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Galatti L, Mazzaglia G, Greco A, Sessa E, Cricelli C, Schito GC, Nicoletti E, Spina E, Caputi AP. Co-prescriptions with
itraconazole and fluconazole as a signal for possible risk of drug-drug interactions: a four-year analysis from
Italian general practice.
Pharmacoepidemiol Drug Saf 2007; 16(4):422-8
ABSTRACT. PURPOSE: To determine the prevalence of concomitant use of drugs potentially responsible for interactions
among itraconazole and fluconazole users in general practice. METHODS: During the years 1999-2002, we obtained
information from the `Health Search Databasť, (HSD) an Italian general practice research database. Among a total
sample of 457 672 eligible patients, we included those aged >16 years, and whose diagnoses could be classified as
mycosis. Itraconazole and fluconazole users were then selected. A potentially drug-drug interaction (DDI) occurred
when the use of concomitant drugs were recorded within +/-30 days from the date of the first azoles prescription.
Interacting drugs were classified according to the summary of product characteristics (SPC) as provided by the Italian
Pharmaceutical Repertory (REFI). RESULTS: From 18 323 cases of mycosis, we selected 4843 itraconazole and 1446
fluconazole users. Potentially interacting drugs were prescribed in 8.7% of itraconazole and 6.1% of fluconazole
users. For itraconazole, calcium channel blockers were the most common interacting drugs (3.3%), followed by statins
(1.7%) and clarithromycin (1.3%), whereas gestoden + ethynylestradiol (2.5%) and benzodiazepines (1.8%) resulted
as the most common interacting drugs among fluconazole users. CONCLUSION: Data indicate a relevant prevalence of
concomitant use of medications potentially leading to drug interactions among azoles users. Because of the wide use of
these medications in general practice, they should be used with clinical monitoring in view of their known side effects
as well as their potential risk for drug interaction.
Tragni E, Filippi A, Mazzaglia G, Sessa E, Cricelli C, Catapano A. Monitoring statin safety in primary care.
Pharmacoepidemiol Drug Saf 2007; 16(6):652-7
ABSTRACT. PURPOSE: To verify General Practitioners (GPs) compliance to the recommended laboratory monitoring
for statin users. METHODS: A retrospective study was conducted collecting data from the database of Italian College
of General Practitioners, named Health Search; all the participant physicians used an automatic pop-up which reminds
them to periodically check liver enzyme levels in statin-users. We examined the patients who received their first statin
prescription from 29 November 1999 to 28 November, 2002. CPK, ASL, AST, and creatinine values recorded before and
after the first prescription were evaluated. The minimum and maximum observation time before and after prescription
were 6 and 42 months, respectively. The prevalence of laboratory monitoring prescribed by GPs was calculated at
baseline and during follow-up for all patients and for the subgroup of high-risk patients. RESULTS: We identified 14
120 first-ever statin users (male 47.4%). CPK, AST, ALT and creatinine tests were prescribed at least once at baseline in
8.5%, 53.9%, 50.9%, and 64.0% of patients, respectively; during the follow-up 37.8%, 64.4%, 60.3%, and 61.5%
of patient received the same tests prescriptions, respectively. No difference between high-risk and non-high-risk patients
was observed. During the follow-up enzyme levels greater than three times the upper normal limit were recorded in
0.4%, 0.1%, 0.1%, and 0.3% of subjects for CPK, AST, ALT and creatinine, respectively. CONCLUSION: Adherence
to the recommended laboratory monitoring for statin users is very low among Italian GPs, even for high-risk patients.
Automatic reminders which pop-up whenever statins are prescribed are ineffective.
Gelatti U, Samani F, Donato F, Covolo L, Mazzaglia G, Cremaschini F, Simon G, Leggieri G, Balestrieri M. Health-related
quality of life in older people using benzodiazepines: a cross-sectional study. Ann Ig 2006; 18(4):313-26
ABSTRACT. Aim of this study is to investigate the QoL older people making regular use of BDZ. All subjects aged 65-84
years attending their General Practitioners were invited to fill in a questionnaire about their consumption of BDZ and all
the subjects consuming BDZ to fill in the Medical Outcome Measures Short Form-36 (MOS SF-36) and the Primary Care
Evaluation of Mental Disorders (PRIME-MD) questionnaires. A total of 2,246 subjects used BDZ and 1,109 (49.4%) of
them filled in the MOS SF-36 questionnaire. 1,005 of these participants also completed the PRIME-MD questionnaire
(90.6%). The presence of sleep disorders and the characteristics of the BDZ used were not associated with any score
in the MOS SF-36 questionnaire, whereas the Prime diagnosis was the most important predictor, since subjects with
depression and/or anxiety had a lower mean score on each scale than subjects without disorders. Among a sample of
Italian seniors taking BDZ, QoL was associated with the presence of anxiety and/or depression. Age, gender, education
and the presence of cardiovascular diseases or stroke were associated with specific aspects of QoL, when anxiety and
depression were controlled for.