Drug utilization, safety and clinical use of Actos and Avandia.
Drug utilization, safety and clinical use of Actos and Avandia.
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DOI：
10.3233/jrs-120581
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发表时间：
2013-01-01
期刊：
影响因子：
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通讯作者：
Marks, Donald H
中科院分区：
文献类型：
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作者：
Marks, Donald H
背景和目的：这篇综述的动机是最近与格列酮使用相关的心血管毒性、骨折和膀胱癌的警告增加。方法：对阿拉巴马州伯明翰市中心安全网络医院库珀绿色慈善医院(CGMH)使用Actos(吡格列酮)和文迪雅(罗格列酮)的药物利用进行综述。对医院范围内的药房记录进行审查，以确定所有抗糖尿病药物的使用模式。Medline和FDA网站上搜索到关于吡格列酮和罗格列酮的安全性和有效性的文章。考虑了这两种药物的相对利用率、疗效、适应症、相对成本和安全性。结果：在所有这些因素的基础上，全医院范围内将罗格列酮的所有处方转换为所有的吡格列酮，估计第一年节省了83,000美元。没有预计到糖尿病控制恶化的事件，也没有由于在处方填写时自动将患者从罗格列酮转换为吡格列酮而导致疗效下降或不良反应的事件。结论：结论可以总结为一些关键点。临床医生应遵循美国糖尿病协会指南[1]进行治疗。控制糖尿病的基础是减肥、节食和锻炼。II型糖尿病的初始药物治疗包括二甲双胍和胰岛素。没有使用格列酮药物比其他药物组更好的情况，也没有临床情况下使用格列酮药物是绝对必要的，这与其他类别的糖尿病药物相反。使用格列酮有重要的禁忌症、警告和预防措施，在每个患者使用之前必须考虑到这一点。格列酮尤其不应用于以下情况：充血性心力衰竭(CHF)、并发膀胱癌或严重骨质疏松。
BACKGROUND AND OBJECTIVE: The impetus for this review was recent increased warnings of cardiovascular toxicity, fractures and bladder cancer associated with glitazone use.METHODS: A drug utilization review was performed regarding the use of Actos (pioglitazone) and Avandia (rosiglitazone) at Cooper Green Mercy Hospital (CGMH), an inner city safety net hospital in Birmingham, Alabama. Pharmacy records were reviewed hospital-wide to determine usage patterns of all anti-diabetic medications. Medline and the FDA websites were searched for articles on safety and efficacy of pioglitazone and rosiglitazone. Considerations were relative utilization profile, comparative efficacy, indications, relative cost, and safety profile of the two available medications in this drug class.RESULTS: On the basis of all of these factors, a hospital-wide switch of all rosiglitazone prescriptions to all pioglitazone was implemented, which was estimated to result in savings of $83,000 for the first year. No episodes of worsening of control of diabetes were anticipated, nor were episodes of decreased efficacy or adverse effects as a result of automatically switching patients from rosiglitazone to pioglitazone at the time of prescription filling.CONCLUSIONS: The conclusions can be summarized in a number of key points. Clinicians should follow the American Diabetes Association guidelines [1] for treatment. The basis for diabetic control is weight loss, diet and exercise. Initial medication management for type II Diabetes Mellitus includes metformin and insulin. There are no circumstances in which use of glitazone medications is preferable to other medication groups, and there are no clinical circumstances in which use of glitazone medications is absolutely necessary, as opposed to other classes of diabetic medication. There are significant contraindications, warnings and precautions to use of glitazones, which must be taken into consideration before use in every individual patient. Glitazones in particular should not be used in the following circumstances: congestive heart failure (CHF), concurrent bladder cancer or severe osteoporosis.