Advertisement

Pharmacy World and Science

, Volume 15, Issue 5, pp 219–224 | Cite as

Decision analysis applied to the selection of angiotensin-converting enzyme inhibitors

  • Bernardo Santos Ramos
  • María José Piña Vera
  • Encarnación Carvajal Gragera
  • Manuela Atienza Fernández
Practice/Case Reports

Abstract

Decision analysis is applied to the group of angiotensin-converting enzyme inhibitors, in order to select those which should be included in the hospital formulary and to establish a research method which allows the reproduction of the process with new, related drugs. Captopril, enalapril and lisinopril were the alternatives considered. Evaluation criteria were efficacy, clinical experience, safety, dosage interval, hepatic bioactivation, interactions, dosage forms and cost. A relative weight was assigned through a survey among the hospital's staff. Each alternative was evaluated in relation to all criteria. Sensitivity analysis was applied to validate the method. Enalapril obtained the highest score, followed by lisinopril and captopril. The sensitivity analysis confirms this result. Enalapril is selected for the hospital formulary due to its higher score, although the differences between the three are very small.

Keywords

Angiotensin-converting enzyme inhibitors Captopril Decision support techniques Enalapril Lisinopril 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Yang HY, Erdos EG, Levin Y. A dipeptidyl carboxypeptidase that converts angiotensin I and inactivates bradykinin. Biochim Biophys Acta 1970;214:374–6.PubMedGoogle Scholar
  2. 2.
    Lant AF, McNabb RW, Noormohamed FH. Kinetic and metabolic aspects of enalapril action. J Hypertens 1984;2(Suppl 2):37–42.PubMedGoogle Scholar
  3. 3.
    Wu MT, Douglas AW, Ondeika DL, Payme LG, Ikeler TJ, Joshua H. Synthesis of N2-(1-carboxy-3-phenylpropyl)-L-lysyl-l-proline (lisinopril). J Pharm Sci 1985;74:352–4.PubMedGoogle Scholar
  4. 4.
    Weinstein MC, Fineberg HV, editors. Clinical decision analysis. Philadelphia: W.B. Saunders, 1980.Google Scholar
  5. 5.
    Einarson TR, McGhan WF, Bootman JL. Decision analysis applied to pharmacy practice. Am J Hosp Pharm 1985;42:364–71.PubMedGoogle Scholar
  6. 6.
    Witte KW, Eck TA, Vogel DP. Decision analysis applied to the purchase of frozen premixed intravenous admixtures. Am J Hosp Pharm 1985;42:835–9.PubMedGoogle Scholar
  7. 7.
    Schumacher GE, Barr JT. Applying decision analysis in therapeutic drug monitoring: using decision trees to interpret serum theophylline concentrations. Clin Pharm 1986;5:325–33.PubMedGoogle Scholar
  8. 8.
    Corder MP, Ellwein LB. Comparison of treatments for symptomatic Hodkgin's lymphoma employing decision analysis. Am J Clin Oncol 1984;7(1):33–8.PubMedGoogle Scholar
  9. 9.
    Cano SB, Fujita NK. Formulary evaluation of third-generation cephalosporins using decision analysis. Am J Hosp Pharm 1988,45:566–9.PubMedGoogle Scholar
  10. 10.
    Calvo MV, Fruns I, Dominguez-Gil A. Decision analysis applied to selection of histamine H2-receptor antagonists for the formulary. Am J Hosp Pharm 1990;47:2002–6.PubMedGoogle Scholar
  11. 11.
    Kresel JJ, Hutchings C, Mackay DN, Delagrauge M, Harckel MD, Frearsou S,et al. Application of decision analysis to drug selection for formulary addition. Hosp Formul 1987;22:658–76.PubMedGoogle Scholar
  12. 12.
    Dukes MNG, editor. Meyler's side effects of drugs. 11th ed. Amsterdam: Excerpta Medica, 1988.Google Scholar
  13. 13.
    McEvoy GK, editor. AHFS drug information 90. Bethesda: American Society of Hospital Pharmacists, 1990.Google Scholar
  14. 14.
    United States Pharmacopeia. Drug Information for the health care professional. Volumes IA + IB. 9th ed. Rockville: The United States Pharmacopeial Convention, 1989.Google Scholar
  15. 15.
    Raia JJ, Barone JA, Byerly WG, Lacy CR. Angiotensin-converting enzyme inhibitors: a comparative review. Drug Intell Clin Pharm 1990;24:506–25.Google Scholar
  16. 16.
    Zanella MT, Salgado BJ, Kohlman Jr O, Ribeiro AB. Angiotensin-converting enzyme inhibition. Therapeutic option for diabetic hypertensive patients. Drugs 1990;39 (Suppl 2):33–9.Google Scholar
  17. 17.
    Fyhrquist F. Clinical pharmacology of the angiotensin converting enzyme inhibitors. Drugs 1986;32:33–9.Google Scholar
  18. 18.
    Laher MS. Lisinopril in elderly patients with hypertension. Long term effects on renal and metabolic function. Drugs 1990;39(Suppl 2):55–63.PubMedGoogle Scholar
  19. 19.
    Giles TD. Clinical experience with lisinopril in congestive heart failure. Focus on the older patient. Drugs 1990;39(Suppl 2):17–22.PubMedGoogle Scholar
  20. 20.
    Consensus Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med 1987;316:1429–35.Google Scholar
  21. 21.
    Swedberg K, Kjekshus J. Effect of enalapril on mortality in congestive heart failure. Follow-up survival data from the Consensus Trial. Drugs 1990;39(Suppl 4):49–52.Google Scholar
  22. 22.
    Eriksson SV, Offstad J, Kjekshus J. M-mode echocardiography in patients with severe congestive heart failure. A subgroup analysis in the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). Drugs 1990;39(Suppl 4):43–8.Google Scholar
  23. 23.
    Powers ER, Chiaramida A, Demaria AN, Giles TD, Hackshaw B, Hart W,et al. A double-blind comparison of lisinopril with captopril in patients with symptomatic congestive heart failure. J Cardiovasc Pharmacol 1987;9(Suppl 3):S82–8.PubMedGoogle Scholar
  24. 24.
    Taguma Y, Kitamoto Y, Futaki G, Ueda H, Mouma H, Ishizaki M,et al. Effect of captopril on heavy proteinuria in azotemic diabetics. N Engl J Med 1985;313:1617–20.PubMedGoogle Scholar
  25. 25.
    Reams GP, Bauer JH. Effect of enalapril in subjects with hypertension associated with moderate to severe renal dysfunction. Arch Intern Med 1986;146:2145–8.PubMedGoogle Scholar
  26. 26.
    Heeg JE, De Jong PE, Van der Hem GK, De Zeeuw D. Efficacy and variability of the antiproteinuric effect of ACE inhibition by lisinopril. Kidney Int 1989;36:272–9.PubMedGoogle Scholar
  27. 27.
    López-Ovejero JA, Sall SD, D'Angelo WA, Cheigh JS, Stenzel KH, Laragh JH. Reversal of vascular and renal crises of scleroderma by oral angiotensin-converting enzyme blockade. N Engl J Med 1979;300:1417–9.PubMedGoogle Scholar
  28. 28.
    Ferder LF, Inserra F, Daccordi H, Romano L, Fernández A, Tessler J. Effects of enalapril on renal parameters in patients with primary glomerulopathies associated with chronic renal failure. Drugs 1990;39(Suppl 2):40–6.PubMedGoogle Scholar
  29. 29.
    Thurm RH, Alexander JC. Captopril in the treatment of scleroderma renal crisis. Arch Intern Med 1984;144:733–5.PubMedGoogle Scholar
  30. 30.
    Smith CD, Smith RD, Korn JH. Hypertensive crisis in systemic sclerosis: treatment with the new oral angiotensin converting enzyme inhibitor MK 421 (enalapril) in captopril-intolerant patients. Arthritis Rheum 1984;27:826–8.PubMedGoogle Scholar
  31. 31.
    Miyazaki S, Miura K, Kasai Y, Abe K, Yoshinaga K. Relief from digital vasospasm by treatment with captopril and its complete inhibition by serine proteinase inhibitors in Raynaud's phenomenon. BMJ 1982;284:310–1.PubMedGoogle Scholar
  32. 32.
    Mimran A, Targhetta R. Captopril treatment of idiopathic edema. N Engl J Med 1979;301:l289–90.Google Scholar
  33. 33.
    Tschollar W, Belz CG. Sublingual captopril in hypertensive crisis. Lancet 1985;2:34–5.Google Scholar
  34. 34.
    Rocci ML, Shaw EW, Vlasses PH, Ferguson RK. Bioactivation of the angiotensin converting enzyme inhibitor enalapril in cirrhosis [abstract]. Clin Res 1986;34:406A.Google Scholar
  35. 35.
    Salvetti A, Pedrinelli R, Magagna A, Abdel-Haq B, Graziadei L, Taddei S,et al. Influence of food on acute and chronic effects of captopril in essential hypertensive patients. J Cardiovasc Pharmacol 1985;7(Suppl 2):25–9.Google Scholar
  36. 36.
    Swanson BN, Vlasses PH, Ferguson RK, Bergquist PA, Till AE, Irvin JD,et al. Influence of food on the bioavailability of enalapril. J Pharm Sci 1984;73:1655–7.PubMedGoogle Scholar
  37. 37.
    Mojaverian P, Rocci ML, Vlasses PH, Hoholick C, Clementi RA, Ferguson RK. Effect on food on the bioavailability of lisinopril, a non-sulfhydryl angiotensin-converting enzyme inhibitor. J Pharm Sci 1986;75:395–7.PubMedGoogle Scholar

Copyright information

© Periodicals Service Company 1993

Authors and Affiliations

  • Bernardo Santos Ramos
    • 1
  • María José Piña Vera
    • 1
  • Encarnación Carvajal Gragera
    • 1
  • Manuela Atienza Fernández
    • 1
  1. 1.Servicio de FarmaciaHospital Vírgen del RocíoSevillaSpain

Personalised recommendations