Drug-Drug Interactions among Kidney Transplant Recipients in The Outpatient Setting

BACKGROUND

Number of patients undergoing kidney transplantation is ever increasing. Drug-drug interactions (DDIs) can complicate transplant patient's treatment course.

OBJECTIVE

To investigate patterns and factors associated with potential DDIs in kidney transplant recipients under maintenance immunosuppressive regimen at a referral transplantation center in Shiraz, Iran.

METHODS

390 eligible kidney transplant outpatients referred to Motahhari clinic and one of the attending nephrologist's private office during an18-month period were assessed for DDIs. Using the Lexi-Interact online drug interactions software, the prescribed drugs were assessed for the number and type of potential DDIs. Only type D and X interactions were considered eligible for inclusion.

RESULTS

During the study period, 344 DDIs were detected of which, 290 were type D; 54 were type XDDIs. 81% of the detected DDIs were pharmacokinetics. Interaction between cyclosporine + mycophenolic acid (32.3%) was the most frequent DDIs followed by cyclosporine + atorvastatin (11.3%). Immunosuppressant (43.44%) was the most frequently used medication responsible for DDIs. Number of co-administered medications (OR: 1.34, 95% CI: 1.12-1.51) and cyclosporine as main immunosuppressive main drug (OR: 10.43, 95% CI: 6.24-17.42) were identified as independent risk factors for DDIs.

CONCLUSION

Major DDIs were common in kidney transplant recipients. Considering the importance of DDIs in kidney transplant patients, more attention is warranted in this regard by health care members, especially physicians and pharmacists.

Efficacy of Combination Therapy of Statin and Vitamin C in Comparison with Statin in the Prevention of Post-CABG Atrial Fibrillation

PURPOSE

Atrial fibrillation (AF) is the most frequent arrhythmia that follows coronary artery bypass graft (CABG). Patients developing postoperative AF (POAF) have significantly higher mortality rates. The consistent prophylactic effectiveness of statins and vitamin C are well-accepted; however, no evaluation on combined therapy has been performed. We aimed at assessing the efficacy of combination therapy with statin and vitamin C in comparison with statin alone in the prevention of post CABG-AF.

METHODS

In a randomized double blind clinical trial, 120 candidates of CABG were recruited in Tabriz Madani Educational Center in a 15-month period of time. Patients were randomized into two groups of 60 receiving oral atorvastatin (40mg) plus oral vitamin C (2g/d operation day and 1g/d for five consequent days) for intervention group and oral atorvastatin (40mg) for control group. Occurrence of post CABG AF was compared between the two groups.

RESULTS

There were 60 patients, 43 males and 17 females with a mean age of 61.0±11.5 (29-78) years, in the intervention group and sixty patients, 39 males and 21 females with a mean age of 60.5±11.3 (39-81) years, in the control group. The post CABG AF occurred in 6 cases (10%) in the interventional group and 15 patients (25%) in the controls (P=0.03, odds ratio=0.33, 95% confidence interval 0.12-0.93).

CONCLUSION

Based on our findings, combination prophylaxis against post CABG AF with oral atorvastatin plus vitamin C is significantly more effective than single oral atorvastatin.