expiry date were 32.7%, 17.7% and 11% respectively. Estimated drug wastage in the 415 households and nationwide would be 16,100 and 19 million USD respectively. The most common drug categories encountered in households were alimentary, musculoskeletal and anti-infective agents. The most common individual drugs encountered were: paracetamol (8.5%), ibuprofen (4.9%) and diclofenac (3.7%). Conclusion: Medications were stored in large quantities in Palestinian households, and a large percentage was being wasted. Drug-use assessments and a comprehensive evaluation of the current national drug policies are warranted to curtail this problem.Correspondence to:
W.M. Sweileh, PhD
Associate Professor
Clinical Pharmacology, College of Pharmacy
An-Najah National University
Nablus, Palestine
Email: [email protected]

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