BackgroundRilpivirine/Emtricitabine/Tenofovir (RPV/FTC/TDF) is a single tablet regimen recommended for treatment-naïve HIV patients with baseline viral load (VL) < 100.000 copies/mL.1 PurposeTo analyse the usage profile, effectiveness and safety of RPV/FTC/TDF.Material and methodsRetrospective study conducted in a Primary Hospital between May 2013–Sept 2014. Patients included were those with HIV infection who started RPV/FTC/TDF treatment. Data were collected from electronic medical records: Demographics, previous antiretroviral therapy (ART), reason for treatment, immunovirological status, laboratory data (VL, CD4, c-LDL, Total Cholesterol) and adverse effects before/after start of RPV/FTC/TDF. Adherence was assessed by the dispensing records and the Simplified Medication Adherence Questionnaire (SMAQ) (patients were considered adherent with scores over 95%).ResultsRPV/FTC/TDF was initiated in 21/390 (5%) patients with ART. Age (years): 45 (range: 31–70); Male: 14/21 (68%). Patients with previous ART: EFV/FTC/TDF: 7; FTC/TDF/ATV/r: 2; 3TC/AZT/NVP: 1; 3TC/AZT/LPV/r: 1; ABC/AZT/LPV/r: 1; TDF/FTC/NVP: 1; FTC/TDF/ETV: 1; FTC/TDF/DRV/r: 1; DRV/r: 1; FTC/TDF: 1. Reasons for prescription: 17 ART-experienced (81%) and 4 ART-naïve (19%). Pretreated reasons: 9 (53%) simplifications, 6 (36%) to avoid previous ART toxicity (EFV: 4, Protease Inhibitors: 2) and 2 (11%) others. Three patients were withdrawn (low adherence: 2, pantoprazole interaction: 1). Pre-treatment data: Adherence > 95% 7/17 (41%), VL < 50 copies/mL: 8/21 (38%), pretreated VL < 50 copies/mL: 8/17 (47%), CD4: 507, c-LDL: 114 mg/dL, Total cholesterol: 180 mg/dL. Post-treatment data: Adherence > 95%: 17/21 (80%), patients simplified to RPV/FTC/TDF who achieved >95% adherence: 6/9 (66%), VL < 50 copies/mL: 18/21 (85%), pretreated VL < 50 copies/mL: 16/17 (94%), CD4: 563, c-LDL: 102 mg/dL, Total cholesterol: 164 mg/dL. Reduction in c-LDL and Total Cholesterol was 10% and 9% respectively, which is consistent with previous studies.2 Only one patient experienced headaches during the first week with RPV/FTC/TDF.ConclusionRPV/FTC/TDF was used primarily as a strategy for simplification and to avoid ART toxicity, mainly due to EFV. All patients had undetectable VL, improved adherence (+39%), effectiveness (11% increase in CD4) and treatment was well tolerated. Lipid profile was improved too.ReferencesEACS Guidelines Version 7.02. June 2014Sharma M, Saravolatz LD. J Antimicrob Chemothe 2013;(68):250–6No conflict of interest.

BackgroundThe use of an alternative liquid anaesthetic sevoflurane has recently been reported in the literature on vascular ulcers. Topical application for management of analgesia appears to be successful.PurposeTo evaluate the stability of sevoflurane in pure polypropylene amber syringes.Material and methodsCommercial solutions of sevoflurane (Sevorane) were packed in polypropylene syringes. The syringes were stored at 23°C for 14 days in a digitally temperature-controlled chamber. The physical parameters monitored were clarity and colour. Chemical stability was determined by means of 19-Fluorine Nuclear Magnetic Resonance (19F-NMR) and gas chromatography coupled with a Flame Ionisation Detector (GC-FID).ResultsOver the 14 days, the clarity and lack of colour of the solutions were maintained. 19F-NMR signals identical to those of the original product were observed in all samples, corresponding to the chemical structure of unchanged sevoflurane. Meanwhile, in the GC-FID analysis, no additional peaks occurred at the storage temperature. No degradation products were observed by either analytical technique.ConclusionPure sevoflurane preserved in amber polypropylene syringes was stable for 14 days at room temperature. This enables it to be stored in a more convenient way, and provides greater comfort in drug instillation onto the ulcer bed from the syringe.References and/or acknowledgementsUniversity of Almería.No conflict of interest.

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BackgroundBotulinum toxin (BT) is a neurotoxin produced by C. botulinum that blocks the release of acetylcholine at peripheral cholinergic nerve endings.PurposeTo evaluate the profile of BT use in our hospital, as well as the savings due to the manufacture of pre-filled syringes in the Pharmacy Department.Material and methodsRetrospective study (Jan–Dec 2013). Data collected: IU consumed of BT, doses, Medical Department, number of patients, indication and cost. Vials of BT (100 IU) were reconstituted with sterile saline 0.9% (in a Horizontal Laminar Flow cabinet). The reconstituted solution was stable for 4–24 h at 2–8°C.1,2 After reconstitution pre-filled syringes were prepared and conditioned with the exact doses requested. After processing, the remaining material was discarded in an appropriate container.ResultsBT manufactured (IU): 11,615, 259 patients (682 doses). Consumption/ Medical Department, Pain Unit: 4,208 IU, General Surgery: 3,074 IU, Rehabilitation: 1,900 IU, others: 2,433 IU. Doses more frequently used were 7 IU/0.21 mL by General Surgery (392), 75 IU/2 mL and 100 IU/2 mL by Pain Unit (31 units and 19 units, respectively) and 5 IU/0.15 mL by Ophthalmology (48). The main ward using pre-filled syringes was General Surgery (400), followed by Ophthalmology (135), Pain Unit (75), others (72). The cost of BT was €28,482.5. 80% of BT was used in blepharospasm and focal spasticity. The manufacture of pre-filled syringes in the Pharmacy Department represented a saving of 81 vials. We estimate a potential saving/year (direct cost) of €12,729.6 (-45%).ConclusionThe Pain Unit and Surgery General presented the higher consumption of BT. The manufacture of pre-filled syringes by the Pharmacy Department allowed us to optimise the consumption of this drug, achieve considerable cost savings as well as ensure the sterility of the process.ReferencesXeomin®. Botox®. No conflict of interest.

BackgroundDarunavir/cobicistat (DRV/COB) is the first fixed combination inhibitor of protease. Both are metabolised by the cytochrome CYP3A4, the reason why they are susceptible to present a multitude of drug interactions (DI).PurposeTo describe the DI of DRV/COB in HIV patients to avoid and to optimise therapy.Material and methodsRetrospective observational study performed in a county hospital. We reviewed the digital clinical history to collect the following data: patients treated with DRV/COB from 1 January 2016 to 1 November 2016, demographics, duration of treatment, concomitant medications, drugs involved, and DI. We review HIV-drug interactions using the database of the University of Liverpool to classify DI according to the mechanism of action (MA) and their potential severity. The pharmaceutical intervention (PI) was to notify to the prescribing physician, by report attached in the patient’s medical record, the contraindicated interactions (CI).ResultsThirty-five patients, 51% males (n=18). Race: 54% non-Caucasian (n=19). Median age 37 years (IQR 64–20). Median days of treatment 195 (IQR 465–22), total of concomitant medications 199, median 5 (IQR 1–19), DI 31% (n=62) median 1 (IQR 0–8), 40 drugs involved in DI. Type of DI according to their MA: CYP3A inhibition 62% (n=25), inhibition CYP2D6 10% (n=4), inhibition CYP3A and CYP2D6 7% (n=3) and inducer CYP3A 5% MA 15% (n=6). DI type according to its potential severity: high (CI) 15% (n=6) (midazolam, budesonide, phenobarbital, ivabradine, simvastatin and domperidone); and potential: 89% (n=35). PI: accepted 3 (50%): one change from simvastatin to rosuvastatin, one change from phenobarbital to levetiracetam and a change from midazolam to lormetazepam.ConclusionA high rate of DI is observed in patients receiving treatment with DRV/COB. The most relevant interactions are observed at the level of the CYP3A family. Acceptance of PI was low in the case of CI detected, probably because the prescribing physician was unaware of it. To have a higher success rate we could have made a phone call to him to put him on notice. The pharmacist is important in optimising drug therapy.References and/or AcknowledgementsThanks to all my colleagues in the Hospital de Poniente for their selfless helpNo conflict of interest