Browsing by Author "Aporanee Chaiyakum"

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    Doripenem pharmacokinetics in hemodialysis
    (2020-07-01) Sirin Phenphinan; Aporanee Chaiyakum; Suphat Subongkot; Chantana Aromdee; Porpon Rotjanapan; Montira Assanatham; Siriluk Jaisue; Khon Kaen University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © Wolters Kluwer Health, Inc. All rights reserved. Background Doripenem is a broad spectrum carbapenem with activity against gram-positive, gram-negative, and anaerobic bacteria. The drug concentration in target sites is an important determinant of carbapenem efficacy. Doripenem is primarily eliminated by kidneys and can be removed by hemodialysis. The purpose of this study was to determine the pharmacokinetics of doripenem in hemodialysis patients with moderate to severe infections. Methods This prospective, single-center study was conducted in end-stage renal disease patients undergoing hemodialysis and receiving doripenem. Low-flux hemodialysis was performed for 4 hours. Blood and dialysate samples were collected during hemodialysis and nonhemodialysis periods. The doripenem concentrations in plasma and dialysate were measured by reverse phase high performance liquid chromatography. The total amount of drug removed during hemodialysis was determined and the hemodialysis clearance of doripenem was calculated using PKSolver, the add-in program for Microsoft Excel. The appropriate dose of doripenem was estimated using Monte Carlo simulation. Results Six patients were eligible for the study. The fraction of doripenem eliminated via hemodialysis was 51.31%. The mean total amount of doripenem removed by 4 hours of hemodialysis was 1472.06 ± 861 mg at a removal rate of 6.13 ± 3.59 mg/min. Hemodialysis drug clearance volume was 26.06 ± 14.59 L/h. The recommended doripenem dose estimated from the simulation was 250 mg infused every 12 hours during hemodialysis and 250 mg infused every 48 hours for nonhemodialysis periods. Conclusions A low-flux dialyzer removes about half of the total amount of doripenem in blood circulation for 4 hours. Therefore, drug dosage adjustment is required for end-stage renal disease patients undergoing hemodialysis.
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    Prescribing pattern of lipid-lowering medications before and after adoption of 2013 american college of cardiology and american heart association guidelines in Thailand: An interrupted time series analysis
    (2021-09-22) Suphannika Pornwattanakavee; Sanita Hirunrassamee; Aporanee Chaiyakum; Sauwakon Ratanawijitrasin; Mahidol University; Thammasat University; Burapha University; The Pharmaceutical Association of Thailand Under Royal Patronage
    The American College of Cardiology (ACC) and the American Heart Association (AHA) in 2013 introduced new Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (2013 ACC/AHA guideline) focusing on use of appropriate statins as first-line drugs to reduce risks of atherosclerotic cardiovascular diseases (ASCVD). The 2013 ACC/AHA guideline was adopted in Thailand in November 2013. Impact of the new guidelines on statin use in the country was assessed by examining changes in prescribing patterns of lipid-lowering agents (LLAs) pre-and post-2013 ACC/AHA guideline release using an interrupted time series (ITS) design with segmented regression analysis. Health records of patients ≥21 years of age were collected from three tertiary-care hospitals in Thailand. ITS analysis carried out on 1,597,346 LLA prescriptions of 133,212 patients revealed a statistically significant increase in prescribed high-intensity statins post-compared to pre-2013 ACC/AHA guideline release for all patients in the three study hospitals, including those with ASCVD, diabetes and primary LDL cholesterol ≥190 mg/dL (p-value <0.001 for all categories). In addition, post-2013 ACC/AHA guideline prescriptions transited from low-or moderate-to high-intensity statins. Thus, the significant rise in trend of prescribing high-intensity statins would suggest a positive impact on prescriber good practice in tertiary-care hospitals of Thailand as a result of adopting the 2013 ACC/AHA guideline.