The edition · Clinical Pharmacology
In liver disease, creatinine misleads vancomycin dosing: measure levels early
Population estimates drifted by 30% or more in patients with hepatic dysfunction; a semaglutide meta-analysis found no significant psychiatric signal, with low certainty.
The edition in brief
A multicentre retrospective study of 157 vancomycin-treated adults found that hepatic dysfunction with low albumin more than doubled the odds that population-based AUC estimates differed by 30% or more from Bayesian estimates using measured troughs (aOR 2.26), and these patients had higher actual exposure. Low creatinine production makes renal function look better than it is, so early drug-level monitoring is the safer course. A meta-analysis of trials, cohorts and pharmacovigilance studies found no statistically significant increase in depression (RR 1.25, 95% CI 0.95–1.65), anxiety or suicidal ideation with semaglutide, but heterogeneity was extreme and certainty low. A randomised crossover study in 36 adults over 50 found similar systemic exposure from diclofenac sodium 1% and diethylamine 1.16% gels, with about 0.5% of the dose excreted in urine; heat made exposure more variable, exercise did not change it. Benzodiazepine prescribing in English primary care fell by about 4% a year from 2020 to 2025, while clobazam use rose. The FDA lists a Class II recall of Baxter's premixed intravenous amiodarone (Nexterone) for manufacturing-practice deviations. The pearl explains why creatinine overestimates kidney function in cirrhosis and sarcopenia.
Semaglutide and depression: no significant signal, but the evidence is weak
Continue semaglutide where indicated, and keep mood on the review checklist for patients with psychiatric history.
Topical diclofenac: sodium and diethylamine gels give similar, very low systemic exposure
Topical diclofenac sodium and diethylamine gels can be treated as similar in systemic exposure; heat and exercise did not raise it on average.
Benzodiazepine prescribing in English primary care fell 4% a year, while clobazam rose
Review long-term benzodiazepine use and taper where possible; deprescribing policy can work at scale.
FDA lists Class II recall of premixed intravenous amiodarone (Nexterone)
Hospitals using premixed amiodarone should check stock against the recall and substitute carefully prepared infusions if affected.
Why creatinine flatters kidney function in liver disease
Do not trust creatinine-based clearance in cirrhosis or sarcopenia; use cystatin C or drug levels where dosing matters.
Vancomycin in hepatic dysfunction: population estimates drifted — check levels early
In hepatic dysfunction, consider early vancomycin level monitoring rather than relying on creatinine-based initial dosing.
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