4 research outputs found
Trends and uptake of new formulations of controlled-release oxycodone in Canada
Purpose: This study investigated the impact of changing availability of tamperâdeterrent and nonâtamperâdeterrent oxycodone on prescribing patterns of controlledârelease oxycodone across Canada. Methods: We conducted a populationâbased, serial crossâsectional study of controlledârelease oxycodone dispensing from community pharmacies across Canada between October 2007 and April 2016. We calculated rates of dispensing (tablets per 100 population) and reported the relative market share of generic nonâtamperâdeterrent controlledârelease oxycodone. All analyses were reported nationally and stratified by province. Results: After the introduction of a tamperâdeterrent formulation, the national rate of controlledârelease oxycodone dispensing fell by 44.6% (from 26.4 to 14.6 tablets per 100 population from February 2012 to April 2016). Between December 2012 and July 2013, there was moderate uptake of generic nonâtamperâdeterrent controlledârelease oxycodone (968 452 tablets; 16.0% in July 2013), which appeared to have little impact on the overall rate of controlledârelease oxycodone dispensing in Canada. However, the uptake of generic nonâtamperâdeterrent oxycodone varied considerably by province. By April 2016, 55.0% of all controlledârelease oxycodone tablets dispensed in Quebec were for the generic formulation. [âŠ
Proton pump inhibitors and the risk of hospitalisation for community-acquired pneumonia: replicated cohort studies with meta-analysis
Objective: Previous observational studies suggest that the use of proton pump inhibitors (PPIs) may increase the risk of hospitalisation for community-acquired pneumonia (HCAP). However, the potential presence of confounding and protopathic biases limits the conclusions that can be drawn from these studies. Our objective was, therefore, to examine the risk of HCAP with PPIs prescribed prophylactically in new users of non-steroidal anti-inflammatory drugs (NSAIDs). Design: We formed eight restricted cohorts of new users of NSAIDs, aged â„40 years, using a common protocol in eight databases (Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, US MarketScan and the UK's General Practice Research Database (GPRD)). This specific patient population was studied to minimise bias due to unmeasured confounders. High-dimensional propensity scores were used to estimate site-specific adjusted ORs (aORs) for HCAP at 6 months in PPI patients compared with unexposed patients. Fixed-effects meta-analytic models were used to estimate overall effects across databases. Results: Of the 4 238 504 new users of NSAIDs, 2.3% also started a PPI. The cumulative 6-month incidence of HCAP was 0.17% among patients prescribed PPIs and 0.12% in unexposed patients. After adjustment, PPIs were not associated with an increased risk of HCAP (aOR=1.05; 95% CI 0.89 to 1.25). Histamine-2 receptor antagonists yielded similar results (aOR=0.95, 95% CI â0.75 to 1.21). Conclusions: Our study does not support the proposition of a pharmacological effect of gastric acid suppressors on the risk of HCAP
Ventricular tachyarrhythmia and sudden cardiac death with domperidone use in Parkinson's disease
Aim: Domperidone is preferentially used over other antiemetic agents to treat digestive symptoms in Parkinson's disease (PD). Concerns have been raised regarding an increased risk of ventricular tachyarrhythmia and sudden cardiac death (VT/SCD) associated with domperidone in the general population. However, the risk in PD is unknown. Methods: We conducted a multicentre retrospective cohort study using administrative databases from seven Canadian provinces and the UK Clinical Practice Research Datalink. Using a nested caseâcontrol analysis, we estimated the rate ratios (RRs) of VT/SCD associated with domperidone use compared to no use in patients newlyâdiagnosed with PD. VT/SCD events were identified using administrative medical records and vital statistics with a manual review of all potential cases. Metaâanalytic methods were used to estimate overall effects across sites. Results: Among 214â962 patients with PD, 2907 cases of VT/SCD were identified during 886â581 personâyears of followâup (incidence rate 3.28 per 1000 persons per year). Current use of domperidone was associated with a nonâstatistically significant 22% increased risk of VT/SCD (RR 1.22; 95% CI 0.99â1.50) compared with no use. The risk was significantly elevated in those with a history of cardiovascular disease (RR 1.38; 95% CI 1.07â1.78), but not in those without (RR 1.21; 95% CI 0.81â1.81). Dose and duration of use did not affect the magnitude of the risk. [...
Regional variation in the potentially inappropriate first-line use of fluoroquinolones in Canada as a key to antibiotic stewardship? A drug utilization review study
Background
Serious adverse effects of fluoroquinolone antibiotics have been described for more than decade. Recently, several drug regulatory agencies have advised restricting their use in milder infections for which other treatments are available, given the potential for disabling and possibly persistent side effects. We aimed to describe variations in fluoroquinolone use for initial treatment of urinary tract infection (UTI), acute bacterial sinusitis (ABS), and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the outpatient setting across Canada.
Methods
Using administrative health data from six provinces, we identified ambulatory visits with a diagnosis of uncomplicated UTI, uncomplicated AECOPD or ABS. Antibiotic exposure was determined by the first antibiotic dispensed within 5Â days of the visit.
Results
We identified 4,303,144 uncomplicated UTI events among 2,170,027 women; the proportion of events treated with fluoroquinolones, mostly ciprofloxacin, varied across provinces, ranging from 18.6% (Saskatchewan) to 51.6% (Alberta). Among 3,467,678 ABS events (2,087,934 patients), between 2.2% (Nova Scotia) and 11.2% (Ontario) were dispensed a fluoroquinolone. For 1,319,128 AECOPD events among 598,347 patients, fluoroquinolones, mostly levofloxacin and moxifloxacin, ranged from 5.8% (Nova Scotia) to 35.6% (Ontario). The proportion of uncomplicated UTI and ABS events treated with fluoroquinolones declined over time, whereas it remained relatively stable for AECOPD.
Conclusions
Fluoroquinolones were commonly used as first-line therapies for uncomplicated UTI and AECOPD. However, their use varied widely across provinces. Drug insurance formulary criteria and enforcement may be a key to facilitating better antibiotic stewardship and limiting potentially inappropriate first-line use of fluoroquinolones.Pharmaceutical Sciences, Faculty ofNon UBCAnesthesiology, Pharmacology and Therapeutics, Department ofReviewedFacult