Jan Schjøtt

• Professor
• Consultant at Haukeland University Hospital

Written drug information to patients

Background Inappropriate prescribing may have detrimental consequences for the patient and increase healthcare utilisation and costs. Academic detailing (AD) is an interactive outreach method to deliver non-commercial evidence-based medical information to healthcare professionals, aiming to improve patient care. Performing AD virtually has recently...

Absorption, distribution, metabolism and elimination of medications vary depending on sex. Physiological differences in body composition, organ function and hormones are well documented. However, less is known about the variations in target proteins to which medications bind. The effect and adverse effects of a medication can differ depending on a...

Aim: There are discrepancies between the information patients desire about adverse drug reactions (ADRs) and the information they receive from healthcare providers; this is an impediment to shared decision-making. This study aimed to establish whether patients received information about ADRs resulting from prescribed pharmacotherapy, before hospita...

Introduction: The medicines information service, SafeMotherMedicine, regularly receives inquiries from breastfeeding women asking about antiemetics for nausea and vomiting during pregnancy (NVP) or hyperemesis gravidarum (HG). However, treatment guidelines for NVP or HG do not address the use of antiemetics in women who are breastfeeding while beco...

Self‐perceived learning outcomes of virtual academic detailing (AD) is poorly studied. We compared self‐perceived learning outcomes of virtual and in‐person AD among general practitioners (GPs). GPs from the Western region of Norway received a questionnaire before, and after, AD concerning rational pharmacotherapy of migraine in the autumn 2022. Fi...

Background Despite experiencing adverse drug reactions (ADRs) more often than men, the proportion of women participating in clinical drug trials is low. Thus, evidence for sex differences in the incidence of ADRs is limited. Aim To determine sex differences in incidence of self-reported ADRs after percutaneous coronary intervention (PCI). Further,...

Background Safety information of antiseizure medication (ASM) during breastfeeding is scarce and conflicting. We aimed to identify characteristic traits of safety concerns among healthcare professionals by reviewing enquiries to the Norwegian Regional Medicines Information and Pharmacovigilance Centres (RELIS). Method Enquiries related to breastfe...

Dear Editor, Most medications can be used while breastfeeding, however, international literature is scarce on how to best deliver such safety information to women. Several clinical and pharmacokinetic elements (e.g. infant age, degree of breastfeeding, transfer of medication into breast milk, relative infant dose, bioavailability, half-life) are ty...

Background Online information about safety of medications during pregnancy and breastfeeding is shown to be conflicting, resulting in anxiety and abstaining from use. The aim of this study was to characterize questions to SafeMotherMedicine, a web-based medicines information service for pregnant and breastfeeding women, to identify target areas tha...

Anthracyclines such as doxorubicin (Dox) are the preferred chemotherapeutics for several cancers. However, Dox-induced cardiotoxicity limits its therapeutic potential. Liposomal encapsulation of Dox has been used for patients with risk to develop Dox induced cardiotoxicity but does not surpass the efficacy of the unencapsulated drug. Statins are wi...

Background Healthcare providers are commonly reluctant to inform patients about potential adverse drug reactions (ADRs) from prescribed therapy to avoid increasing the incidence of ADRs through the nocebo effect. However, patients need information on all aspects of prescribed therapy to facilitate informed decision-making and take ownership of thei...

Objective To determine patient perceptions of generic medicines 2 and 6 months after percutaneous coronary intervention (PCI), and to determine whether these perceptions moderate medication adherence. Design Prospective multicentre cohort study with repeated measures of perceptions of generic medicines and medication adherence. Setting The CONCAR...

Background: Direct oral anticoagulants are increasingly replacing vitamin K antagonists for prevention of stroke in patients with atrial fibrillation, partly owing to the lack of a need for routine monitoring. Therapeutic drug monitoring may still be warranted under certain circumstances. It is generally assumed that serum and plasma can be interch...

Response to the comments by Kounis and colleagues on our recent article “Incidence, clinical presentation and management of myocarditis following mRNA-based Covid-19 vaccines: A brief report”, published in Cardiology. We focus on the pharmacological aspects of hypersensitivity myocarditis related to mRNA-based COVID-19 vaccines, which is believed t...

About second opinion in medicine

Background Generic medicines are bioequivalents to brand-name medicines, and compelling evidence for the safety and efficacy of generic medicines exists. However, negative perceptions about generic medicines can potentially reduce adherence to prescribed therapy and thereby efficacy of the treatment. Purpose To describe patients' perceptions of ge...

The authors describe a patient with substance use disorder admitted to the hospital with septic shock and multiorgan failure, in whom the serum concentration of methadone kept increasing despite discontinuation of the drug. Therapeutic drug monitoring (TDM) was performed to monitor the methadone serum concentration during treatment of the underlyin...

The use of ultrasound and microbubble-enhanced drug delivery, commonly referred to as sonoporation, has reached numerous clinical trials and has shown favourable results. Nevertheless, the microbubbles and acoustic path also pass through healthy tissues. To date, the majority of studies have focused on the impact to diseased tissues and rarely eval...

Background: Patients need information on all aspects of prescribed drug therapy to make informed decisions about their treatment for autonomy. Purpose: This study assessed whether patients received information about potential adverse drug reactions (ADRs) from prescribed drug therapy before or after discharge following percutaneous coronary interve...

Purpose The second-generation antipsychotic quetiapine has been associated with misuse and dependency. We aimed to review questions to the Norwegian network of drug information centers concerning this potential drug safety problem. Methods We conducted a Boolean search in the database of the Regional Medicines Information and Pharmacovigilance Cen...

Both cannabis and amphetamine are the most commonly used illegal substances worldwide and are associated with a number of adverse cardiovascular effects including transient coronary vasospasm. Here, we present the case of a 39-year-old male admitted to our institution with a 6-h history of severe chest pain and ST-segment elevation on the ECG. Coro...

Patient-centric care entails optimising healthcare provision to patients based on their perspective and opinion. It involves appropriate treatment at a reasonable cost and a focus on patient characteristics in the decision-making process to make it more personally useful. The optimisation of medicines in the older population is a challenge due to p...

Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) is challenging due to a wide age span among patients, risk of reduced adherence, and comorbidities like psychiatric disorders and drug addiction. Drugs used for ADHD are associated with risk of interactions and adverse drug reactions due to their potent pharmacological eff...

Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDS) are associated with concern of adverse drug reactions (ADRS) including gastrointestinal, cardiovascular, renal, and musculoskeletal. Non-selective and selective NSAIDS are proposed to differ with regard to their potential to cause ADRS. The aim of this pilot study was to compare perception...

PurposeApproximately 80% of pregnant women use medications. There is a need for evidence based medicines information that provide realistic risk estimates as pregnant and breastfeeding women tend to overestimate the risk of medications. The purpose of this paper is to describe the development and future perspectives of an innovative medicines infor...

Introduction: Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust the...

Pancreatic ductal adenocarcinoma (PDAC) is a major cause of cancer death worldwide. Poor drug delivery to tumours is thought to limit chemotherapeutic treatment efficacy. Sonoporation combines ultrasound (US) and microbubbles to increase the permeability of cell membranes. We assessed gemcitabine uptake combined with sonoporation in vitro in three...

Cytidine deaminase (CDA) is a determinant of in vivo gemcitabine elimination kinetics and cellular toxicity. The impact of CDA activity in pancreatic ductal adenocarcinoma (PDAC) cell lines has not been elucidated. We hypothesized that CDA regulates gemcitabine flux through its inactivation and activation pathways in PDAC cell lines. Three PDAC cel...

NURSING RESEARCH AND CLINICAL SESSION TITLE: TRANSITIONS OF CARE ACROSS SETTINGS

Drug interaction databases are integrated with dispensing software and computerised clinical decision support systems in health care and are important tools in medication reviews. The databases provide alerts about interaction risks for health care professionals.1‐3 In the absence of standardisation, there is great variation across healthcare organ...

Background: Inappropriate prescribing of psychotropics is a persistent and prevalent problem in nursing homes. The present study compared inappropriate prescribing of psychotropics in nursing homes 16 years apart with prescribing quality indicators. The purpose was to identify any change in inappropriate prescribing of relevance for medical inform...

Aim: The aim of this pilot study was to investigate whether psychotropic drugs frequently analyzed in a routine therapeutic drug monitoring (TDM) laboratory bind to low density lipoproteins/very low-density lipoproteins (LDL/VLDL) in human serum. Methods: Drug concentrations in 20 serum sample pools containing one psychotropic drug each, and in...

The Norwegian network of drug information centres (RELIS) has achievements in person-centred and personalised medicine. RELIS receive questions from physicians, pharmacists, nurses and other health professionals and provide decision support in all aspects of pharmacotherapy. Questions associated with person-centred medicine often include problems w...

What is known and objective Appraisal of drug information centres (DICs) is mainly by word of mouth communication and surveys of overall user satisfaction. Efforts to study the impact of this type of informatics and decision support systematically are generally lacking within the healthcare system. Comment Scandinavian DICs question‐answering data...

Background: Therapeutic drug monitoring is a relevant tool in drug treatment of elderly patients. The aim of this study was to assess the possibility of therapeutic drug monitoring of the most important potential interactions in nursing homes. Methods: A material of prescribed drugs to 446 patients in three nursing homes in Bergen, Norway from a...

Purpose: Previous Phase II trials indicated clinical benefit from B-cell depletion using the monoclonal anti-CD20 antibody rituximab in patients with myalgic encephalopathy/chronic fatigue syndrome (ME/CFS). The association between rituximab serum concentrations and the effect and clinical relevance of antidrug antibodies (ADAs) against rituximab...

Background: The aim of this study was to compare use of references in responses from Scandinavian drug information centres (DICs). Methods: Six different fictitious drug-related queries were sent to each of seven Scandinavian DICs. The six queries concerned adverse effects, pharmacokinetics, pregnancy, complementary medicine, polypharmacy, and brea...

Abstract Background Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, sear...

Questions from physicians to regional medicines information and pharmacovigilance centres in Norway (RELIS) concerning older patients were described. Question–answer pairs (QAPs) from the RELIS database indexed with the category “older”, and concerning individual patients from the period 01 Jan 2010 to 31 Dec 2015, were analysed. Two-hundred and ei...

PurposeThe aim of this study was to identify structure and language elements affecting the quality of responses from Scandinavian drug information centres (DICs). Methods Six different fictitious drug-related queries were sent to each of seven Scandinavian DICs. The centres were blinded for which queries were part of the study. The responses were a...

Pregnant women, but also physicians, have unrealistically high perceptions of teratogenic drug effects. This may result in suboptimal treatment of disease and even influence decisions of whether to continue pregnancy. To attain more realistic teratogenic risk perceptions, several factors that influence this issue should be considered, and these are...

Background: The primary aim of our study was to evaluate the safety and potential toxicity of gemcitabine combined with microbubbles under sonication in inoperable pancreatic cancer patients. The secondary aim was to evaluate a novel image-guided microbubble-based therapy, based on commercially available technology, towards improving chemotherapeu...

Objectives: To examine associations between exposure to various subgroups of antipsychotic drugs and risk of hip fracture in older adults. Design: Nationwide cohort study. Setting: Norway, 2005-2010. Participants: Everyone living in Norway born before 1945 (N = 906,422). Measurements: Information was obtained on all prescriptions of antips...

Purpose: The aims of this study were to assess the quality of responses produced by drug information centers (DICs) in Scandinavia, and to study the association between time consumption processing queries and the quality of the responses. Methods: We posed six identical drug-related queries to seven DICs in Scandinavia, and the time consumption...

Purpose: Clinical decision support provided by drug information centers is an intervention that can ensure rational drug therapy for pregnant women. We have examined whether physicians' teratogenic risk perceptions and confidence in prescribing drugs to pregnant women is altered after advice from the Norwegian drug information centers, Regional Me...

Polypharmacy and complex drug treatment regimens are becoming increasingly common, which may lead to adverse drug reactions, drug interactions, medication nonadherence, and increasing costs and thus challenge the rational use of drugs. At the same time, the accessibility of drug information increases, and health care professionals may have limited...

What is known and objective: Questions about psychotropic drugs are frequently submitted to drug information centres (DICs). Twenty years' experience from Norwegian DICs was used to identify particular challenges in responding to those questions. Comment: Questions about psychopharmacological therapy are usually patient-related and are often dif...

Purpose The cloned enzyme donor immunoassay (CEDIA) for buprenorphine is applied for both urine drugs-of-abuse screening and compliance monitoring. Sensitivity, specificity, and optimal cutoff of this assay have differed between studies. This may indicate that cross-reactivity has to be taken into account during assay evaluation. We therefore inves...

Gemcitabine (2′,2′-difluoro-2′-deoxycytidine, dFdC) and metabolite (2′,2′-difluoro-2′-deoxyuridine, dFdU) quantification is warranted for individualized treatment strategies. Analyte stability is crucial for the validity of such quantification. We therefore studied the impact of the time interval from blood sampling to separation of plasma on gemci...

Purpose: There is little research-based documentation on the services provided by drug information centres (DICs). The aim of this multi-centre study was to explore for the first time the factors associated with time consumption when answering drug-related queries at eight different but comparable DICs. Methods: During an 8-week period, staff me...

Background Elevated cardiac troponin levels are consistent with the diagnosis of an acute coronary syndrome, but may also represent adverse drug reactions. Psychostimulating drugs raise both blood pressure and heart rate, and case reports of sudden death, stroke, and myocardial infarction have led to regulatory and public concern about the cardiova...

Background RELIS is a Norwegian network of four regional medicine-information and pharmacovigilance centers where pharmacists and clinical pharmacologists provide feedback to health care professionals in spontaneous drug-related questions and adverse drug-reaction (ADR) reports published in a question–answer pair (QAP) database (the RELIS database)...

Aim Chemotherapy with doxorubicin is limited by cardiotoxicity. Free radical generation and mitochondrial dysfunction are thought to contribute to doxorubicin-induced cardiac failure. In this study we wanted to investigate if opening of mitochondrial KATP-channels by diazoxide is protective against doxorubicin cardiotoxicity, and if 5-hydroxydecano...

Interventions to reduce the cardiotoxicity of doxorubicin are clinically relevant. Pharmacological preconditioning mimicking ischemic preconditioning has been demonstrated with morphine and represents an acceptable clinical intervention. The purpose of this study was to examine if pretreatment in vivo with morphine could reduce doxorubicin-induced...

Provision of clinically relevant information about complementary and alternative medicine (CAM) to health care professionals is not well described. The aim of the study was to assess questions about CAM to the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS). All question-answers pairs (QAPs) in the RELIS database inde...

BACKGROUND Diagnosis of rare adverse effects of drugs is particularly difficult in the presence of multiple organ failure. We present a patient who developed severe adverse effects from linezolid after 23 days' treatment with the recommended dose.CASE PRESENTATIONA male in his seventies with cardiac disease and diabetic nephropathy was admitted to...

Neuropathic pain represents a diagnostic challenge and is difficult to treat. In recent years, clinical trials have led to the development of a number of new treatment guidelines. The guidelines recommend drugs for the most important types of neuropathic pain and suggest alternatives in the event of lack of effect or intolerable adverse effects. Pa...

Objective: The aim of this study was to examine teratogenic risk perceptions and confidence in the use of medicines in pairs of pregnant women and general practitioners (GPs) through assessments of medicines information texts from patient information leaflets (PILs). Methods: A questionnaire was handed out to women attending regular ultrasound e...

Aim: Short-time models (STM) to study the cardiotoxicity (acute or chronic) of doxorubicin in rats are of interest to assess protective interventions and pathways. STM promotes more ethical animal treatment with less stress, and at a lower cost compared to established long-time models (LTM). We wanted to investigate if an STM of 9 d yields the sam...

Postgraduate courses in clinical pharmacology are important for dentists to be updated on drug therapy and information related to their clinical practice, as well as knowledge of relevant adverse effects and interactions. A traditional approach with classroom delivery as the only method to teaching and learning has shortcomings regarding flexibilit...

To explore risk perception and medicines information needs in pregnant women with epilepsy (WWE). In-depth interviews with pregnant WWE treated with antiepileptic drugs (AEDs). Ten women aged 22-39 years in 20-34 weeks' gestation were interviewed. Avoiding seizures by taking AEDs in pregnancy outweighed perceived risks, but dose adjustments during...

To assess a question-answer pair (QAP) database integrated with websites developed for drug information centres to answer complex questions effectively. Descriptive study with comparison of two subsequent 6-year periods (1995-2000 and 2001-2006). The Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS). A randomised sample...

Urinary tract infections (UTIs, including upper and lower symptomatic) are the most common infections in nursing homes and prevention may reduce patient suffering, antibiotic use and resistance. The spectre of agents used in preventing UTIs in nursing homes is scarcely documented and the aim of this study was to explore which agents are prescribed...