Therapeutic interchange standardization for antiotensin II receptor antagonists in the treatment of hypertension in the hospital setting

• Published in: Farmacia hospitalaria 2005-03, Vol.29 (2), p.104-112
• Main Authors: Porta Oltra, B, Borrás Almenar, C, Jiménez Torres, N V
• Format: Article
• Language: Spanish
• Subjects: Angiotensin II Type 1 Receptor Blockers - pharmacokinetics; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Antihypertensive Agents - pharmacokinetics; Antihypertensive Agents - therapeutic use; Humans; Hypertension - drug therapy; Pharmacy Service, Hospital - standards; Reference Standards; Therapeutic Equivalency
• ISSN: 1130-6343

Standardization of the therapeutic inter change process in the hospital setting by the establishment and spreading of standard criteria has been defined as an activity conducent to increased health care quality, and hence improved patient care. To establish standardized therapeutic swapping for angiotensin II receptor antagonists (ARA-II) in the treatment of blood hypertension, and to evaluate the suitability of therapeutic interchange in an integrated individualized drug dispensation system. Standardized therapeutic inter-change was performed based on therapeutic equivalence criteriafor ARA-Ils such as candesartan, eprosartan, irbesartan, losartan,olmesartan, telmisartan, and valsartan, according to the pharmacodynamic characteristics, dosage recommendations, pharmacokinetic characteristics and interactions of each one of them. The suitability of therapeutic interchange was assessed in terms of standardization or adaptation to this practice developed by using percentage adherence in the previous 12 months (period A) and during the 12 months following its implementation and spread(period B). The only ARA-II included in the hospital's pharmacotherapeutic guide is losartan, on which standardized therapeutic interchange for initial and maintenance doses of any drug within this class was based. The overall number of interchanges per-formed was 417-216 during period A and 201 during period B. Implementing therapeutic swapping has significantly increased adherence to explicitly established criteria by 35.2% (95% CI:25.9 to 44.5%). Similarly, during period B a reduction in the variability of therapeutic interchanges among various pharmacists was observed regarding losartan dosage. The standardization of therapeutic interchange procedures for ARA-lls allowed a reduction of the variability seen in this process, and hence the potential for medication-related problems. Another benefit of the spread of therapeutic swapping has been an increased adjustment of medical prescriptions to the hospital's pharmacotherapeutic guide.