Formes à libération prolongée, un conseil officinal s’impose

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Un exemple d’évaluation de l’abus et de la dépendance en addictovigilance : à propos du tramadol

L’objectif de cet article est de présenter l’évaluation du potentiel d’abus et de dépendance d’un médicament à partir des différentes sources de données pharmacoépidémiologiques utilisées par le réseau français des Centres d’Évaluation et d’Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), en prenant l’exemple du tramadol. La confrontation des données de notification spontanée, d’enquêtes menées auprès de populations spécifiques ou encore d’évaluation d’indicateurs de détournement d’usage ne met pas en évidence un problème majeur d’abus et de dépendance au tramadol sur le plan de la santé publique, mais souligne l’importance de faire attention au signal. L’exemple de l’addictovigilance du tramadol illustre l’intérêt de confronter les résultats obtenus à partir de différentes sources validées. La mise en œuvre répétée de programmes observationnels de l’abus et de la dépendance à des médicaments psychoactifs représente une aide importante aux autorités de santé pour définir la teneur des informations à délivrer, voire la prise de décisions réglementaires pour réduire ces usages problématiques

Evaluation of Abuse and Dependence in Addiction Monitoring Systems: Tramadol as an example

The objective of this paper is to present an evaluation of the potential for abuse of and dependence on a drug from the data obtained from the different pharmacoepidemiological tools used by the French network for evaluation and information on pharmacodependence and addiction monitoring taking the example of tramadol. Comparison of the data from spontaneous reports with surveys in specific populations and with evaluations of indicators of diverted uses does not highlight a major problem of tramadol abuse and dependence in terms of public health, but stresses the importance of paying attention to the signal. This example of addiction monitoring of tramadol illustrates the interest of comparing results obtained from different validated sources. The implementation of repeated observational programs of abuse of and dependence on psychoactive drugs is an important aid to health authorities to define the content of the information to be delivered or regulatory decisions to reduce these problematic uses

Medicines and frailty in older people. Towards a new nosological entity: A pharmacological frailty?

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Probable Interaction Between an Oral Vitamin K Antagonist and Turmeric (Curcuma longa)

We report a probable interaction between a vitamin K antagonist, fluindione, and the herbal medicine turmeric that resulted in the elevation of the international normalized ratio (INR). The case presented here underlines the importance of considering potential exposure to herbal medications when assessing adverse effects

Contributions of a blended learning based on peer evaluation for teaching drug-drug interactions to undergraduate pharmacy students

International audienceBACKGROUND:Numerous studies have pointed out the need for better training of healthcare professionals in drug-drug interactions management in order to minimize adverse drugs reactions impacts on patients. The aim of this study was to evaluate the benefits of a blended learning strategy based on peer evaluation (PE) for teaching drug-drug interactions to undergraduate pharmacy students.METHODS:Third-year pharmacy students (n = 72) from the University of Limoges were involved in a hybrid teaching using the Moodle platform (2.9 version). After the theoretical lectures, an online activity was proposed to students. Each student submitted a report addressing a clinical case for peer evaluation. Students evaluated the pedagogical approach using an online survey. Quantitative benefits were assessed from students randomly assigned into two groups: PE in pharmacodynamics items (PE-PD) or PE in pharmacokinetics items (PE-PK). During this activity, three marks were given: one from peers for their evaluation work and two from teachers for oral group presentation of the clinical cases and for the final written examination. Statistics were performed using two-tailed unpaired t-test and significance was set for p < 0.05.RESULTS:Only a few students (n = 14, 20.6%) were aware of the peer evaluation principle and even less, only one student (n = 1, 1.5%), had already encountered it. Students considered that they benefited from this evaluation (n = 65, 95.6%); from their work being reviewed (n = 62, 91.2%) and that they participated in improving their classmates understanding (n = 59, 86.8%). Peers' allocated marks were similar in the two PE groups (PE-PD = 17.4 ± 1.4; PE-PK = 17.3 ± 1.4). Teachers' marks for oral presentation were significantly lower for pharmacodynamics than for pharmacokinetics items (PE-PD = 15.2 ± 1.2; PE-PK = 16.1 ± 2.1; p < 0.05). The final examination marks were equivalent in both groups (PE-PD = 11.0 ± 2.1; PE-PK = 11.2 ± 1.9).CONCLUSIONS:Besides the fact that a major short-term quantitative improvement was not detected, our teaching approach was qualified as being a positive and stimulating learning tool by students

[Drug Shortage May Have Serious Outcome: the French Exemple of Phenytoine].

International audienceIn 2012, in France, phenytoin sodium was used as a substitute for phenytoin base during a shortage at the dose of 100 mg for 100 mg, according to the French Health Agency recommendations. However, this substitution was problematic because the two specialties were not bioequivalent. We report here the case of a 29-year old woman who presented with severe epilepsy. The substitution of phenytoin base by phenytoin sodium induced an increase of seizure frequency leading to several hospitalizations and sick leave. Phenytoin base was finally available again in 2013 which allowed a reduction of seizure frequency. Six similar cases, including one death, were reported to the French pharmacovigilance system. Drug shortages are increasingly common and can have serious consequences. Reporting the difficulties that drug shortage causes to health authorities is important in order to improve their management and to better support patients