Journal of Clinical Pharmacy and Therapeutics Impact Factor & Information

Publisher: Wiley

Journal description

The Journal of Clinical Pharmacy and Therapeutics has become established among pharmacists in various disciplines and areas of specialization as a forum for the communication of significant developments in clinical and hospital pharmacy. Its scope embraces: the manufacture, quality control and formulation of medicines; drug information services; pharmacokinetics; radiopharmacy; organisation and management of the hospital pharmacy; drug distribution systems including unit dose systems; clinical pharmacy education; all other aspects of clinical pharmacy.

Current impact factor: 1.53

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.533
2012 Impact Factor 2.104
2011 Impact Factor 1.57
2010 Impact Factor 1.649
2009 Impact Factor 1.671
2008 Impact Factor 1.755
2007 Impact Factor 1.364
2006 Impact Factor 0.966
2005 Impact Factor 1.164
2004 Impact Factor 0.984
2003 Impact Factor 1.157
2002 Impact Factor 1.324
2001 Impact Factor 1.245
2000 Impact Factor 0.902
1999 Impact Factor 0.409
1998 Impact Factor 0.529
1997 Impact Factor 0.431
1996 Impact Factor 0.355
1995 Impact Factor 0.328
1994 Impact Factor 0.442
1993 Impact Factor 0.437
1992 Impact Factor 0.281

Impact factor over time

Impact factor

Additional details

5-year impact 1.91
Cited half-life 6.30
Immediacy index 0.47
Eigenfactor 0.00
Article influence 0.51
Website Journal of Clinical Pharmacy and Therapeutics website
Other titles Journal of clinical pharmacy and therapeutics (Online), Journal of clinical pharmacy & therapeutics
ISSN 1365-2710
OCLC 45469824
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
    • Author's pre-print may not be updated with Publisher's Version/PDF
    • Author's pre-print must acknowledge acceptance for publication
    • On a non-profit server
    • Publisher's version/PDF cannot be used
    • Publisher source must be acknowledged with citation
    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Vascular endothelial growth factor (VEGF) proteins are involved in the regulation of vascular endothelium, and their inhibition led to the development of a number of drugs used for malignancies or exudative neo-vascular age-related macular degeneration (AMD). We report a case of ischemic stroke in an 87-year-old woman having received intravitreal aflibercept, a new anti-VEGF for AMD. She had been treated with ranibizumab since 2007. In 2013, ranibizumab was replaced with aflibercept, followed by a decrease in the International Normalized Ratio, complicated by a stroke a few days later. The rechallenge was positive. A potential time-dependent interaction between aflibercept and VKA antagonist and/or a direct effect of aflibercept may have contributed to the occurrence of the ischaemic stroke. Currently available data suggest some pharmacokinetic and pharmacodynamic effects of aflibercept by explaining its pro-thrombotic profile. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12278
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    ABSTRACT: Hyponatraemia, the most common electrolyte imbalance occurring in hospitalized subjects, is usually classified as hypovolaemic, euvolaemic or hypervolaemic. Hyponatraemia is a predictor of death among subjects with chronic heart failure and cirrhosis. The inappropriate secretion of the antidiuretic hormone (AVP) seems to be of pivotal importance in the decline of serum sodium concentration in these clinical conditions. The objective of this review was to summarize recent progress in management of hyponatraemia in SIADH, cirrhosis and heart failure. Literature searches were conducted on the topics of hyponatraemia and vasopressin receptor antagonists, using PubMed, pharmaceutical company websites and news reports. The information was evaluated for relevance and quality, critically assessed and summarized. The initial treatment of severe hyponatraemia is directed towards the prevention or management of neurological manifestations and consists of an intravenous infusion of hypertonic saline. Fluid restriction is indicated in oedematous states. Diuretics alone or in combination with other specific drugs remain the main strategy in the management of volume overload in heart failure. In resistant cases, ultrafiltration can lead to effective removal of isotonic fluid preventing new episodes of decompensation; however, aquapheresis is associated with increased costs and other limits. In several trials, the efficacy of vasopressin receptor antagonists in euvolaemic patients (inappropriate antidiuretic hormone secretion) or in hypervolaemic hyponatraemia (chronic heart failure, cirrhosis) has been evaluated. It was found that vaptans, which promote aquaresis, were superior to a placebo in raising and maintaining serum sodium concentrations in these subjects. Combined with conventional therapy, vasopressin receptor antagonists (AVP-R antagonists) are able to increase the excretion of electrolyte-free water and the sodium concentration. Further studies are needed to assess efficacious outcomes of aquaresis compared with aquapheresis and with conventional therapy. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12279
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    ABSTRACT: Ischaemic heart disease (IHD) is a major cause of death in developed countries. Patients with IHD are at greater risk of subsequent myocardial infarction (MI). International studies suggest that guideline recommended therapies proven to reduce this risk are underutilised. The objectives of this study were to review the use of guideline-recommended medications for the secondary prevention of IHD in Australians and identify patient characteristics influencing use of these medications. The medication regimens of community dwelling Australians with documented IHD who received a Home Medicines Review (HMR) between January 2010 and September 2012 were extracted from a pharmacist decision support software database and retrospectively reviewed. Each patient's use of antithrombotics; angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs); statins; and β-blockers (BBs) or non-dihydropyridine calcium channel blockers (CCBs) was evaluated in conjunction with documented contraindications. Guideline concordance in all four categories was classified as 'Optimal Medical Therapy' (OMT). Univariate and multivariate analyses identified patient characteristics influencing OMT use. Of the 5396 patient medication regimens reviewed, 24·3% demonstrated OMT. Guideline concordance was observed in 91·6%, 75·6%, 74·8%, and 42·4% of patients for antithrombotics, statins, ACEI/ARBs, and BB/CCBs, respectively. The independent predictors of not receiving OMT were age 75 years or over (adjusted odds ratio [AOR] 0·76; 95% confidence interval [CI] 0·67-0·87), asthma (AOR 0·69; 95% CI 0·57-0·84), and depression or anxiety (AOR 0·84; 95% CI 0·71-0·99). Diabetes (AOR 1·20; 95% CI 1·04-1·38), hypertension (AOR 1·56; 95% CI 1·36-1·79) and a high Charlson Comorbidity Index score (AOR 1·37; 95% CI 1·15-1·64) independently predicted receipt of OMT. Only one quarter of community dwelling Australian patients with IHD receive antithrombotics, ACEI/ARBs, BB/CCBs and statins. The potential consequences of these evidence-to-practice gaps are exacerbated by Australia's increasing prevalence of IHD. Healthcare professionals must work to ensure that recommended therapies are prescribed and adhered to long-term, especially in the elderly and patients with asthma and mental health problems, to reduce IHD-related mortality and morbidity and the consequent healthcare and financial impact. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12274
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    ABSTRACT: The use of prophylactic antibiotics in clean operations was routine in China before 2011. Along with the appeal for using antibiotics rationally by WHO in 2011, China launched a national special rectification scheme on clinical use of antibiotics from April that year. The scheme, aimed at achieving rational use of antibiotics, made pharmacists part of the responsible medical team. Our objective was to describe the impacts of pharmacist intervention on the use of antibiotics, particularly in urology clean operations. Pharmacists participated in antibiotic stewardship programmes of the hospital and urological clinical work and conducted real-time interventions at the same time from 2011 to 2013. Data on the use of antibiotics between 2010 and 2013 in urology were collected. Comparison of the 2013 data with those of 2010 showed that antibiotic use density [AUD= DDDs*100/(The number of patients who were treated the same period*Average days in hospital). DDDs = Total drug consumption (g)/DDD. DDD is the Defined Daily Dose] decreased by 57·8(58·8%); average antibiotic cost decreased by 246·94 dollars; the cost of antibiotics as a percentage of total drug cost decreased by 27·7%; the rate of use of antibiotics decreased from 100% to 7·3%. The study illustrates how an antibiotic stewardship programme with pharmacist participation including real-time interventions can promote improved antibiotic-prescribing and significantly decrease costs. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12275
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    ABSTRACT: In times of financial and economic hardship, governments are looking to contain pharmaceutical expenditure by focusing on cost-effective drugs. Because of their high prices and difficulties in demonstrating effectiveness in small patient populations, orphan drugs are often perceived as not able to meet traditional reimbursement threshold value for money. The aim of this study was to provide an overview of the available evidence on the cost-effectiveness of orphan drugs. All orphan drugs listed as authorized on the website of the European Medicines Agency on 21 November 2013 were included in the analysis. Cost-utility analyses (CUAs) were identified by searching the Tufts Medical Center Cost-Effectiveness Analysis Registry and Embase. For each CUA, a number of variables were collected. The search identified 23 articles on the Tufts registry and 167 articles on Embase. The final analysis included 45 CUAs and 61 incremental cost-utility ratios (ICURs) for 19 orphan drugs. Of all ICURS, 16·3% were related to dominant drugs (i.e. more effective and less expensive than the comparator), 70·5% were related to drugs that are more effective, but at a higher cost, and 13·1% were related to dominated drugs (i.e. less effective and more expensive than the comparator). The median overall ICUR was €40 242 per quality-adjusted life year (QALY) with a minimum ICUR of €6311/QALY and a maximum ICUR of €974 917/QALY. This study demonstrates that orphan drugs can meet traditional reimbursement thresholds. Considering a threshold of £30 000/QALY, in this study, ten (52·6%) of a total of 19 orphan drugs for which data were available meet the threshold. As much as fifteen orphan drugs (78·9%) are eligible for reimbursement if a threshold of €80 000/QALY is considered. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; 40(3). DOI:10.1111/jcpt.12271
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    ABSTRACT: Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs. However, the quantum clinical benefit of newer and more expensive PPIs over the older generation PPIs remains uncertain. This meta-analysis sought to assess the clinical and safety profiles of esomeprazole versus omeprazole at pharmacologically equivalent doses in healing gastroesophageal reflux disease (GERD), peptic ulcer disease and eradicating Helicobacter pylori (H. pylori) infection. PubMed and the Cochrane Library were searched for randomized controlled trials comparing esomeprazole with omeprazole at all doses up to February 2015. Trials were assessed by two reviewers for eligibility according to predefined study inclusion criteria. Meta-analysis was conducted using a random effects model, and heterogeneity in the estimated effects was investigated using meta-regression. Sensitivity analysis was performed to test the robustness of the findings. Fifteen trials were included and none of which compared esomeprazole with omeprazole in peptic ulcer disease. The included studies had not evaluated esomeprazole 20 mg versus omeprazole 40 mg. In GERD, esomeprazole 40 mg (relative risk (RR) = 1·07; 95% confidence interval (CI) 1·02 to 1·12) and 20 mg (RR=1·04; 95% CI 1·01 to 1·08) significantly improved esophagitis healing when compared with omeprazole 20 mg at week 8. The corresponding numbers needed to treat were 17 and 30, respectively. No significant difference was observed between esomeprazole 20 mg and omeprazole 20 mg at week 4. In H. pylori eradication, there was no difference in the treatment effects between esomeprazole 20 mg and omeprazole 20 mg (RR = 1·01;95% CI 0·96 to 1·05). Their safety profiles were comparable. Esomeprazole demonstrated better esophagitis healing rate in patients with GERD than omeprazole at week 8. However, this clinical advantage diminished when both drugs were given at the same doses at week 4. Superiority of esomeprazole was not observed in the H. pylori eradication rates. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12277
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    ABSTRACT: The Food and Drug Administration (FDA) instituted a risk evaluation mitigation strategy (REMS) for erythropoiesis-stimulating agent (ESA) use in patients with cancer in February 2010. Implementation of REMS was considered likely to reduce ESA use and increase red blood cell transfusions. We aimed to quantify ESA and transfusion use pre- and post-REMS. A retrospective data analysis was conducted using the Medicare 5% Sample Database from 2008 through 2011. Patients were 66 years of age or older and had lung and/or breast cancers along with chemotherapy-induced anaemia. Patients initiated chemotherapy in pre-REMS and post-REMS periods (1Q2008 through 4Q2009 and 1Q2010 through 4Q2011, respectively). Logistic regression was used to evaluate differences in proportions of patients receiving ESAs and transfusions pre-REMS and post-REMS. The pre-REMS group included 1526 patients and the post-REMS group included 1689 patients. ESA use in patients with lung cancer decreased 30·2% from pre- to post-REMS and 33·1% in patients with breast cancer. Both decreases were statistically significant. Transfusion rates increased 22·1% from the pre-REMS period to the pre-REMS period in patients with breast cancer (P < 0·0001), but there was no statistically significant change over time in patients with lung cancer. Erythropoiesis-stimulating agent use decreased in patients with both lung and breast cancer (P < 0·0001), and transfusion rates increased significantly post-REMS in patients with breast cancer (P < 0·0001) but not in those with lung cancer. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; 40(3). DOI:10.1111/jcpt.12269
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    ABSTRACT: Off-label medication is often used in the treatment of paediatric patients. However, it should be restricted due to the lack of evidence related to its efficacy and safety. Little is known about the frequency of off-label drug use or the degree of scientific evidence supporting this practice in Indonesia. The aim of this study was to investigate the off-label prescribing practice for paediatric patients in Bandung city, Indonesia. We conducted a retrospective and population-based study including 4936 prescriptions written by paediatricians for 0- to 5-year-old patients from 14 selected community pharmacies in 2012 and analysed the off-label uses. Of the total prescriptions, 18.6% contained at least one off-label drug. Furthermore, 7% of the 16 516 prescribed drugs were categorized as off-label. Of all of the prescribed drugs, doxycycline and domperidone were the most prescribed drugs with off-label indications. This is the first study that shows a significant number of off-label drugs prescribed for children in Indonesia; therefore, efforts should be made to scrutinize under-evaluated off-label prescribing practices that may compromise patient safety. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12276
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    ABSTRACT: Since their introduction, tyrosine kinase inhibitors (TKIs) have been increasingly used in clinical practice. We describe the prescribing and the clinical and biological consequences of two such inhibitors, imatinib and erlotinib, in patients with chronic myeloid leukaemia (CML) in a practice setting over a period of more than 10 years. All patients who received at least one TKI for chronic phase CML between 2001 and 2012 in our university hospital were included in the study. Of the 139 patients, with a median age of 57 years, who were surveyed, imatinib and nilotinib were prescribed as the first TKI in 131 (94%) and 8 (6%) patients, respectively. With a median follow-up of 6 years, 342 treatment modifications were observed: 113 (33%) increased doses, 109 (32%) decreased doses, 89 (26%) TKI changes, 14 (4%) definitive discontinuations, 13 (4%) temporary discontinuations and 4 (1%) additions of IFN-α. The main reasons for the 342 treatment modifications were adverse events (n = 112, 33%), long-term optimal response (n = 58, 17%) and failure (n = 57, 17%). Eighty-five (61%), 31 (22%), 18 (13%) and 5 (4%) patients had no, 1, 2 and 3 TKI changes, respectively. Imatinib was the most prescribed TKI (75%). Adverse events resulting in treatment modifications occurred in 18% of patients for imatinib, 49% for nilotinib and 41% for dasatinib (P < 0·001). Median time to TKI change whatever the reason was >50 months (not achieved) for imatinib, 22 months for nilotinib and 27 months for dasatinib (log-rank test, P < 0·001). Imatinib was the most prescribed TKI both in the first and in subsequent therapeutic lines for chronic phase CML. Our study showed a very good efficacy-safety profile for imatinib at a median follow-up of 6 years in an unselected French population. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12273
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    ABSTRACT: What is known and objectiveVancomycin is administered via intermittent infusion (II) almost exclusively in the United States, whereas continuous infusion (CI) dosing methods are used regularly in many European countries. The purpose of this literature analysis is to review current evidence regarding the advantages and disadvantages of CI vancomycin in relation to II, based on the pharmacokinetic and pharmacodynamic aspects of dosing and monitoring therapy, and to identify current practices of CI vancomycin dosing.Methods Medline, Cochrane and GoogleScholar databases were searched using vancomycin as a MeSH term, along with continuous and infusion in all fields, which identified 136 citations. A second search added the terms intermittent and survey, producing nine additional articles. All articles that reported an assessment of CI or II vancomycin administration in adult patients, based on clinical, pharmacokinetic, cost or monitoring considerations, were identified. A total of 43 publications were determined to be suitable for final analysis and possible inclusion in the report.Results and discussionA meta-analysis of six studies concluded that CI vancomycin was associated with a lower relative risk of kidney injury than II therapy, although other studies reported equivocal findings. The results of several clinical studies suggest that CI vancomycin produces clinical outcomes that are comparable to II. Current vancomycin consensus guidelines promote aggressive dosing to achieve trough levels of 10–15 or 15–20 mg/L, but also include recommendations to target a daily area under the curve (AUC24) to minimum inhibitory concentration (MIC) ratio of at least 400. Because vancomycin is a non-concentration-dependent antibiotic, it might be more prudent to monitor steady-state serum concentrations (Css) during a CI rather than trough concentrations during II, due to the questionable correlation between measured trough concentration and AUC. From a pharmacokinetic/pharmacodynamic perspective, vancomycin dosing and monitoring practices associated with CI offer potentially greater reliability than II. A major disadvantage of CI involves the possibility of having to intravenously co-administer another drug that might not be compatible with vancomycin.What is new and conclusionContinuous infusion vancomycin therapy offers the advantage of Css monitoring, thus avoiding the variabilities associated with the timing of trough levels. Current CI practices include a loading dose of 15–20 mg/kg followed by an infusion of 10–40 mg/kg/day based on the patient's renal function, with a target Css of about 20–30 mg/L. An alternative approach to weight-based (mg/kg) CI dosing is to calculate the dose from an estimation of the patient's vancomycin clearance (in L/h), derived from creatinine clearance (CrCl) via the equation (CrCl∙0·041) + 0·22. The daily dose is then determined by multiplying vancomycin clearance (in L/h) by the desired AUC24. A new CI vancomycin dosing chart includes clearance-based dosing recommendations for Css values ranging from 17·5 to 27·5 mg/L or AUC24 values ranging from 420 to 660 mg h/L. Although sufficient data already exist to support the use of CI vancomycin as a reasonable therapeutic alternative to II, there is still much to learn about administering the drug in this fashion.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12270
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    ABSTRACT: What is known and objectiveOne-third of patients with epilepsy are resistant to anti-epileptic drugs (AEDs). Drug-resistant epilepsy is believed to be multifactorial involving both genetic and non-genetic factors. Genetic variations in the ABCB1 gene encoding the drug efflux transporter, p-glycoprotein (p-gp), may influence the interindividual variability in AED response by limiting drugs from reaching their target. Phenobarbital (PB), one of the most cost-effective and widely used AEDs in developing countries, has been reported to be transported by p-gp. This study aimed to investigate the association of a genetic variant, ABCB1 3435C>T, and non-genetic factors with phenobarbital response in Thai patients with epilepsy.Methods One hundred and ten Thai patients with epilepsy who were treated with PB maintenance doses were enrolled in this study. Two phenotypic groups, PB-responsive epilepsy and PB-resistant epilepsy, were defined according to the International League Against Epilepsy (ILAE) criteria. Subjects were genotyped for ABCB1 3435C>T (rs1045642). Multiple logistic regression analysis was tested for the association of ABCB1 3435C>T polymorphism and non-genetic factors with PB response.Results and discussionSixty-two PB-responsive epilepsy subjects and 48 PB-resistant epilepsy subjects were identified. All genotype frequencies of the ABCB1 3435C>T SNP were consistent with the Hardy–Weinberg equilibrium (P > 0·05). The ABCB1 3435C>T polymorphism and type of epilepsy were associated with response to PB. Patients with PB-resistant epilepsy had a significantly higher frequency of ABCB1 3435CC genotype and had focal epilepsy more often than patients with PB-responsive epilepsy (adjusted OR = 3·962, 95% CI = 1·075–14·610, P-value = 0·039; adjusted OR = 5·936, 95% CI = 2·272–15·513, P-value < 0·001, respectively). The model explained 25·5% of the variability in response to PB (R2 = 0·255).What is new and conclusionThai patients of ABCB1 3435CC genotype and with focal epilepsy were more often PB resistant. Those two factors partly account for the variability in Thai epilepsy patients’ response to phenobarbital.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12263
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    ABSTRACT: CoenzymeQ10 (CoQ10 ), or ubiquinone, is an endogenous enzyme cofactor produced by most human cells. It is a potent antioxidant and is necessary for energy production in mitochondria. Diabetes mellitus is a chronic disease with multiple metabolic abnormalities, principally resulting from the inflammation and oxidative stress associated with mitochondrial dysfunctions. Clinical trials of the effects of supplementary CoQ10 on metabolic control in diabetes have reported inconsistent results. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effects of CoQ10 supplementation on glycaemic control, lipid profile and blood pressure in patients with diabetes. A systematic search was conducted on MEDLINE, The Cochrane Library, CINAHL, NCCAM, Web of Science, Scopus, and historical search of reference lists of relevant articles. The bibliographic databases were searched from inception to February 2015. We included randomized, placebo-controlled trials of CoQ10 in diabetes lasting at least 12 weeks. HbA1c or fasting plasma glucose had to be reported. Primary outcome was glycemic control, and secondary outcomes were lipid profile and blood pressure. Treatment effect was estimated with mean difference. Seven trials were included in the meta-analysis, involving 356 patients. Neither CoQ10 alone nor CoQ10 plus fenofibrate improved glycemic control. In addition, CoQ10, alone or in combination with fenofibrate, did not alter LDL-C, HDL-C and blood pressure. Triglycerides levels were significantly reduced with CoQ10 (mean difference -0·26 mmol/L, 95% CI -0·05 mmol/L to -0·47 mmol/L, P = 0·02) and CoQ10 plus fenofibrate (mean difference -0·72 mmol/L, 95% CI -0·32 mmol/L to -1·12 mmol/L, P = 0·0004). CoQ10 plus fenofibrate also effectively reduced total cholesterol (mean difference: -0·45 mmol/L, 95% CI -0·06 mmol/L to -0·84 mmol/L, P = 0·02). CoQ10 supplementation has no beneficial effects on glycemic control, lipid profile or blood pressure in patients with diabetes. However, it may reduce triglycerides levels. Due to limited data availability, well-powered and well-designed randomized controlled trials are needed to clearly determine the effect of CoQ10 on metabolic profile in diabetes. Dosage effects should also be explored. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12280
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    ABSTRACT: The endogenous opioid system co-evolved with chemical defences, or at times symbiotic relationships, between plants and other autotrophs and heterotrophic predators - thus, it is not surprising that endogenous opioid ligands and exogenous mimetic ligands produce diverse physiological effects. Among the endogenous opioid peptides (endomorphins, enkephalins, dynorphins and nociception/orphanin FQ) derived from the precursors encoded by four genes (PNOC, PENK, PDYN and POMC) are the pentapeptides Met-enkephalin (Tyr-Gly-Gly-Phe-Met) and Leu-enkephalin (Tyr-Gly-Gly-Phe-Leu). The physiological effects of the enkephalins are mediated via 7-transmembrane G protein-coupled receptors, including delta opioid receptor (DOR). We present a concise update on the status of progress and opportunities of this approach. A literature search of the PUBMED database and a combination of keywords including delta opioid receptor, analgesia, mood and individual compounds identified therein, from industry and other source, and from DOR agonist and antagonist ligands have been developed with ever increasing affinity and selectivity for DOR over other opioid receptor subtypes and studied for therapeutic utility, primarily for pain relief, but also for other clinical endpoints. Selective DOR agonists have been designed with a large increase in therapeutic window for a variety of potential CNS applications including pain, depression, and learning and memory among others. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; 40(2):155-66. DOI:10.1111/jcpt.12244
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    ABSTRACT: It has been reported that more than 80% of out-of-hospital medication errors among the young children involve liquid formulations. The usefulness of pictorial aids to improve communication of medication instructions has not been extensively investigated for child health. The objective of this study was to determine the effectiveness of pictorial aids used to assist caregivers in the administration of liquid medications. MEDLINE, CINAHL, PsycINFO, ScienceDirect, Scopus and the Cochrane Library were searched for articles published up to February 2015. Studies that used pictorial aids with liquid medications and measured at least one of the following outcomes were included: dosing accuracy, comprehension of medication instructions, recall of information and adherence of caregivers. Two authors independently selected studies, extracted data and assessed methodological quality of studies using the Cochrane Collaboration's tool. Five experimental studies (four hospital based and one community based) with a total of 962 participants were included. A wide range of liquid formulations were studied, including both prescription and over-the-counter medications. The existing findings suggest that pictographic interventions reduced dosing errors, enhanced comprehension and recall of medication instructions and improved adherence of caregivers. Incorporating pictorial aids into verbal medication counselling or text-based instructions was more beneficial than using the single approach alone. Mixed results were identified for the relationship between health literacy of caregivers and effectiveness of pictorial aids. The evidence remains limited due to the small number of studies found and variations in methodological quality. This review suggests that pictorial aids might be potential interventions, but more high-quality studies are needed to support the routine use of any pictogram-based materials with liquid medications in the clinical settings. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 04/2015; DOI:10.1111/jcpt.12272
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    ABSTRACT: Aspirin is an important drug in acute coronary syndromes (ACS) and percutaneous coronary interventions (PCI). However, its use is contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency (risk for haemolytic anaemia). We report the management of 2 patients with class II G6PD deficiency and non-ST-segment elevation ACS (NSTE-ACS). The two patients were safely and efficiently treated with dual antiplatelet treatment (DAPT, aspirin plus ticagrelor) and PCI using new-generation drug-eluting stent (DES) despite G6PD deficiency. NSTE-ACS management with DAPT and DES is probably safe and effective in class II G6PD-deficient patients. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 03/2015; DOI:10.1111/jcpt.12262
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    ABSTRACT: Variation of the cytochrome P450 2C19 gene coding for the CYP2C19 enzyme has been reported to be associated with clopidogrel response variability. The activity of the CYP2C19 enzyme is genetically influenced by polymorphisms of its gene. This study was conducted to assess the impact of CYP2C19 polymorphism on the clopidogrel metabolism, indirectly selecting the plasma concentration ratios of clopidogrel to its inactive metabolite SR26334 as an evaluation index. Genotyping and plasma concentration results of 366 patients on clopidogrel maintenance therapy (75 mg daily dose) were analysed in this study. CYP2C19 genotypes were determined by PCR-restriction fragment length polymorphism method. As for CYP2C19, patients were classified into three metabolism genotype groups: EM (44·3%), IM (43·4%) and PM (12·3%). The mean plasma concentration ratio of clopidogrel to its inactive metabolite SR26334 for the entire sample was 0·507. The plasma concentration ratios of the 3 metabolism groups were significantly different (P < 0·001). The lowest plasma concentration ratio value was observed for PM patients. Polymorphism of CYP2C19 was significantly associated with plasma concentration ratios of clopidogrel to its inactive metabolite SR26334. Clopidogrel metabolism was regulated by CYP2C19. The *2 and *3 allele carriage were independently associated with the antiplatelet effect of chronic clopidogrel therapy. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 03/2015; DOI:10.1111/jcpt.12254
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    ABSTRACT: Rituximab-induced interstitial lung disease (R-ILD) has aroused more concern in recent years. Anti-TNF-α treatment has been suggested for the treatment of severe R-ILD, due to the plausible suggestion that its pathogenesis is related to TNF-α. This commentary aimed to comment on the role of TNF-α antagonists in R-ILD. Although most R-ILD patients respond well to glucocorticoids, other treatment options are needed for patients who are refractory to conventional treatment. Contrary to expectations, the TNF-α antagonist etanercept brought no benefit in R-ILD. Moreover, TNF-α-targeted therapies were reported to induce or exacerbate interstitial lung disease. The role of TNF-α in the pathogenesis of R-ILD is still unclear due to limited studies on its aetiology. Use of TNF-α antagonists in R-ILD is still speculative, as clinical trials do not support its efficacy. What's more, TNF-α antagonists may themselves induce interstitial lung disease with poor prognosis. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 03/2015; DOI:10.1111/jcpt.12252
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    ABSTRACT: High levels of adherence to antiretroviral therapy (ART) are needed to achieve the desired results. Because pharmaceutical care might contribute to improved adherence to treatment, the aim of this study was to assess the impact of pharmaceutical interventions on ART via a systematic review of randomized clinical trials (RCT). Study selection, data extraction and risk-of-bias assessment were performed independently by two reviewers. A total of 681 studies were located; only four of these met the inclusion criteria and were analysed. The summary measure corresponding to the outcome adherence to treatment was 1·47 (95% confidence interval [CI]: 0·81-2·65), and the measure corresponding to the outcome virologic suppression was 1·95 (95% CI: 0·61-6·25). The results suggest that pharmaceutical interventions might contribute to improved adherence to ART and the achievement of virologic suppression, although the differences between the intervention and control groups were not statistically significant. Pharmaceutical interventions might be more efficacious in populations with low adherence to treatment and greater vulnerability. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 03/2015; DOI:10.1111/jcpt.12253
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    ABSTRACT: Metamizole (dipyrone) is an analgesic that has been the focus of considerable controversy regarding its safety. Because of potentially life-threatening blood disorders such as agranulocytosis, it has been withdrawn in many countries but not in Germany, where prescribing even increased over recent years. We aimed to evaluate prescribing of metamizole in Germany with respect to age, sex and regional variations. Using data of a statutory health insurance, we analysed a cohort of 1·7 million persons who were insured at least 1 day in each quarter of 2009. Outcome of interest was the outpatient prescription prevalence, for example the proportion of persons receiving at least one prescription of metamizole. A total of 6·8% received metamizole with a higher prescribing prevalence in females (7·8% vs. 6·0%). The prevalence increased with age up to 26·7% in persons ≥85 years (men: 21·1%; and women: 30·4%). We found large regional variations with higher prevalences in the northern part of Germany. Most of the prescriptions were issued by general practitioners (78·9%). 58·3% were liquid oral formulations with considerable regional variations ranging between 32·3% in Mecklenburg-West Pomerania and 67·3% in North Rhine-Westphalia. Overall, liquid oral forms are much more often prescribed in the western than in the eastern part of Germany. Metamizole - a drug with a relatively narrow indication - is often prescribed in Germany with relevant differences by age, sex and region. Qualitative studies should clarify reasons for this. Further quantitative research should investigate small-area variations, indications and treatment durations. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Pharmacy and Therapeutics 03/2015; DOI:10.1111/jcpt.12261