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We assessed the effect of body weight and BMI on plasma concentrations of venlafaxine (VEN), O-desmethylvenlafaxine (ODVEN), active moiety (AM=VEN+ODVEN), and dose-corrected plasma concentrations (C/D). A database containing concentrations of VEN and ODVEN including 737 of 1594 eligible patients was analyzed. Analyses included sex, body weight, and BMI as well as concentrations of VEN, ODVEN, AM, and C/D. A positive correlation was detected between body weight and daily dosage (rs=0.168, P<0.001). A negative correlation was found between body weight and AM (rs=-0.124, P=0.001) and ODVEN (rs=-0.137, P<0.001). Negative correlations were also found between body weight and C/D ratios (C/D VEN: rs=-0.134, P<0.001, C/D ODVEN: rs=-0.239, P<0.001, C/D AM: rs=-0.256, P<0.001). No correlations were detected between BMI and concentrations for VEN, ODVEN, and AM. Comparing low-BMI (<20 kg/m²), medium-BMI (20-29.9 kg/m²), and high-BMI (≥30 kg/m²) groups, higher values of some pharmacokinetic variables in the lower BMI group did not remain significant after controlling for sex. Women had higher VEN, ODVEN, AM, and C/D values for AM, VEN, and ODVEN than men (P<0.001 for all comparisons). Our results highlight the role of different pharmacokinetically relevant parameters and foremost of sex as mediators for the effect of BMI on VEN metabolism.

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Zusammenfassung Ziel der Studie war es zu überprüfen, ob die Verordnung „potenziell inadäquater Wirkstoffe“ (PIW) mit einem erhöhten Risiko für unerwünschte Arzneimittelwirkungen (UAW) einhergeht. Methodik 304 stationäre gerontopsychiatrische Patienten wurden in die Studie eingeschlossen. Anhand der klinischen Daten und Verlaufsdokumentationen wurden Hinweise auf UAW identifiziert. Der Kausalzusammenhang der UAW und der verordneten Wirkstoffe wurde von Experten bewertet. Ergebnisse Vor der stationären Aufnahme erhielten ca. 30 % aller Patienten ≥ 1 PIW, bei Entlassung waren es 22 %. Risikofaktoren für die Verordnung ≥ 1 PIW waren zunehmende Anzahl verordneter Wirkstoffe und Schizophrenie. Protektiv wirkten daher die Faktoren Demenz und zunehmendes Lebensalter. Die Verordnung von ≥ 1 PIW führte zu einem 5-fach erhöhten Risiko für das Auftreten von ≥ 1 UAW; das Risiko für UAW stieg mit der Zahl der PIW. Die Verordnung von ≥ 1 PIW ging mit einem 4-fach erhöhten Risiko für das Auftreten schwerwiegender UAW einher. Bei Einnahme von ≥ 2 PIW war das Risiko hierfür sogar um ein 10-Faches erhöht. Schlussfolgerungen Die PRISCUS-Liste bildet wesentliche Risiken für das Auftreten von UAW in der Gerontopsychiatrie ab.

<b><i>Background:</i></b> Severe asthma commonly affects 5–10% of the asthmatic population and accounts for approximately 50% of the overall asthma costs. <b><i>Objective:</i></b> This analysis investigated how severe asthma is diagnosed, treated, and managed by specialists and general practitioners (GPs) in Switzerland. <b><i>Methods:</i></b> Two surveys, one each among specialists (<i>N</i> = 44) and GPs (<i>N</i> = 153), were conducted to understand their self-perception on diagnosis, treatment, and management of severe asthma. <b><i>Results:</i></b> Fifty-five percent of the specialists felt very confident and 43% confident in recognizing the symptoms of severe asthma and diagnosing severe asthma. In contrast, 9% of the GPs were very confident and 59% confident in diagnosing severe asthma. More specific diagnostic tests for severe asthma, like total and specific immunoglobulin E levels and measurement of the fraction of exhaled nitric oxide, were run by specialists (χ² = 171.4; df = 15, <i>p</i> &#x3c; 0.001). GPs and specialists were using different measurements to assess severe asthma (χ² = 385.2; df = 13, <i>p</i> &#x3c; 0.001) and their prescribing patterns differed significantly (χ² = 189.8; df = 10, <i>p</i> &#x3c; 0.001). GPs referred patients with severe asthma if the diagnosis was unclear (24%), if treatment failure occurred (26%), and if the patients were at high risk (41%). <b><i>Conclusions:</i></b> Oral corticosteroids (OCSs) are considered as background therapy for severe asthma by GPs and specialists. In order to reduce the OCS burden, there is a need to improve the awareness for other add-on therapies. A joint collaboration between GPs and specialists is the key to leverage therapeutic strategies together.