Jennifer Bolt

Development of Left Atrial Thrombus After Coadministration of Dabigatran Etexilate and Phenytoin

Dabigatran etexilate is a substrate of the P-glycoprotein (adenosine triphosphate-binding cassette subfamily B member 1) transport system and is subject to interactions with medications that induce or inhibit this system. The clinical relevance of the interaction between dabigatran and phenytoin has not been well described. We report a case of left atrial thrombus in a patient receiving concomitant dabigatran etexilate and phenytoin, which is a P-glycoprotein inducer. This case illustrates the potential clinical significance of the interactions of medications that affect P-glycoprotein and dabigatran.

Checklists for the use of novel oral anticoagulants by the front-line clinician:

Author Contributions:T.J. Bungard drafted the initial manuscript and revised it along the way. J. Bolt participated in writing the initial draft and reviewing the final draft. P. Thomson participated in initiating the checklist project, writing the initial draft and reviewing the final draft. W. Semchuk participated in writing the initial draft and reviewing checklists. J. Lowerison participated in initiating the checklist project, writing the initial draft and reviewing the final draft. Declaration of Conflicting Interests:Tammy J. Bungard has received honoraria from Bayer, Boehringer Ingelheim and Bristol Myers Squibb-Pfizer within the past 2 years. Jennifer Bolt has received honoraria from Boehringer Ingelheim in the past 2 years. Peter Thomson has received speaker honoraria from Bayer, Boehringer Ingelheim, Pfizer and Sanofi within the past 2 years. He has served as a consultant or on an Advisory Board for Boehringer Ingelheim, Pfizer and Sanofi within the past 2 years. William Semchuk has received honoraria from Bayer, Pfizer, Bristol Myers Squibb and Boehringer Ingelheim within the past 2 years. He has served as a consultant or on an Advisory Board for Bayer and Pfizer/Bristol Myers Squibb in the last 2 years and has received a research grant from Pfizer in the last 2 years. Jennifer Lowerison has nothing to disclose. Funding:The authors received no financial support for the research, authorship and/or publication of this article.

Inhaler assessment in COPD patients: A primer for pharmacists.

Chronic obstructive pulmonary disease (COPD) is an incurable disease that affects 4.2% of Canadians 35 years of age and older.1-3 Pharmacotherapy for COPD is prescribed to achieve 2 main goals of therapy: symptomatic improvement/quality of life and reduction in frequency and severity of exacerbations.4 Administration of medication via inhalation is the preferred route of drug delivery for respiratory disease treatment.3,4 The inhalation route allows for medications to be delivered directly to the intended site of action with minimal systemic absorption, resulting in enhanced clinical benefit and reduced risk of systemic adverse effects.3,5