Renal drug dosing recommendations: evaluation of product information for brands of the same drug

Khanal, A.; Peterson, Gregory M.; Castelino, Ronald L.; Jose, Matthew

doi:10.1111/imj.12446

Cited by 13 publications

(8 citation statements)

References 15 publications

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“…An example of this generalised information was the recommendation to ‘gradually taper’. This finding is similar to another recent finding that the PI provided some information on adjustments in renal failure, but that it lacked sufficient detail to action …”

Section: Discussionsupporting

confidence: 90%

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Informing deprescribing decisions in older people: does the Product Information contain advice on medication use for older people and medication withdrawal?

Page

Clifford

Potter³

et al. 2018

Pharmacy Practice and Res

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Background Product Information (PI) details the indications for prescribing, dosage and administration, and recognised side effects and contraindications. No formal requirement exists for PI to include information on medication use in older people and what to expect while withdrawing medication (deprescribing). Deprescribing has a focus on older people, so we designed this study to evaluate how frequently the PI includes information on medication withdrawal and medication use in older people. Methods We identified PIs currently available from the Therapeutic Goods Administration website for medications commonly used by older people. Data were abstracted using data extraction tables for eight categories of information, including statements of possible withdrawal effects, specified advice on discontinuation strategies and specified advice for older people. Results We retrieved the PI for 99 different medications. Statements of possible withdrawal effects were provided in half of the PIs (n = 57). Of these, three PIs specified scenarios that constituted clinical criteria for withdrawal of the medication from long‐term use. The majority of PIs (n = 73) did not provide specified advice on discontinuation strategies. Of these medications, 23 PIs provided specific recommendations and three PIs made a general recommendation to gradually withdraw medication. Discussion Almost all the PIs reviewed included information about medication use in older people, but only half included information about medication withdrawal. The inclusion of information about discontinuation effects and strategies may improve PIs.

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Section: Discussionsupporting

confidence: 90%

“…This finding is similar to another recent finding that the PI provided some information on adjustments in renal failure, but that it lacked sufficient detail to action. 30 Professionals rely on information to support medication decisions. 22 Clinical guidance on how and when to deprescribe medications is currently limited.…”

Section: Discussionmentioning

confidence: 99%

Informing deprescribing decisions in older people: does the Product Information contain advice on medication use for older people and medication withdrawal?

Page

Clifford

Potter³

et al. 2018

Pharmacy Practice and Res

View full text Add to dashboard Cite

show abstract

“…Another important aspect to consider is the inconsistencies with dosage adjustment recommendations between different drug information sources, as well as the product information of different brands of the same drug. [13,14] Most of the medications with PIP were consistent with previous studies. [2] Antidiabetic agents and cardiovascular drugs were commonly associated with PIP, which is not surprising given that both diabetes and CVD often co-exist with CKD.…”

Section: Discussionsupporting

confidence: 87%

Quality Use of Medicines in Patients With Chronic Kidney Disease

Castelino

Saunder

Kitsos

et al. 2020

Preprint

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Objective: To determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures.Design: Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). Setting & Participants: All adults (aged ≥18 years) with chronic kidney disease (CKD) presenting to general practices across Australia.Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation.Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

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“…Another important aspect to consider is the inconsistencies with dosage adjustment recommendations between different drug information sources, as well as the product information of different brands of the same drug. [14,15] It is important to note that most drug information sources provide dosage adjustment based on the CG equation rather than eGFR formulae (MDRD/CKD-EPI), whilst eGFR (especially CKD-EPI) based formulae have been found to be the most accurate indicator of kidney function. [16] Secondly, many of the recommendations based on the CG equation are questionable due to the variability in creatinine assays at the time and were prior to SCr being isotope dilution mass spectrometry (IDMS) standardised.…”

Section: Discussionmentioning

confidence: 99%

Quality Use Of Medicines In Patients With Chronic Kidney Disease

Castelino

Saunder

Kitsos

et al. 2020

Preprint

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Background: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures.Methods Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values <60 mL/min/1.73m2, and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

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Renal drug dosing recommendations: evaluation of product information for brands of the same drug

Abstract: The reporting of renal function quantification methods, and associated dosage recommendations, in PI requires standardisation to ensure optimal drug dosing. Regularly updating of PI is also necessary.

Cited by 13 publications

References 15 publications

Informing deprescribing decisions in older people: does the Product Information contain advice on medication use for older people and medication withdrawal?

Informing deprescribing decisions in older people: does the Product Information contain advice on medication use for older people and medication withdrawal?

Quality Use of Medicines in Patients With Chronic Kidney Disease

Quality Use Of Medicines In Patients With Chronic Kidney Disease

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