Annals of Pharmacotherapy (Ann Pharmacother)

Journal description

The Annals of Pharmacotherapy was founded in 1967 as an international, independent journal for pharmacists, physicians, nurses, and other healthcare professionals. It continues to be the leading peer-reviewed journal dedicated to the advancement of safe, effective, and economical use of medications in patient care. Article categories include: Original Research, Comprehensive Reviews, Case Reports, Editorials, Visual Observations, International Reports.

Current impact factor: 2.92

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 2.923
2012 Impact Factor 2.567
2011 Impact Factor 2.126
2010 Impact Factor 2.166
2009 Impact Factor 2.453
2008 Impact Factor 2.305

Impact factor over time

Impact factor

Additional details

5-year impact 2.44
Cited half-life 6.70
Immediacy index 0.55
Eigenfactor 0.01
Article influence 0.72
Website The Annals of Pharmacotherapy website
Other titles Annals of pharmacotherapy (Online), Annals of pharmacotherapy, Ann pharmacother
ISSN 1542-6270
OCLC 47647817
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Identifying patients at high risk for multidrug-resistant urinary tract infections (UTIs) is important for guiding empirical antimicrobial therapy. Clinical risk factors associated with antimicrobial-resistant urinary pathogens and the derivation of a simple clinical decision rule could help define health care-associated UTI. To derive a simple clinical decision rule to identify clinical risk factors associated with antimicrobial-resistant urinary pathogens. This was a retrospective case-control study of all emergency department (ED) patients from July 1, 2011, to July 1, 2012, who presented to the ED with UTI and a positive urine culture. Candidate risk factors were collected retrospectively from medical record review. We compared differences in patient characteristics stratified by the presence of an antimicrobial-resistant urinary pathogen. A total of 360 patients with UTI had a positive, noncontaminated urine culture during the study period. About 6.7% of patients (n = 24) had a multidrug-resistant (MDR) urinary infection. Logistic regression modeling identified 3 clinical factors associated with the identification of a MDR pathogen: male sex, chronic hemodialysis, and nursing home residence. A scoring system was created to identify patients with MDR pathogens. Test characteristics were calculated using bootstrapping for internal validation, with a sensitivity of 74.7% (95% CI = 55.1%-91.3%) and specificity of 85.1% (95% CI = 77.8%-86.2%), positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.3. Clinical factors can be used to identify UTI patients at high risk of MDR urinary pathogens. © The Author(s) 2015.
    Annals of Pharmacotherapy 03/2015; DOI:10.1177/1060028015578259
  • Annals of Pharmacotherapy 01/2015; 49(1):127-129.
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    ABSTRACT: Several case reports have documented acute kidney injury (AKI) attributable to antibiotic-impregnated cement (AIC) spacers. To identify AKI risk factors among patients who underwent AIC placement and determine whether vancomycin-AIC placement affects systemic vancomycin dosing. Phase 1 was a case-control study to identify AKI risk factors among patients who underwent AIC placement. Cases experienced AKI; controls had unchanged renal function. Phase 2 was a retrospective cohort study. Patients who received ≥72 hours of intravenous (IV) vancomycin were divided into 2 groups according to whether they underwent vancomycin-AIC placement. Primary outcome was number of vancomycin dosing changes. Phase 1: Among 26 cases and 74 controls AKI risk factors on univariate and multivariable analysis included exposure to angiotensin-converting-enzyme (ACE) inhibitor exposure within 7 days of AIC placement (42% vs 20%, P = 0.03) and piperacillin-tazobactam within 7 days following AIC placement (31% vs 12%, P = 0.03). Phase 2: Among 53 patients who underwent vancomycin-AIC placement and 104 who underwent another surgery type, vancomycin was adjusted more frequently in patients who underwent vancomycin-AIC placement (28% vs 15%, P = 0.06). Among patients who undergo AIC placement with vancomycin and/or tobramycin, exposure to ACE inhibitors and piperacillin-tazobactam are associated with increased risk of AKI in the immediate postoperative period. No empirical adjustments to IV vancomycin dosing are necessary in patients undergoing vancomycin-AIC placement.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014535360
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    ABSTRACT: To evaluate the literature for published reports regarding the efficacy of standard versus higher dosing of oseltamivir in critically ill patients with severe influenza. An English-language literature search was conducted using MEDLINE (1966-February 2014) using the terms oseltamivir and influenza limited to humans and adults older than 19 years. Additional articles were identified through a manual search of the references obtained from the MEDLINE search. Articles were manually screened for inclusion related to pharmacokinetic or clinical studies comparing varying doses of oseltamivir, particularly in the critically ill patient population. Studies investigating the pharmacokinetics of oseltamivir in continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) were also included. During the 2009 H1N1 influenza pandemic, the World Health Organization suggested 150 mg twice daily as a consideration in critically ill patients with severe influenza. The basis for the recommendation can be traced back to animal studies investigating the H5N1 virus. Three different studies in humans investigating higher doses in severe influenza have found no differences in clinical outcomes between standard and higher dosing. Pharmacokinetic studies suggest adequate absorption in critically ill patients. Although no dosage adjustment appears to be needed for ECMO patients, reduction may berequired for CRRT.. . Although additional data are needed for a definitive conclusion, the small body of literature available in humans does not support routine use of high-dose oseltamivir in critically ill patients.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014535362
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    ABSTRACT: Many medications used in older adults have strong anticholinergic (ACH) properties, which may increase the risk of falls and fractures. Use of these medications was identified in a population-based Canadian cohort. To identify the fall and fracture risk associated with ACH medication use. Data collection and analysis were conducted at baseline, year 5, and year 10. Cross-sectional analyses were performed to examine associations between ACH medication use and falls. Time-dependent Cox regression was used to examine time to first nontraumatic fracture. Finally, change in bone mineral density (BMD) over 10 years was compared in ACH medication users versus nonusers. Strongly ACH medications were used by 618 of 7753 participants (8.0%) at study baseline, 592 (9.5%) at year 5, and 334 (7.7%) at year 10. Unadjusted ACH medication use was associated with falls at baseline (odds ratio = 1.50; 95% CI = 1.14-1.98; P = 0.004), but the association was no longer significant after covariate adjustment. Similar results occurred at years 5 and 10. ACH medication use was associated with increased incident fracture risk before (hazard ratio = 1.22; CI = 1.13-1.32; P < 0.001) but not after covariate adjustment. Mean (SD) change in femoral neck BMD T-score over 10 years, in those using ACH medications at both years 0 and 5, was -0.60 (0.63) in ACH users versus -0.49 (0.45) in nonusers (P = 0.041), but this was not significant after covariate adjustment. ACH medications were not found to be independently associated with an increased risk of falling, fractures, or BMD loss. Rather, factors associated with ACH medication use explained the apparent associations.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014535363
  • Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014535200
  • Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014533666
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    ABSTRACT: To review the literature evaluating the efficacy of dornase alfa for non-cystic fibrosis pediatric patients with pulmonary atelectasis. Articles were retrieved after a search of MEDLINE/PubMed (1946 to April 2014), and International Pharmaceutical Abstracts (1970-April 2014) was performed using the terms dornase alfa, recombinant human deoxyribonuclease, pulmonary, persistent, and atelectasis. Other relevant articles referenced from the MEDLINE search were also utilized. Data sources were limited to English language clinical trials and case studies including only children; 8 clinical trials and 12 case reports met the criteria. Dornase alfa is used as an off-label treatment option for pulmonary atelectasis because limited treatment modalities exist after conventional therapy has failed. We evaluated 8 clinical trials and 12 case reports involving this pediatric population with varying primary diagnoses. The majority of patients experienced improvement in atelectasis, suggesting benefit after receiving treatment with dornase alfa. However, the outcomes were possibly confounded by those receiving combination therapies, varying primary diagnoses, and varying end points evaluated. Dornase alfa was overall well tolerated, with only a few patients experiencing worsening atelectasis posttreatment. Dornase alfa may be considered as a therapeutic option in non-cystic fibrosis pediatric patients with pulmonary atelectasis, who require treatment intervention when conventional therapy is unsuccessful.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014535199
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    ABSTRACT: To provide a clinical overview of the antidepressant levomilnacipran. Articles were identified by searching the MEDLINE, PubMed, Cochrane Library, and databases through March 2014 using the keyword levomilnacipran. The manufacturer provided additional information from unpublished phase II and phase III trials. Any clinical trial conducted for at least 3 weeks and published in the English language was selected for review. Additional documentation, including the product dossier, package insert, pharmacokinetic studies, and poster presentations supplied by the manufacturer, was also evaluated. Levomilnacipran is the more potent enantiomer of milnacipran. It is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), dosed from 20 to 120 mg daily for the treatment of major depressive disorder (MDD). Efficacy and tolerability were established during 3 phase III randomized, double-blind placebo-controlled trials finding levomilnacipran to be significantly more efficacious than placebo in reduction of Montgomery-Åsberg Depression Rating Scale scores. It is not known whether this agent is more efficacious than other antidepressants because direct comparison studies have not been conducted as of the time of this review. Levomilnacipran demonstrates efficacy and tolerability for short-term treatment of MDD in adults. Available evidence does not strongly indicate that there is a specific subpopulation of patients who would benefit from levomilnacipran over currently available SNRIs. Full characterization of the agent's place in therapy alongside multiple other agents with similar mechanisms and efficacy requires trials with longer duration and active comparators.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014535074
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    ABSTRACT: To review the use of sofosbuvir for the treatment of chronic hepatitis C virus (HCV). Review and nonreview articles were identified through MEDLINE (1996-April 2014), citations of articles, and meeting abstracts using keywords, including NS5B polymerase inhibitor, GS-7977, sofosbuvir, direct-acting antiviral (DAA), and others. Phase 1, 2, and 3 studies describing dose-ranging potential, pharmacokinetics, efficacy, safety, and tolerability of sofosbuvir were identified. Sofosbuvir is an NS5B polymerase inhibitor that was approved for use by the Food and Drug Administration in December 2013 for the treatment of chronic HCV in combination with pegylated interferon (peg-IFN) and ribavirin (RBV) for genotype 1. Additionally, it has been evaluated with other oral DAAs, such as simeprevir and others in the pipeline. It is not recommended as monotherapy because of lower sustained virological response (SVR) rates in clinical studies. Most of the treatment regimens are 12 weeks in duration; however, certain populations require a longer duration. Sofosbuvir has activity against all 6 genotypes, although most clinical trials evaluated genotypes 1 to 3. Sofosbuvir has a favorable safety and tolerability profile, making it a recommended first-line agent for chronic HCV infection. In clinical trials, 12 weeks of sofosbuvir with concomitant peg-IFN and RBV therapy in treatment-naïve and experienced HCV genotype 1 patients resulted in SVR rates of >90%. An all-oral regimen of sofosbuvir and RBV is highly effective for genotype 2 and 3 patients. Sofosbuvir was found to be tolerable with minimal adverse effects (AEs), and no treatment discontinuations occurred secondary to drug related AEs..
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014534194
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    ABSTRACT: To summarize the literature regarding antiretroviral and other medication errors in hospitalized HIV-positive patients and to discuss potential interventions and solutions that have been studied to minimize drug error. A systematic search of MEDLINE, PubMed, and EMBASE (2000-April 2014) was conducted. Search terms included HIV/AIDS, HAART, hospitalization, patient admission, inpatient, patient transfer, medication error, inappropriate prescribing, drug interaction, drug omission, drug toxicity, and contraindication. English-language research articles, case reports, conference abstracts, and letters to the editor were reviewed. A high overall medication error rate was reported in HIV-positive inpatients. Errors occurred mainly at the time of prescribing on admission but were also detected throughout hospitalization and at discharge. Errors in the antiretroviral regimen, dosing, scheduling, and drug-drug and drug-food interactions were the most common. The most successful interventions involved a clinical pharmacist, who specializes in infectious diseases and/or HIV, completing medication reconciliation on admission, reviewing orders daily, and screening for errors at discharge. Although studies varied greatly in methodology, overall, a large number of medication errors occurred in this patient population. This underscores the important role the pharmacist has in optimizing care to hospitalized HIV-positive patients and provides further insights into the types of medication errors that occur and proposed solutions to reduce these errors. Because medication errors are multifactorial, ongoing initiatives to improve the quality of medication reconciliation processes, educate the health care team on antiretroviral medications, and improve the drug distribution system are required.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014534195
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    ABSTRACT: Topiramate (TPM) is a sulfamate-substituted monosaccharide that is structurally different from other antiepileptic drugs. TPM inhibits carbonic anhydrase activity, which is associated with loss of bicarbonate from the kidney and consequently metabolic acidosis or electrolyte imbalance. The objectives of the study were to investigate the influence of TPM therapy on bicarbonate and potassium levels in adult epileptic patients. Data were collected from 59 adult patients on monotherapy or co-therapy of TPM and other antiepileptic drugs. Serum bicarbonate and potassium levels were available from all patients. Steady-state TPM trough concentrations were determined in blood samples by high-performance liquid chromatography. Data analysis was performed by SPSS software (version 17, Chicago, IL). Patients were divided into group A (duration of therapy shorter than or equal to 5 years) and group B (duration of therapy longer than 5 years). Significant difference (P < 0.05) in serum bicarbonate levels was observed between these 2 groups. Bicarbonate levels were linearly related to the TPM therapy duration. No correlation was found between the TPM dose or patient age and bicarbonate or potassium levels, as well as between therapy duration and potassium level. Linear regression analysis showed no significant association among 54 available TPM trough concentrations and bicarbonate or potassium levels. Results highlight the frequent occurrence of lower bicarbonate level associated with prolonged TPM therapy. Monitoring bicarbonate levels in patients on long-term TPM therapy might be useful.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014534397
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    ABSTRACT: To report a case where rivaroxaban was used in the management of an ovarian vein thrombosis and to briefly review the literature, pathophysiology, and clinical implications therein. A 30-year-old previously healthy woman was diagnosed with acute, spontaneous, left-ovarian vein thrombosis (OVT) with proximal extension into the renal vein. After initial catheter-directed thrombolysis with tPA, angioplasty of the left renal vein, and heparinoid treatment, rivaroxaban was begun for long-term anticoagulation. Three months after her index event she was symptom free, with complete resolution of her thrombosis and no adverse effects or bleeding complications from rivaroxaban. To our knowledge, this is the first report of OVT successfully treated with rivaroxaban. OVT is a rare but potentially fatal cause of abdominal pain that may pose diagnostic and therapeutic dilemmas. Factor V Leiden (FVL) homozygosity, an uncommon but severe inherited thrombophilia, increases the risk of thrombosis by approximately 50- to 80-fold. This case report and accompanying literature review highlight important clinical pearls related to the diagnosis and management of OVT and inherited thrombophilias. This clinical vignette adds to the published literature suggesting that novel oral anticoagulants, such as rivaroxaban, may eventually emerge as an alternative to vitamin K antagonists for the treatment of extra-axial thromboses. Reporting these cases is important because their prevalence is low outside of specialized referral centers, and thus, dissemination of these experiences may help other providers in treating their patients.
    Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014533304
  • Annals of Pharmacotherapy 05/2014; 48(5):667. DOI:10.1177/1060028014521590
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    ABSTRACT: To describe a case of a patient diagnosed with major depressive disorder whose trigeminal neuralgia was unexpectedly but rapidly and efficiently responsive to duloxetine. A 37-year-old woman was diagnosed with trigeminal neuralgia, and the initial treatment with carbamazepine 800 mg/d did not improve her pain. In the following 3 years, she was poorly responsive to the combination therapy with several medications, including carbamazepine, valproate, baclofen, diclofenac, and acetaminophen. The repeated gamma knife radiosurgery still did not relieve her symptoms. She developed clinically significant depressive symptoms, and a diagnosis of major depressive disorder was made. Duloxetine 30 mg/d was initiated for the management of depression, with the dose gradually increased to 60 mg/d. Unexpectedly, at the dose of 60 mg/d, the patient reported remarkable relief in her trigeminal neuralgia within the first week. Her depressed mood gradually improved in the following 3 weeks. At the 4-year follow-up, she was gradually tapered off her medications, and her depression and trigeminal neuralgia were well managed on duloxetine 60 mg/d and carbamazepine 600 mg/d. The mechanisms may be related to duloxetine's ability to modulate norepinephrine and serotonin and antagonize N-methyl-d-aspartate (NMDA) receptors. The ignition hypothesis is a proposed etiology of trigeminal neuralgia, in that any individual hyperexcitable neuron can spread its discharge quickly to activate the entire population of neurons. We suggest that duloxetine exerts desynchronizing effects through its NMDA antagonism, modulating the hyperexcitable state of the trigeminal afferents. Duloxetine may be an adjuvant in treatment-resistant trigeminal neuralgia.
    Annals of Pharmacotherapy 04/2014; 48(8). DOI:10.1177/1060028014532789
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    ABSTRACT: Cisplatin is a widely used antineoplastic. One of the major complications of cisplatin use is dose-limiting nephrotoxicity. There are many strategies to prevent this toxicity, including the use of mannitol as a nephroprotectant in combination with hydration. We aimed to evaluate the rates of cisplatin-induced nephrotoxicity in cancer patients receiving single-agent cisplatin with and without mannitol. This single-center retrospective analysis was a quasi experiment created by the national mannitol shortage. Data were collected on adult cancer patients receiving single-agent cisplatin as an outpatient from January 2011 to September 2012. The primary outcome was acute kidney injury (AKI). We evaluated 143 patients who received single-agent cisplatin; 97.2% of patients had head and neck cancer as their primary malignancy. Patients who did not receive mannitol were more likely to develop nephrotoxicity: odds ratio [OR] = 2.646 (95% CI = 1.008, 6.944; P = 0.048). Patients who received the 100 mg/m(2) dosing and patients who had a history of hypertension also had a higher likelihood of developing nephrotoxicity: OR = 11.494 (95% CI = 4.149, 32.258; P < 0.0001) and OR = 3.219 (95% CI = 1.228, 8.439; P = 0.017), respectively. When limited quantities of mannitol are available, it should preferentially be given to patients at particularly high risk of nephrotoxicity. Our analysis suggests that those patients receiving the dosing schedule of 100 mg/m(2) cisplatin every 3 weeks and those with hypertension are at the greatest risk of nephrotoxicity and would benefit from the addition of mannitol.
    Annals of Pharmacotherapy 04/2014; 48(7). DOI:10.1177/1060028014533303
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    ABSTRACT: To describe an elderly male patient with a prior history of New York Heart Association (NYHA) class I heart failure (HF) who presented with cardiac decompensation related to pregabalin therapy and to review the literature involving the effects of pregabalin in HF patients. An 84-year-old man with NYHA class I HF (left-ventricular ejection fraction between 45% and 50%) presented to the emergency department with acute HF decompensation approximately 10 days after initiation of pregabalin for the management of peripheral neuropathy. Discontinuation of pregabalin and administration of furosemide resulted in resolution of symptoms. Shortness of breath; facial, neck, and peripheral edema; and weight gain all improved within 2 days. Three months following discontinuation of furosemide and pregabalin, the patient remained stable without any recurring symptoms or progression in HF. Pregabalin is associated with a 10% to 15% prevalence of peripheral edema and weight gain, with cases reported in patients both with and without HF. Whereas most reported HF exacerbations have occurred in patients with NYHA class II to IV HF, this case is one of the first to be reported in a patient with NYHA class I. According to the Naranjo probability scale (score of 4), it was possible that the patient's HF symptoms were related to pregabalin. The mechanism of action of pregabalin-induced HF is unknown, but pregabalin has been shown to act as a calcium channel antagonist. Although further studies are needed, this case suggests that close monitoring of patients with NYHA class I HF should be considered when initiating pregabalin therapy.
    Annals of Pharmacotherapy 04/2014; 48(8). DOI:10.1177/1060028014530551