Pharmacology
Antidepressants Plus NSAIDs and the Risk of Intracranial Hemorrhage
Study shows a cocktail of antidepressants and NSAIDs have an increasing risk of gastrointestinal bleeding.
Many patients inappropriately receive drugs for stress ulcer prophylaxis, and the problem is compounded when the drugs are continued on discharge, say researchers from Banner-University Medical Center in Phoenix and Midwestern University Glendale campus, both in Arizona, and University of Pittsburgh School of Pharmacy in Pennsylvania. They add that although acid suppression therapy plays an important role in reducing the risk of stress-related mucosal disease bleeding in patients in the intensive care unit (ICU), the drugs should be used more judiciously in all patients, particularly given the potential adverse clinical outcomes, such as pneumonia.
Related: Antidepressants Plus NSAIDs and the Risk of Intracranial Hemorrhage
At their hospital, clinical pharmacists have the prescriptive authority to modify stress ulcer prophylaxis to promote use of histamine 2 receptor antagonists (H2RAs) in ICU patients with risk factors while discontinuing prophylaxis in patients without any indications. Famotidine is the preferred agent at that hospital; pharmacists are authorized to substitute H2RAs for proton pump inhibitors in ICU patients with major risk factors.
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The researchers designed a pharmacist-led program to reduce inappropriate use and reduce costs. They then analyzed data on 1,134 patients, pre- and postimplementation.
The pharmacist program had a “significant impact” on the rate of prophylaxis use, with no difference in clinical outcomes. The appropriate use of famotidine significantly increased in the postimplementation period, from 18% to 89%. The researchers found the preimplementation period had a 41% rate of inappropriate prophylaxis days, compared with 7% after the program. The program also cut down on inappropriate prophylaxis among general ward patients and patients being discharged.
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The program also saved an estimated $200,000 per year in costs associated with medications.
Source
Buckley MS, Park AS, Anderson CS, et al. Am J Med. 2015;128(8):905-913.
doi: 10.1016/j.amjmed.2015.02.014.