title: Clinical Pharmacist Patient-Safety Initiative to Reduce Against-Label Prescribing of Statins With Cyclosporine.
abstract: BACKGROUND
  Against-label prescribing of statins with interacting drugs, such as cyclosporine, represents an important patient safety concern.
  
  
  OBJECTIVE
  To implement and evaluate the effectiveness of a clinical pharmacist patient-safety initiative to minimize against-label prescribing of statins with cyclosporine.
  
  
  METHODS
  Kaiser Permanente Colorado clinical pharmacists identified patients receiving both cyclosporine and against-label statin through prescription claims data. Academic detailing on this interaction was provided to health care providers. Clinical pharmacists collaborated with physicians to facilitate conversion to on-label statin. Conversion rates along with changes in low-density lipoprotein cholesterol (LDL-C) were assessed.
  
  
  RESULTS
  Of the 157 patients identified as taking cyclosporine, 48 were receiving concurrent statin therapy. Of these 48 patients, 33 (69%) were on an against-label statin regimen; 25 (76%) of these patients were converted to on-label statin. Overall, patients converted to on-label statin had a mean LDL-C prior to conversion of 82.9 (±26.4) mg/dL and mean LDL-C after conversion of 90.7 (±31.2) mg/dL ( P = 0.21). In all, 17 patients (68%) were switched to pravastatin 20 mg daily and 8 patients (32%) to rosuvastatin 5 mg daily. In patients converted to pravastatin 20 mg daily, the mean LDL-C was 13.5 mg/dL higher than prior to conversion ( P = 0.066). In patients converted to rosuvastatin 5 mg daily, the mean LDL-C was 3.8 mg/dL lower than prior to conversion ( P = 0.73).
  
  
  CONCLUSIONS
  Utilizing a patient-safety-centered approach, clinical pharmacists were able to reduce the number of patients on against-label statin with cyclosporine while maintaining a comparable level of LDL-C control.
authors: 1 Kaiser Permanente Colorado, Aurora, CO, USA.|2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors: Donald G
authors: DG
authors: Lamprecht
authors: 1 Kaiser Permanente Colorado, Aurora, CO, USA.|2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors: Brittany A
authors: BA
authors: Todd
authors: 1 Kaiser Permanente Colorado, Aurora, CO, USA.|2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors: Anne M
authors: AM
authors: Denham
authors: 1 Kaiser Permanente Colorado, Aurora, CO, USA.|2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors: Leslie K
authors: LK
authors: Ruppe
authors: 1 Kaiser Permanente Colorado, Aurora, CO, USA.|2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors: Sheila L
authors: SL
authors: Stadler
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood*; D003120:Colorado; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D061214:Patient Safety; D010595:Pharmacists / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D016572:Cyclosporine
keywords: HMG CoA reductase inhibitors; adverse drug reactions; clinical pharmacy; cyclosporine; drug interactions; dyslipidemia; hyperlipidemia; medication safety; pharmaceutical care