A PROSPECTIVE STUDY ON DRUG DOSING EVALUATION AND CONCURRENT FEEDBACK MECHANISM BY THE CLINICAL PHARMACIST TO IMPROVE DRUG SAFETY IN PATIENTS WITH RENAL IMPAIRMENT

Ansi K. S.*, Praise Varghese, Thomas Varghese and Dr. Dhanya H.

ABSTRACT

Title: A prospective study on drug dosing evaluation and concurrent feedback mechanism by the clinical pharmacist to improve drug safety in patients with renal impairment. Plan: To assess the incidence of inappropriate dosing of prescribed drugs, to improve the rate of achieving dosage adjustment of drugs and to optimize the drug therapy in patient with renal dysfunction. Preface: Inappropriate dosing in patients with renal dysfunction can cause renal drug accumulation and toxicity. Method: Creatinine clearance or estimated glomerular filtration rate of patients with serum creatinine greater than 1.5 mg% was calculated using Cockcroft-Gault equation and Modified Diet in Renal Disease equation respectively. Dose of all prescribed drugs especially potentially nephrotoxic drugs was evaluated using the published drug dosing guidelines and the new dose or dosing interval was recommended based on the patients individual degree or stage of renal impairment. Outcome: Thousand one hundred and twelve drugs in 100 patients were evaluated. Among the 1112 evaluated drugs, 115 drugs (10.34%) were renally eliminated and among those 48 (41.73%) required dose adjustments and rest of the 12(10.43%) drugs were either not recommended in kidney disease or contraindicated. Of these, dose of 37 (77.07%) were adjusted at the time of prescribing and 11 (22.91%) were not adjusted. Conclusion: Drug dosing evaluation and concurrent feedback mechanism by the pharmacist improved drug safety in patients with renal impairment.

Keywords: Creatinine clearance, glomerular filtration rate, renal impairment, nephrotoxic drugs.