I was born in 1973 and educated at the University of Gothenburg taking my doctors exam in 2002. I then performed my specialization at Södersjukhuset, qualifying as a specialist in Internal Medicine in 2007 and as a specialist in Endocrinology and Diabetes in 2010. Since my specialization I have continued working at Södersjukhuset and been a consultant since 2016.
I defended my thesis at Karolinska Institutet in 2009 becoming an Associate Professor in 2016. Since 2018 I’m part time employed as the Director of Doctoral Education of the Department of Clinical Science and Education at Karolinska Institutet.
In 2009 I defended my thesis ”Drug-related problems with special emphasis on drug-drug interactions”. The thesis includes pharmacogenetic, pharmacokinetic as well as epidemiologic aspects on mainly adverse effects due to the treatment with psychotropic drugs. Since then I have moved towards a mainly register based research. Several projects have included the use of the Swedish Prescribed Drug Register (SPDR) and investigated prescription patterns but also associations with clinical outcome.
Combining the SPDR with Auricula and Journalia, registries containing data on individuals treated with anticoagulantia we have established a cohort of over 100 000 patients treated with warfarin. The cohort enables a unique epidemiologic therapeutic drug monitoring approach, efficiently targeting the effects of any added drug with regard to changes in INR and warfarin doses. So far, we have published data on the effects of initiating carbamazepine and amiodarone. Four of five warfarin-treated patients in whom cotreatment with carbamazepine was initiated experienced subtherapeutic anticoagulative effect within 3–5 weeks. The warfarin dose was subsequently increased by 49 %. For amiodarone, a powerful inhibitor of enzymes of importance for warfarin metabolism, the opposite effect was evident with supratherapeutic INR and a subsequent average 25 % compensatory dose decrease. This knowledge is important to avoid severe bleedings or thromboembolic complications due to changes in anticoagulation caused by interactions. Onwards we plan to investigate the effect of several additional drugs.
Another project focuses on different aspects of hyponatremia. We recently established a cohort of over 14 000 individuals hospitalized due to hyponatremia. Using a case control design we studied the associations between antidepressants and hospitalization due to hyponatremia. The results indicated a strong association between selective serotonin reuptake inhibitors (SSRIs) and venlafaxine, and hospitalization due to hyponatremia exclusively related to newly initiated treatment. Consequently, in patients with clinically significant hyponatremia with newly initiated treatment with SSRI or venlafaxine, an alternative treatment should be considered. For patients with ongoing antidepressant treatment, other causes should be explored. The project has a lot of potential. One future aim is to investigate the effects of other drugs. Another is to follow the cohort over time which will be interesting in several ways. For example we plan to compare the cases and controls with regard to mortality.
A limited number of prescribed drugs account for the great majority of drug-drug interactions
European journal of clinical pharmacology 2014;70(11):1375-83
Risperidone metabolic ratio as a biomarker of individual CYP2D6 genotype in schizophrenic patients
European journal of clinical pharmacology 2014;70(6):695-9
[Acute adrenal insufficiency. Easy to miss Waterhouse-Friderichsen syndrome, as shown in two cases]
The impact of interacting drugs on dispensed doses of warfarin in the Swedish population: A novel use of population based drug registers
Journal of clinical pharmacology 2013;53(12):1322-7
UGT1A4*3 Encodes Significantly Increased Glucuronidation of Olanzapine in Patients on Maintenance Treatment and in Recombinant Systems
CLINICAL PHARMACOLOGY & THERAPEUTICS 2012;92(2):221-7
Carriers of the UGT1A4 142T > G gene variant are predisposed to reduced olanzapine exposure-an impact similar to male gender or smoking in schizophrenic patients
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 2010;66(5):465-74
Drug-drug interactions that reduce the formation of pharmacologically active metabolites: a poorly understood problem in clinical practice
JOURNAL OF INTERNAL MEDICINE 2010;268(6):540-8
Nationwide drug-dispensing data reveal important differences in adherence to drug label recommendations on CYP2D6-dependent drug interactions
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY 2010;69(4):411-7
["Silent" interactions are often missed. Different combinations of pharmaceuticals can result in non-drug effect]
How Drug-Drug Interactions Related to Serotonin Reuptake Inhibitors Affect Drug Dispensing: A Population-Based Study
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 2009;:S242-S242
HOW DRUG-DRUG INTERACTIONS RELATED TO SEROTONIN REUPTAKE INHIBITORS AFFECT DRUG DISPENSING: A POPULATION-BASED STUDY
BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY 2009;:68-69
A clinical evaluation of the Janus Web Application, a software screening tool for drug-drug interactions
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 2008;64(12):1209-14
Impact of multiple inhibitors or substrates of cytochrome P450 2D6 on plasma risperidone levels in patients on polypharmacy
THERAPEUTIC DRUG MONITORING 2008;30(5):565-9
[Right-sided hydrothorax--the only sign of ovarian hyperstimulation syndrome]
The validation of a new quality of life questionnaire for patients with congestive heart failure - an extension of the Cardiac Health Profile
SCANDINAVIAN CARDIOVASCULAR JOURNAL 2007;41(4):235-41
An evaluation of the Janus Web Application: A computer program used for screening for drug-drug interactions
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 2006;15(4):287-288
Descriptive study and pharmacoterapeutic advisory intervention at a medicine clinic of a large hospital in Stockholm
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 2006;:S154-S154
Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 2006;62(12):1075-81