Background and Importance Monitoring of narrow-margin drugs in primary care is important to optimise the efficacy and safety of treatment.
Aim and Objectives To analyse the impact of the activity and repercussions of monitoring plasma levels of antiepileptics, lithium and digoxin in primary care patients carried out by the Pharmacokinetics Area-Hospital Pharmacy Service (PA-HPS).
Material and Methods Two-month retrospective observational study of the pharmacokinetic reports of all patients who required monitoring of their plasma levels. The circuit starts with a request from the primary care physician asking for the determination of the plasma level, the blood sample is analysed by the laboratory and the PA-HPS interprets all the data from the clinical history, finally producing a pharmacokinetic report integrated in the clinical history together with the analytical.
The variables recorded from the analyses and clinical history were: age, sex, renal clearance, liver enzymes (GOT, GPT and gamma), monitored drug and plasma level, pharmacokinetic reports and their degree of acceptance.
Results A total of 202 pharmacokinetic reports were performed targeting 191 ambulatory patients. The mean age of the total was 42.33 ± 16.46 years (range: 6-106) and 51% were female. Only 5 patients had established renal insufficiency with renal clearance < 60 ml/min and 3 patients with hepatic insufficiency (liver enzymes greater than 3 times the upper limit of normal).
The pharmacokinetic reports produced were valproic (43.56%), lithium (37.62%), carbamazepine (8.91%), digoxin (5.94%), phenytoin (2.47%) and phenobarbital (1.48%). Of the patients, 82.68% had plasma levels in therapeutic range, 14.85% were subtherapeutic and 2.47% were supratherapeutic. We highlight a degree of intervention in 17.32% of the pharmacokinetic reports made, and 10.93% of these reports required a change in the dosing regimen or dosing interval together with a new monitoring. The degree of acceptance by the physician was 67%.
Conclusion and Relevance It is important to perform an adequate follow-up of patients with active treatment of drugs with a narrow therapeutic margin for a constant optimisation of the treatment
The data reflect the importance of the hospital pharmacist as part of the multidisciplinary team and the need for direct communication with the primary care physician.
The high degree of acceptance of pharmacokinetic reports shows that the circuit is well received.
Conflict of Interest No conflict of interest.
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