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Antihypertensive drugs utilisation and educational activities

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Velickovic-Radovanovic R., Petrovic J., Kodela B., Janković S.
Open Medicine
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2010
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vol. 5
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issue 5
627-635
EN
The mortality rate from cardiovascular diseases is high in Serbia. Analysis of antihypertensive drugs utilization is the basis for assessment of cardiovascular pharmacotherapy appropriateness. The aim of this study was to analyze the trend in antihypertensive drugs utilization among outpatients in Niš region, South Serbia compared to some Nordic countries (Norvay, Sweden) and Australia as well as to analyze trends in educational and drug promotion activities directed to primary healthcare workers within the same region. Using the ATC/DDD methodology, we analyzed the utilization of antihypertensive drugs dispensed on prescription in the Nis region over the 2003–2007 period. The study was retrospective, based on data obtained from Central City Pharmacy Nis. Educational and drug promotion activities were noted from the records of Medical Faculty, University of Nis, and from the records of local branches of pharmaceutical companies active in Serbia. Wilcoxon’s test was used in order to calculate the statistical significance of difference. A significant increase of 79.8% (153.8/ 276.6 DDD/inhabitants/day) in antihypertensive drug consumption was observed in the same period. This analysis showed there were substantial increases in the use of diuretics (134.7%), ACE inhibitors (79.5%) and calcium channel blockers (116.1%), especially amlodipin (241.2%). During the observed period, annual numbers of educational activities and of pharmaceutical sales representatives employed within the region increased for almost one fourth. This analysis pointed to a significant increase in the use of antihypertensive drugs in the Nis region, which was matched with increase in educational and drug promotion activities within the region, so that in 2006–2007 total consumption was approximate to some referential countries (Norvay, Sweden).
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Interactions between Tacrolimus and Metronidazole in a renal transplant patient

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Catic-Djordjevic A., Velickovic-Radovanovic R., Stefanovic N., Cvetkovic T.
Open Medicine
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2012
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vol. 7
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issue 5
587-590
EN
We present a case which reports the occurrence of a potential elevation of Tacrolimus (Tac) plasma levels to toxic values in a renal transplant recipient after adding Metronidazole (Met) to the medication regimen. A 30-year old female, status post living-related renal transplant, who was stabilized on Tac 4.5 mg, twice daily, for 4 months, presented to the clinic with diarrhea. We used Microparticle Enzyme Immunoassay (MEIA) to determine Tac trough concentration (trough concentrations 5–10 ng/ml). After 6 days of Met therapy on 1.5 g/d, Tac trough concentration and serum creatinine (sCr) increased to 20.2 ng/ml and 7.8 mg/dl respectively. Met therapy was discontinued, also one dose of Tac was withheld, while daily dose was decreased to 2 mg/d. Four days after Met discontinuation, Tac concentration dropped to 8.7 ng/ml, sCr to 2.1 mg/dl, warranting Tac dose increase to 3 mg/d. Co-administration of Tac with Met may result in elevated Tac concentrations, possibly leading to tacrolimus nephrotoxicity. Clinicians should be aware of this potential interaction and closely monitor Tac concentration and renal function.
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Acute renal failure after licorice ingestion: A case report

76%
Velickovic-Radovanovic R., Mitic B., Kitic D., Kostic S., Cvetkovic T., Djordjevic V.
Open Medicine
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2011
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vol. 6
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issue 1
113-116
EN
A 39-year-old female presented to the nephrology clinic emergency department with a complaint of muscle weakness and stomach pain. A detailed personal history revealed ingestion of 50–100 g herbal products which contained licorice, every day for 8 weeks to treat sterility. The herbal product was studied and determined to contain ‘licorice’ containing glycyrrhizic acid. Licorice (a plant which contains glycyrrhizic acid) induced hypokalemia which usually has a mild progression. However, it may cause critical failure in physical action by means of weakness followed by paralysis and may cause rhabdomyolysis, acute renal failure and hyperaldosteronism. This report presents the first case with acute renal failure due to licorice consumption from Serbia. In addition, the report aims to emphasize the importance of obtaining the detailed personal history of a patient for precise diagnosis.
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