[Review of pharmaceutical interventions regarding prescriptions for oral anti-rejection drugs: feedback from a university hospital].

OBJECTIVES

Solid organ transplantation is a standard treatment for end-stage organ failure, which improves patient survival. The long-term success of the transplant depends in particular on the use of immunosuppressive treatments known as anti-rejection drugs, the dispensing of which requires rigorous pharmaceutical analysis due to their narrow therapeutic index. The detection of treatment-related issues during analysis leads to the formulation of pharmaceutical interventions.

METHODS

This study, conducted as a review of pharmaceutical interventions, aims to describe the types of pharmaceutical interventions involving oral anti-rejection drugs, with a view to standardizing clinical practice and ensuring the safe management for transplant patients. Conducted in accordance with a local procedure by a pharmacy resident and two clinical pharmacists over a five-year period, this review compiled data on each intervention (121), their clinical impact according to the rating system of the French Society of Clinical Pharmacy, and their acceptance rate.

RESULTS

The main issues related are inappropriate route and/or administration (37%), drug interactions (23%) and overdoses (19%). Two-thirds of issues were attributed to calcineurin inhibitors, primarily tacrolimus. Issues with moderate clinical impact were the most common, particularly those related to drug interactions involving cyclosporine. The acceptance rate (38%) found in the study was lower than the national average, regardless of the clinical impact of the adverse drug reaction. No overall association was found between the type of IP and its acceptance (p = 0.50).

CONCLUSION

These findings confirm the value of a systematic pharmaceutical review of oral anti-rejection prescriptions and highlight the importance of improving communication with prescribers.