Objective: To evaluate whether clinical pharmacist's interventions have any impact on medication adherence of patients having inflammatory bowel disease and to assess the awareness of patients about their disease and the significance of medications they use. Materials and Methods: A prospective, interventional follow up study was conducted in the outpatients visiting Gastroenterology and Hepatology department of Amrita Institute of Medical Sciences, Kochi. To assess the level of medication adherence and patient's awareness, MMAS-8 and CCKNOW has been utilized. Once this baseline information's were collected, counselling was given to patients and they were supplemented with pill cards and patient information leaflets as educational material. During the follow up visit, all the above parameters were reassessed and compared with the baseline visit. Result: About 110 IBD patients have participated in this study. In baseline visit, 6.36% patients had low adherence, 62.73% patients had medium adherence, 30.91% patients had high adherence. During follow up visit, after intervention by clinical pharamcist, 3.64% patients had low adherence, 18.18% patients had medium adherence and 78.18 % patients had high adherence. From this study, it was notified that the average score of CCKNOW was only 8.15 in the beginning. Later on, it was escalated to 11.65 during the revisit periods. Conclusion: Knowledge of patients about their disease and medications were insufficient during baseline visit. Adherence to medication was found to be poor among IBD patients. Counselling provided by clinical pharmacist about the importance of medication adherence and provision of information leaflets and pill cards lead to an improvement in medication adherence and knowledge of IBD patients. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Escitalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors. It is effective in the treatment of generalized anxiety and major depressive disorders. It also has an off-labeled use of treating mild agitation associated with dementia in non-psychotic patients. The most common adverse effects of escitalopram are a headache, fatigue, and diarrhea. Escitalopram-induced hyponatremia is rare; it is seen in elderly, especially in women. This is a rare case of escitalopram-induced hyponatremia which was observed in a 73-year-old female patient who was admitted, with complaints of increased tension and palpitation, in the psychiatry department. She also had a history of asthma for the past 30 years, a surgery done for carpel tunnel syndrome 6 years back and had no history of liver or renal disease. Tablet Nexito (escitalopram) 10 mg 1-0-0 was started as an antidepressant, and after 1 day, she developed fatigue due to hyponatremia which was evident from the laboratory values of sodium. The sodium level was found to be 122.3 mmol/l, the normal range is between 135 and 145 mmol/l. Hence, she was advised to include 2 g of salt in her diet. As she had hyponatremia, NS 3% was added, and also her dose of escitalopram was decreased to 5 mg OD, resulting in a gradual increase in the sodium level. This case showed a causality score of 8 according to Naranjo Scale and the causality to be probable.
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