Publications by authors named "Jivan Moaddeb"

19 Publications

  • Page 1 of 1

Primary Care Providers' Acceptance of Pharmacists' Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease.

J Gen Intern Med 2020 01 28;35(1):63-69. Epub 2019 Oct 28.

Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.

Background: Patients with diabetic kidney disease (DKD) often struggle with blood pressure control. In team-based models of care, pharmacists and primary care providers (PCPs) play important roles in supporting patients' blood pressure management.

Objective: To describe whether PCPs' acceptance of pharmacists' recommendations impacts systolic blood pressure (SBP) at 36 months.

Design: An observational analysis of a subset of participants randomized to the intervention arm of the Simultaneous risk factor control using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study.

Participants: STOP-DKD participants for whom (1) the pharmacist made at least one recommendation to the PCP; (2) there were available data regarding the PCP's corresponding action; and (3) there were SBP measurements at baseline and 36 months.

Intervention: Participants received monthly telephone calls with a pharmacist addressing health behaviors and medication management. Pharmacists made medication-related recommendations to PCPs.

Main Measures: We fit an unadjusted generalized linear mixed model to assess the association between the number of pharmacists' recommendations for DKD and blood pressure management and PCPs' acceptance of such recommendations. We used a linear regression model to evaluate the association between PCP acceptance and SBP at 36 months, adjusted for baseline SBP.

Key Results: Pharmacists made 176 treatment recommendations (among 59 participants), of which 107 (61%) were accepted by PCPs. SBP significantly declined by an average of 10.5 mmHg (p < 0.01) among 47 of 59 participants who had valid measurements at baseline and 36 months. There was a significant association between the number of pharmacist recommendations and the odds of PCP acceptance (OR 1.19; 95%CI 1.00, 1.42; p < 0.05), but no association between the number of accepted recommendations and SBP.

Conclusions: Pharmacists provided actionable medication-related recommendations. We identified a significant decline in SBP at 36 months, but this reduction was not associated with recommendation acceptance.

Trial Registration: NCT01829256.
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http://dx.doi.org/10.1007/s11606-019-05403-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957634PMC
January 2020

Pharmacogenomics courses in pharmacy school curricula.

Pharmacogenomics 2019 06;20(9):625-630

Department of Medicine, Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA.

The appropriate use and integration of pharmacogenetic (PGx) testing will pivot on provider preparation and training. Pharmacists have been recognized as one of the key providers in the delivery of PGx testing and as such, professional organizations have recommended inclusion of PGx content in pharmacy curricula. We reviewed the curriculum of 132 US pharmacy schools for information about PGx courses. A total of 70 core curriculum courses were identified. 55 (42%) pharmacy schools included at least one PGx course as part of the core curriculum, and ten (8%) schools that offered a PGx course elective. While many pharmacy schools have responded to the accreditation standards to include PGx, less than half of the schools have developed a standalone course.
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http://dx.doi.org/10.2217/pgs-2019-0024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912845PMC
June 2019

Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study: Protocol and baseline characteristics of a randomized controlled trial.

Contemp Clin Trials 2018 06 10;69:28-39. Epub 2018 Apr 10.

Division of Nephrology, Duke University School of Medicine, Durham, NC, United States; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States; Gilead Sciences, Inc, Foster City, CA, United States.

Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD) in the United States. Multiple risk factors contribute to DKD development, yet few interventions target more than a single DKD risk factor at a time. This manuscript describes the study protocol, recruitment, and baseline participant characteristics for the Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study. The STOP-DKD study is a randomized controlled trial designed to evaluate the effectiveness of a multifactorial behavioral and medication management intervention to mitigate kidney function decline at 3 years compared to usual care. The intervention consists of up to 36 monthly educational modules delivered via telephone by a study pharmacist, home blood pressure monitoring, and medication management recommendations delivered electronically to primary care physicians. Patients seen at seven primary care clinics in North Carolina, with diabetes and [1] uncontrolled hypertension and [2] evidence of kidney dysfunction (albuminuria or reduced estimated glomerular filtration rate [eGFR]) were eligible to participate. Study recruitment completed in December 2014. Of the 281 participants randomized, mean age at baseline was 61.9; 52% were male, 56% were Black, and most were high school graduates (89%). Baseline co-morbidity was high- mean blood pressure was 134/76 mmHg, mean body mass index was 35.7 kg/m, mean eGFR was 80.7 ml/min/1.73 m, and mean glycated hemoglobin was 8.0%. Experiences of recruiting and implementing a comprehensive DKD program to individuals at high risk seen in the primary care setting are provided.

Trial Registration: NCT01829256.
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http://dx.doi.org/10.1016/j.cct.2018.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986182PMC
June 2018

Primary care providers' use of pharmacist support for delivery of pharmacogenetic testing.

Pharmacogenomics 2017 Mar 22;18(4):359-367. Epub 2017 Feb 22.

Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC, USA.

Aim: To investigate provider utilization of pharmacist support in the delivery of pharmacogenetic testing in a primary care setting.

Methods: Two primary care clinics within Duke University Health System participated in the study between December 2012 and July 2013. One clinic was provided with an in-house pharmacist and the second clinic had an on-call pharmacist.

Results: Providers in the in-house pharmacist arm consulted with the pharmacist for 13 of 15 cases, or about one of every four patients tested compared with one of every 7.5 patients in the on-call pharmacist arm. A total of 63 tests were ordered, 48 by providers in the pharmacist-in-house arm.

Conclusion: These findings suggest that the availability of an in-house pharmacist increases the likelihood of pharmacogenetic test utilization.
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http://dx.doi.org/10.2217/pgs-2016-0177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558524PMC
March 2017

Assessing feasibility of delivering pharmacogenetic testing in a community pharmacy setting.

Pharmacogenomics 2017 Mar 22;18(4):327-335. Epub 2017 Feb 22.

Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA.

Aim: To describe the rationale and design of a study evaluating the delivery of pharmacogenetic (PGx) testing in community pharmacies. Study rationale: Pharmacists have expressed interest in offering PGx testing; however, their lack of knowledge and experience, patients' acceptance and feasibility are unknown in this setting.

Study Design: Through a cluster randomized trial, we will assess pharmacist and patient experiences with delivery of PGx testing as a standalone service or integrated into medication therapy management services. Anticipated results: We anticipate that PGx testing can be delivered in a community pharmacy setting and accepted and valued by patients.

Conclusion: This study is expected to provide valuable evidence about the real-world feasibility and acceptance of a community pharmacist-delivered approach of PGx testing.
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http://dx.doi.org/10.2217/pgs-2016-0175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558549PMC
March 2017

Patient experiences with pharmacogenetic testing in a primary care setting.

Pharmacogenomics 2016 10 20;17(15):1629-1636. Epub 2016 Sep 20.

Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA.

Aim: To investigate patient experiences with pharmacogenetic (PGx) testing.

Methods: Patients were offered PGx testing through a study on pharmacist-assisted delivery of PGx testing and invited to complete pre- and post-testing surveys about their experience.

Results: Of 63 patients tested, 17 completed the baseline survey (27%). Interest in testing was mostly impacted by desire to inform selection of best treatment (n = 13). Seven of 12 patients that completed the follow-up survey indicated that their provider discussed the test result with them. Five patients understood their test result very or somewhat well. All would be likely to have PGx testing again.

Conclusion: Patients perceived PGx testing to be useful, though more effort may be needed to improve patient-provider communication of test results.
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http://dx.doi.org/10.2217/pgs-2016-0077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558503PMC
October 2016

Evaluation of a pharmacogenetic educational toolkit for community pharmacists.

Pharmacogenomics 2016 09 17;17(14):1491-502. Epub 2016 Aug 17.

Center for Applied Genomics & Precision Medicine, Duke University, School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA.

Aim: Over the past several decades, the roles and services of community pharmacists have expanded beyond traditional medical dispensation and compounding, and include health services such as vaccinations, and clinical testing and screening. Incorporating pharmacogenetic (PGx) testing into the menu of pharmacy services is logical and feasible; however, few pharmacists have experience with PGx testing, and few educational resources about PGx are available to support the uptake of PGx testing in community pharmacies.

Methods: We developed a toolkit of four resources to assist pharmacists to provide PGx testing. We conducted a survey of pharmacists in North Carolina to evaluate each component of the toolkit and the toolkit as a whole.

Results: A total of 380 respondents completed the evaluation of one or more toolkit components (344 evaluated all four components and the overall toolkit). Most respondents (84%) have never ordered or used PGx test results. Though the usability of the toolkit overall was below average (65.1 on a range of 0-100), individual components were perceived as useful and more than 75% of pharmacists reported that they would use the toolkit components when offering testing, with the result summary sheet receiving the highest score (4.01 out of 5). Open-text comments highlighted the need for more patient-friendly language and formatting.

Conclusion: The majority of pharmacist respondents scored the components of the toolkit favorably. The next steps will be to revise and assess use of the toolkit in community pharmacy settings.
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http://dx.doi.org/10.2217/pgs-2016-0002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220456PMC
September 2016

Proposal for a pharmacogenetics certificate program for pharmacists.

Pharmacogenomics 2016 04 29;17(6):535-9. Epub 2016 Mar 29.

Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, North Building, Room #262, Box 90141, Durham, NC 27708, USA.

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http://dx.doi.org/10.2217/pgs.16.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558551PMC
April 2016

Incorporation of pharmacogenetic testing into medication therapy management.

Pharmacogenomics 2015 Nov 10;16(17):1931-41. Epub 2015 Nov 10.

Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 201 Trent Dr, Durham, NC 27710, USA.

Aim: To assess feasibility and patient satisfaction with a pharmacist-delivered medication therapy management (MTM) plus pharmacogenetic (PGx) testing service.

Methods: Thirty patients from a cardiology outpatient clinic were enrolled to attend two MTM sessions, undergo PGx testing and complete pre- and post-intervention surveys. Outcome measures included duration of MTM sessions, clinical application of test results, self-reported medication adherence, patient recall of results and perceived value of testing and MTM.

Results: Overall, patients were very satisfied with the MTM plus PGx testing service. About half of participants (47%) were able to accurately recall their PGx test results. Comparable to MTM without PGx testing, the first MTM session averaged 40 min and the follow-up MTM session averaged 15 min.

Conclusion: PGx testing incorporated into a clinical MTM service offered by pharmacists may be a feasible delivery model and is satisfactory to patients.
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http://dx.doi.org/10.2217/pgs.15.124DOI Listing
November 2015

Community pharmacists' experience with pharmacogenetic testing.

J Am Pharm Assoc (2003) 2015 Nov-Dec;55(6):587-594

Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address:

Objective: Appendix 1 Statements of knowledge of correct medication use Appendix 2 Statements of self-efficacy of correct medication use Appendix 3 Statements of skills of correct medication use To characterize the experiences and feasibility of offering pharmacogenetic (PGx) testing in a community pharmacy setting.

Design: Pharmacists were invited to complete a survey about PGx testing for each patient who was offered testing. If the patient consented, pharmacists were also asked to complete a follow-up survey about the process of returning PGx testing results to patients and follow-up with the prescribing provider.

Setting: Community pharmacies in North Carolina from August through November 2014.

Participants: Pharmacists at five community pharmacies.

Main Outcome Measures: Patient consent for testing, time to introduce PGx testing initially and communicate results, interpretation of test results, and recommended medication changes.

Results: Of the 69 patients offered testing, 56 (81%) consented. Pre-test counseling typically lasted 1-5 minutes (81%), and most patients (55%) did not have any questions about the testing. Most pharmacists reported test results to patients by phone (84%), with discussions taking less than 1 minute (48%) or 1-5 minutes (52%). Most pharmacists believed the patients understood their results either very well (54%) or somewhat well (41%). Pharmacists correctly interpreted 47 of the 53 test results (89%). All of the incorrect interpretations were for patients with test results indicating a dosing or drug change (6/19; 32%). Pharmacists reported contacting the ordering physician for four patients to discuss results indicating a dosage or drug change.

Conclusion: The provision of PGx services in a community pharmacy setting appears feasible, requiring little additional time from the pharmacist, and many patients seem interested in PGx testing. Additional training may be necessary to improve test result interpretation, as well as for communication with both patients and ordering physicians.
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http://dx.doi.org/10.1331/JAPhA.2015.15017DOI Listing
October 2016

Potential use of auxiliary labels to promote patient awareness of pharmacogenetic testing.

Pharmacogenomics 2015 ;16(4):299-301

Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA.

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http://dx.doi.org/10.2217/pgs.14.184DOI Listing
January 2016

Challenges to integrating pharmacogenetic testing into medication therapy management.

J Manag Care Spec Pharm 2015 Apr;21(4):346-52

Duke University School of Medicine, 304 Research Dr., Box 90141, Durham, NC 27708.

Some have proposed the integration of pharmacogenetic (PGx) testing into medication therapy management (MTM) to enable further refinement of treatments to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This "enhanced" MTM might also reduce patient concerns about side effects and increase confidence that the medication is effective, addressing 2 key factors that impact patient adherence: concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. In this commentary, we consider some of the challenges to the integration and delivery of PGx testing in MTM services.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522310PMC
http://dx.doi.org/10.18553/jmcp.2015.21.4.346DOI Listing
April 2015

Improving diabetes medication adherence: successful, scalable interventions.

Patient Prefer Adherence 2015 23;9:139-49. Epub 2015 Jan 23.

Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA ; Department of Medicine, Duke University, Durham, NC, USA ; School of Nursing, Duke University, Durham, NC, USA ; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.

Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US health care system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population). We identify key characteristics that make these interventions effective and scalable. This information is intended to inform health care systems seeking proven, low resource, cost-effective solutions to improve medication adherence.
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http://dx.doi.org/10.2147/PPA.S69651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315534PMC
February 2015

Pilot study: incorporation of pharmacogenetic testing in medication therapy management services.

Pharmacogenomics 2014 Nov;15(14):1729-1737

Duke University, 304 Research Drive, Box 90141, Durham, NC 27708, USA.

Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered medication therapy management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.
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http://dx.doi.org/10.2217/pgs.14.118DOI Listing
November 2014

Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting.

Pharmacogenomics 2014 Sep;15(13):1677-86

Duke University Center for Applied Genomics & Precision Medicine, 304 Research Drive, Box 90141 Durham, NC 27708, USA.

Aim: To describe the rationale and design of a pilot program to implement and evaluate pharmacogenetic (PGx) testing in a primary care setting.

Study Rationale: Several factors have impeded the uptake of PGx testing, including lack of provider knowledge and challenges with operationalizing PGx testing in a clinical practice setting.

Study Design: We plan to compare two strategies for the implementation of PGx testing: a pharmacist-initiated testing arm compared with a physician-initiated PGx testing arm. Providers in both groups will be required to attend an introduction to PGx seminar. Anticipated results: We anticipate that providers in the pharmacist-initiated group will be more likely to order PGx testing than providers in the physician-initiated group.

Conclusion: Overall, we aim to generate data that will inform an effective delivery model for PGx testing and to facilitate a seamless integration of PGx testing in primary care practices.
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http://dx.doi.org/10.2217/pgs.14.109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280849PMC
September 2014

Pharmacogenetic information for patients on drug labels.

Pharmgenomics Pers Med 2014 3;7:297-305. Epub 2014 Oct 3.

Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA.

Advances in pharmacogenetic research have improved our understanding of adverse drug responses and have led to the development of pharmacogenetic tests and targeted drugs. However, the extent of the communication process and provision of information to patients about pharmacogenetics is unclear. Pharmacogenetic information may be included in sections of a drug's package insert intended for patients, which is provided directly to patients or communicated via the health provider. To determine what pharmacogenetic information, if any, is included in patient-targeted sections of the drug label, we reviewed the labels listed in the US Food and Drug Administration's Table of Pharmacogenomic Biomarkers in Drug Labels. To date, 140 drugs include pharmacogenetic-related information in the approved label. Our analysis revealed that pharmacogenetic information is included in patient-targeted sections for a minority (n=29; 21%) of drug labels, with no obvious pattern associated with the inclusion of pharmacogenetic information. Therefore, patients are unlikely to learn about pharmacogenetics through written materials dispensed with the drug. Given that there are also inconsistencies with regard to inclusion of pharmacogenetic information in the patient counseling information section, it is also unlikely that patients are receiving adequate pharmacogenetic information from their provider. The inconsistent presence of pharmacogenetic information in patient-targeted sections of drug labels suggests a need to review the criteria for inclusion of information in patient-targeted sections in order to increase consistency and patient knowledge of pharmacogenetic information.
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http://dx.doi.org/10.2147/PGPM.S67876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205933PMC
October 2014

Comparison of delivery strategies for pharmacogenetic testing services.

Pharmacogenet Genomics 2014 Mar;24(3):139-45

Institute for Genome Sciences & Policy, Duke University, Durham, North Carolina, USA.

The number and use of pharmacogenetic tests to assess a patient's likelihood of response or risk of an adverse event is expanding across medical specialties and becoming more prevalent. During this period of development and translation, different approaches are being investigated to optimize delivery of pharmacogenetic services. In this paper, we review pre-emptive and point-of-care delivery approaches currently implemented or being investigated and discuss the advantages and disadvantages of each approach. The continued growth in knowledge about the genetic basis of drug response combined with development of new and less expensive testing technologies and electronic medical records will impact future delivery systems. Regardless of delivery approach, the currently limited knowledge of health professionals about genetics generally or PGx specifically will remain a major obstacle to utilization.
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http://dx.doi.org/10.1097/FPC.0000000000000028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925746PMC
March 2014

Pharmacogenetic testing: Current Evidence of Clinical Utility.

Ther Adv Drug Saf 2013 Aug;4(4):155-169

Duke Institute for Genome Sciences & Policy 304 Research Drive Box 90141 Durham, NC 27708 USA

Over the last decade, the number of clinical pharmacogenetic tests has steadily increased as understanding of the role of genes in drug response has grown. However, uptake of these tests has been slow, due in large part to the lack of robust evidence demonstrating clinical utility. We review the evidence behind four pharmacogenetic tests and discuss the barriers and facilitators to uptake: 1) warfarin (drug safety and efficacy); 2) clopidogrel (drug efficacy); 3) codeine (drug efficacy); and 4) abacavir (drug safety). Future efforts should be directed toward addressing these issues and considering additional approaches to generating evidence basis to support clinical use of pharmacogenetic tests.
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http://dx.doi.org/10.1177/2042098613485595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765014PMC
August 2013

Hypertensive Urgency Associated With Xenadrine EFX Use.

J Pharm Pract 2011 Jun 6. Epub 2011 Jun 6.

Johnston Health Systems, Clayton, NC, USA.

Several supplements and herbal products have been shown to increase catecholamines and subsequently mean arterial pressure and systemic vascular resistance. Since ephedra-containing products have been removed from the market, manufacturers of weight loss herbal supplements must produce ephedra-free formulations. Xenadrine EFX is an ephedra-free weight loss product containing a mixture of caffeine, guarana, and bitter orange (standardized to synephrine). Synephrine has been shown in animals and humans to increase systemic vascular resistance and mean arterial pressure. We present a case of a patient who took Xendarine EFX for 2 weeks prior to her presentation to an emergency department with headaches and hypertensive urgency (blood pressure [BP] 234/130 mm Hg). Her BP was controlled after discontinuation of Xenadrine and initiation a nitroprusside drip and oral clonidine. A Naranjo probability score of 6 indicates the adverse drug reaction was probable. Clinicians should be aware of potential cardiovascular changes in patients on Xenadrine EFX or other synephrine-containing products.
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http://dx.doi.org/10.1177/0897190011406127DOI Listing
June 2011