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Guzmán Cordero C, Sáez-Torres de Vicente M, Jiménez Espinosa Á, Gago Sánchez AI. Pharmacist's role in the management of drug-drug interactions caused by nirmatrelvir/ritonavir in COVID-19 oncohematology patients. J Oncol Pharm Pract 2024:10781552241237750. [PMID: 38454628 DOI: 10.1177/10781552241237750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE New drugs developed for SARS-CoV-2 infection, such as nirmatrelvir/ritonavir (NMV/r), represent a potential for oncohematology patients, but also pose a challenge in managing the potential clinically relevant drug-drug interactions (pDDIs) that may arise. The aim of this study is to assess the frequency, severity, and pharmacist detection of pDDIs. METHODS This prospective, observational, study spanned 8 months, involving 42 oncohematology patients prescribed NMV/r in a tertiary-level hospital. A Board Certified oncology pharmacist assessed pDDIs using three databases and made recommendations to prescribing physicians. Linear and logistic regression analyses were employed to explore the relationship between prescribed drugs and pDDIs. RESULTS Clinically relevant pDDIs were detected in 76.2% of patients, with 18.1% of all medications involved in drug-drug interactions (DDIs). The most common drugs implicated were atorvastatin and imatinib. Micromedex® identified 63.3% of interactions as major severity, while Lexicomp® and University of Liverpool classifications were less restrictive. Pharmacists prevented most DDIs from reaching patients through different interventions, including treatment monitoring (44.2%), discontinuation (36.5%), and dose reduction (17.3%). CONCLUSION This study highlights the high prevalence of clinically significant pDDIs in oncohematology patients receiving NMV/r for COVID-19. Pharmacists, as integral members of the healthcare team, played a crucial role in detecting, categorizing, and mitigating these interactions. The results underscore the need for comprehensive studies to evaluate the impact of pharmacist-led interventions in optimizing drug therapy and enhancing patient safety in this vulnerable population.
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Affiliation(s)
- Carlos Guzmán Cordero
- Pharmacy Department, Reina Sofía University Hospital / Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) / University of Córdoba, Córdoba, Spain
| | - María Sáez-Torres de Vicente
- Pharmacy Department, Reina Sofía University Hospital / Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) / University of Córdoba, Córdoba, Spain
| | | | - Ana Isabel Gago Sánchez
- Pharmacy Department, Reina Sofía University Hospital / Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) / University of Córdoba, Córdoba, Spain
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Mahzoni H, Naghsh E, Sharifi M, Moghaddas A, Momenzadeh M, Moghaddas A. Potential Drug Interactions in Terminally-Ill Cancer Patients, a Report from the Middle East. J Pain Palliat Care Pharmacother 2023; 37:278-285. [PMID: 37712672 DOI: 10.1080/15360288.2023.2253223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 07/07/2023] [Accepted: 08/20/2023] [Indexed: 09/16/2023]
Abstract
This study aims to evaluate the epidemiology of potential drug interactions in terminally-ill cancer patients receiving exclusively supportive care. In this cross-sectional study, during a 6-month follow-up, we considered the medical record of terminally-ill cancer patients referred to palliative care at the cancer center in Isfahan, Iran. Potential drug-drug interactions (DDIs) were assessed by Lexi-Interact ver.1.1 online software. During the study period, 133 terminally-ill cancer patients were recruited. We detected 1678 DDIs with moderate or major severity levels. Among them, 330, 219, 32, 1075, and 51 interactions were categorized in B, C, D, and X drug interactions categories, respectively. One hundred and twenty-two patients (91.73%) encountered at least one potential drug-drug interaction during the end of life care. Mechanistically, most drug-drug interactions (64.5%) were pharmacodynamics. The most frequent pharmacological class of drugs responsible for DDIs were quetiapine (91 cases), oxycodone (87 cases), and sertraline (55 cases). Interaction between oxycodone and sertraline was found to be in the top 10 detected DDIs (13.7%). Our results showed that potentially moderate or major drug-drug interactions often occur among terminally-ill cancer patients and the clinical significance of DDIs should be considered meticulously in the palliative care cancer setting.
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Affiliation(s)
- Hamed Mahzoni
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Naghsh
- Research Associate, Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada
| | - Mehran Sharifi
- Associate Professor of Internal Medicine, Department of Internal Medicine, Oncology and Hematology Section, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ayda Moghaddas
- Internal Medicine Physician, Department of Internal Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Momenzadeh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Moghaddas
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
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Wang TF, Hill M, Mallick R, Chaudry H, Unachukwu U, Delluc A, Carrier M. The prevalence of relevant drug-drug interactions and associated clinical outcomes in patients with cancer-associated thrombosis on concurrent anticoagulation and anticancer or supportive care therapies. Thromb Res 2023; 231:128-134. [PMID: 37857226 DOI: 10.1016/j.thromres.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND A main concern in the management of patients with cancer-associated thrombosis (CAT) is drug-drug interactions (DDIs) between anticoagulants and anticancer therapies. Their clinical implications remain unclear. METHODS To quantify the prevalence of DDIs and risks of recurrent venous thromboembolism (VTE) and bleeding events in patients with CAT on anticoagulation, we conducted a retrospective cohort study in patients with CAT on concurrent anticoagulants and anticancer and/or supportive care therapies. All patients were followed for 6 months from CAT diagnosis or until death (whichever occurred first). The primary outcome was the percentage of patients with anticoagulant DDIs classified as risk C, D, or X in Lexicomp® at any time during the 6 months. Secondary outcomes included recurrent VTE and clinically relevant bleeding events. We calculated the 6-month cumulative incidence of outcomes with 95 % confidence interval (CI) and compared those with and without DDIs, considering death as a competing risk. RESULTS Among 267 patients included, 111 (41.6 %) had DDIs with anticoagulants at any time during the study. Those on DOACs at any time had more DDIs compared to LMWH (50.9 % vs 19.3 %, p < 0.0001). The 6-month incidence was 8.2 % (95 % CI 5.3-11.9) for recurrent VTE and 6.7 % (95 % CI 4.2-10.2) for clinically relevant bleeding, with no significant differences between groups with or without DDIs. CONCLUSIONS There are high incidences of DDIs in patients with CAT on anticoagulants, more with DOACs. DDIs classified as risk C, D, or X by Lexicomp® were not associated with recurrent VTE or bleeding events in our cohort.
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Affiliation(s)
- Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | | | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Hina Chaudry
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Aurélien Delluc
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Kim SY, Lim J, Shim GH. Comparison of mortality and short-term outcomes between classic, intubation-surfactant-extubation, and less invasive surfactant administration methods of surfactant replacement therapy. Front Pediatr 2023; 11:1197607. [PMID: 37780042 PMCID: PMC10541210 DOI: 10.3389/fped.2023.1197607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023] Open
Abstract
Background Intubation-Surfactant-Extubation (InSurE) and less invasive surfactant administration (LISA) are alternative surfactant replacement therapy methods for reducing the complications associated with invasive mechanical ventilation. This study aimed to compare the Classic, InSurE, and LISA methods in Very-Low-Birth-Weight infants (VLBWIs) in South Korea. Methods The Korean Neonatal Network (KNN) enrolled VLBWIs born between January 1, 2019 and December 31, 2020. They were analyzed retrospectively to compare the duration of respiratory support, length of hospitalization, mortality, and short-term outcomes of the three groups. Results The duration of invasive ventilator support was shorter in the following order: InSurE (3.99 ± 11.93 days), LISA (8.78 ± 29.32 days), and the Classic group (22.36 ± 29.94 days) (p = 0.014, p < 0.01) and InSurE had the shortest hospitalization (64.91 ± 24.07 days, p < 0.05) although the results couldn't adjust for confounding factor because of irregular distribution. InSurE had the lower risk of intraventricular hemorrhage (IVH) grade II-IV [odds ratio (OR) 0.524 [95% confidence interval (CI): 0.287-0.956], p = 0.035] than in the Classic group. Mortality was lower in the InSurE [OR 0.377 (95% CI: 0.146-0.978), p = 0.045] and LISA [OR 0.296 (95% CI: 0.102-0.862), p = 0.026] groups than in the Classic group. There was a reduced risk of moderate to severe bronchopulmonary dysplasia (BPD) [OR 0.691 (95% CI: 0.479-0.998, p = 0.049), OR 0.544 (95% CI: 0.355-0.831, p = 0.005), respectively], pulmonary hypertension [OR 0.350 (95% CI: 0.150-0.817, p = 0.015), OR 0.276 (95% CI: 0.107-0.713, p = 0.008), respectively], periventricular leukomalacia (PVL) [OR 0.382 (95% CI: 0.187-0.780, p = 0.008), OR 0.246 (95% CI: 0.096-0.627, p = 0.003), respectively], and patent ductus arteriosus (PDA) with treatment [OR 0.628 (95% CI: 0.454-0.868, p = 0.005), OR 0.467 (95% CI: 0.313-0.696, p < 0.001) respectively] in the InSurE and LISA groups compared to the Classic group. Conclusion InSurE showed the lowest duration of invasive ventilator support, length of hospitalization. InSurE and LISA exhibited reduced mortality and decreased risks of moderate to severe BPD, pulmonary hypertension, PVL, and PDA with treatment compared to the Classic group.
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Affiliation(s)
- Seung Yeon Kim
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University Scholl of Medicine, Daejeon, Republic of Korea
| | - Gyu-Hong Shim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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H.V. A, Maka VV, Patil P, C. A. Incidence, Patterns, and Severity of Potential Drug Interactions Among Cancer Patients on Chemotherapy in a Tertiary Care Hospital. J Pharmacol Pharmacother 2023. [DOI: 10.1177/0976500x231162712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Objective To study the incidence of potential drug−drug interactions (DDIs) and evaluate their pattern and severity in cancer inpatients. Materials and Methods A detailed clinical data and prescriptions of 150 inpatients with different malignancies were subjected to DDI screening using Micromedex software. The frequency of potential DDIs and their types, patterns, and severity were investigated. Results A total of 360 potential DDIs were present in 111 (74%) of 150 inpatients, dominated by female (67.33%) and breast cancer (30%) patients. The incidence of severe interactions was 63.88%, moderate interactions 35.83%, and mild interactions 0.27%. The potential mechanisms of DDIs were 38.33% pharmacodynamic, 48.33% pharmacokinetic, and 13.33% unspecified. The drug interactions were found to be positively correlated ( p < 0.01) with the 6–10 number of prescribed medicines. Conclusion According to this study, the number of medicines prescribed to cancer inpatients increased the chance of DDIs. As a result, the drug surveillance program could save a sizable number of patients from the potentially hazardous clinical effects of DDIs.
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Timilsina M, Tandan M, Nováček V. Machine learning approaches for predicting the onset time of the adverse drug events in oncology. MACHINE LEARNING WITH APPLICATIONS 2022. [DOI: 10.1016/j.mlwa.2022.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Koni AA, Nazzal MA, Suwan BA, Sobuh SS, Abuhazeem NT, Salman AN, Salameh HT, Amer R, Zyoud SH. A comprehensive evaluation of potentially significant drug-drug, drug-herb, and drug-food interactions among cancer patients receiving anticancer drugs. BMC Cancer 2022; 22:547. [PMID: 35568834 PMCID: PMC9107751 DOI: 10.1186/s12885-022-09649-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION During the cancer treatment path, cancer patients use numerous drugs, including anticancer, supportive, and other prescribed medications, along with herbs and certain products. This puts them at risk of significant drug interactions (DIs). This study describes DIs in cancer patients and their prevalence and predictors. METHODS A cross-sectional study design was used to achieve the study objectives. The study was carried out in two centers in the northern West Bank, Palestine. The Lexicomp® Drug Interactions tool (Lexi-Comp, Hudson OH, USA) was applied to check the potential DIs. In addition, the Statistical Package for the Social Sciences (SPSS) was used to show the results and find the associations. RESULTS The final analysis included 327 patients. Most of the participants were older than 50 years (61.2%), female (68.5%), and had a solid tumor (74.6%). The total number of potential DIs was 1753, including 1510 drug-drug interactions (DDIs), 24 drug-herb interactions, and 219 drug-food interactions. Importantly, the prevalence of DDIs was 88.1%. In multivariate analysis, the number of potential DDIs significantly decreased with the duration of treatment (p = 0.007), while it increased with the number of comorbidities (p < 0.001) and the number of drugs used (p < 0.001). CONCLUSIONS We found a high prevalence of DIs among cancer patients. This required health care providers to develop a comprehensive protocol to monitor and evaluate DIs by improving doctor-pharmacist communication and supporting the role of clinical pharmacists.
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Affiliation(s)
- Amer A. Koni
- grid.11942.3f0000 0004 0631 5695Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Maisa A. Nazzal
- grid.11942.3f0000 0004 0631 5695Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Bushra A. Suwan
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samah S. Sobuh
- grid.11942.3f0000 0004 0631 5695Department of Clinical Pharmacy, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Najiya T. Abuhazeem
- grid.11942.3f0000 0004 0631 5695Department of Clinical Pharmacy, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Asil N. Salman
- grid.11942.3f0000 0004 0631 5695Department of Clinical Pharmacy, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Husam T. Salameh
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Riad Amer
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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Yekedüz E, Aktaş EG, Köksoy EB, Doğan N, Ürün Y, Utkan G. The prognostic role of polypharmacy in metastatic colorectal cancer patients treated with regorafenib. Future Oncol 2022; 18:1067-1076. [PMID: 35109668 DOI: 10.2217/fon-2021-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate polypharmacy (PP) in patients with metastatic colorectal cancer receiving regorafenib. Methods: Patients with metastatic colorectal cancer receiving regorafenib were included and divided into two categories by their PP status: PP- (<5 regular drug use/day) and PP+ (≥5 regular drug use/day). Results: 80 patients were included. 31 (38.7%) patients had PP. The median number of drugs used was three and seven in PP- and PP+ patients, respectively. Antiemetics (26.5%) and antacids (48.4%) were the most common drugs used by PP- and PP+ patients, respectively. In multivariate analysis, the risk of death was higher in PP+ patients (hazard ratio: 2.1; 95% CI: 1.2-3.7; p = 0.005). Conclusion: PP was an independent prognostic factor for overall survival in patients with metastatic colorectal cancer receiving regorafenib.
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Affiliation(s)
- Emre Yekedüz
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Elif Gizem Aktaş
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, 06590, Turkey
| | - Elif Berna Köksoy
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Neslihan Doğan
- Medical Oncology Clinic, Prof Dr A İlhan Özdemir Training and Research Hospital, Giresun University, Giresun, 28100, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
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Georgiev KD, Hvarchanova N, Stoychev E, Kanazirev B. Prevalence of polypharmacy and risk of potential drug-drug interactions among hospitalized patients with emphasis on the pharmacokinetics. Sci Prog 2022; 105:368504211070183. [PMID: 35072561 PMCID: PMC10358706 DOI: 10.1177/00368504211070183] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Both polypharmacy and potential drug-drug interactions (pDDIs), especially those at the pharmacokinetic level, are common in hospitalized patients and are associated with adverse effects and failure of therapy. OBJECTIVE The aim of the present study is to investigate retrospectively the prevalence of polypharmacy and the risk of potential pharmacokinetic drug-drug interaction among hospitalized patients. METHODS The medical documentation of hospitalized patients in the unit of internal diseases at the hospital "St Marina" in Varna, Bulgaria for a period of six months (January-July 2016) was retrospectively reviewed. Lexicomp® Drug Interaction software was used for the detection of pDDI. Descriptive statistic and logistic regression were used for data analysis. RESULTS In this study, 294 patients out of 510 (57%) were selected with polypharmacy. The number of detected potential pharmacokinetic DDIs (pPKDDIs) was only 216 (or 12,4%), but almost 40% of patients with polypharmacy were exposed to at least one pPKDDIs. The most common pPKDDIs occur at the biotransformation level - 78 (36,1%), and the most common enzyme form that is involved in these interactions is cytochrome 3A4 (44 or 20,4%). The number of prescribed medications (>7) was found to increase the possibility of having pDDIs (OR 25.535, 95% CI 12.529 to 52.042; p = <0.001) and pPKDDIs (OR 5.165, 95% CI 3.430 to 7.779; p = <0.001) as well. CONCLUSION AND RELEVANCE Caution should be taken in patients taking more than seven drugs and careful assessment of the pPKDDIs should be made. When such interactions are detected, they need to be properly evaluated and managed.
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Affiliation(s)
- Kaloyan D. Georgiev
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Nadezhda Hvarchanova
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Elitsa Stoychev
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Branimir Kanazirev
- Department of Internal Medicine, UMHAT “St Marina”, Faculty of Medicine, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
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Yasin AI, Topcu A, Akuc MN, Türk HM, Soysal P. A comparison of anticholinergic burden in older patients with and without cancer. Future Oncol 2021; 17:5067-5075. [PMID: 34704458 DOI: 10.2217/fon-2021-0469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare anticholinergic burden (ACB) in older patients with and without cancer and evaluate the effects of ACB on geriatric syndromes. Methods: A total of 291 patients from the geriatric clinic and 301 patients from the oncology clinic were evaluated. ACB <2 was categorized as low ACB and ACB ≥2 was categorized as high ACB. A comprehensive geriatric assessment was performed on patients from the geriatric clinic. Results: ACB scores were significantly higher in patients without cancer compared with those with cancer (p < 0.005). Number of falls and Geriatric Depression Scale 15 scores were higher and Mini-Nutritional Assessment and Barthel/Lawton activities of daily living scores were lower in geriatric patients with high ACB scores compared with those with low ACB scores (p < 0.005). Conclusion: It is crucial to understand the potential effects of ACB for rational drug use and optimum cancer management in older patients with cancer.
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Affiliation(s)
- Ayse Irem Yasin
- Department of Medical Oncology, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Atakan Topcu
- Department of Medical Oncology, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Meysere Nur Akuc
- Department of Internal Medicine, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Hacı Mehmet Türk
- Department of Medical Oncology, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Pinar Soysal
- Department of Geriatrics, Bezmialem Vakıf University, Istanbul 34093, Turkey
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Rashid K, Khan Y, Ansar F, Waheed A, Aizaz M. Potential Drug-Drug Interactions in Hospitalized Medical Patients: Data From Low Resource Settings. Cureus 2021; 13:e17336. [PMID: 34557372 PMCID: PMC8450024 DOI: 10.7759/cureus.17336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Adverse events related to Drug-Drug Interactions (DDIs) are among the few common reasons for hospitalization worldwide; however, they can be prevented with an efficient patient-centered system. Different mechanisms have successfully limited the prevalence of DDIs in developed countries. There are limited data regarding DDIs from limited-resource settings. Furthermore, there is no cost-effective system that has shown promising results in preventing them in this setting. This study aims to assess the frequency of potential DDIs in a low-resource setting and to check its association with different factors such as poly-pharmacy and demographics. Methods Through this cross-sectional study, drug charts of patients admitted to a medical unit in November 2019 were analyzed using a structured questionnaire. A list of drugs co-prescribed to each patient was entered into the Medscape Drug Interaction checker to calculate the frequency and severity of potential DDIs. Results The mean age of patients was 49 years, and on average, seven drugs were prescribed to each patient. Among 100 analyzed prescriptions, 400 potential DDIs were identified with a mean of 4±5.42 per patient. According to Medscape interaction checker classification, 2 DDIs were contraindicated, 28 were serious, 246 required close monitoring, and 124 were minor. The most frequently encountered drug interaction was "spironolactone with furosemide." There was a significant correlation of the occurrence of potential DDIs with increased numbers of prescribed drugs. Conclusion Our patient population was prescribed more drugs per patient than calculated in other settings. Poly-pharmacy is an independent risk factor for DDIs. Lastly, advancing age exposes patients to poly-pharmacy, and therefore, they are at a higher risk of developing DDIs.
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Affiliation(s)
- Khalid Rashid
- Internal Medicine, James Cook University Hospital, Middlesbrough, GBR
| | - Yahya Khan
- Department of Medical Education, Pak International Medical College, Peshawar, PAK
| | - Farrukh Ansar
- Medicine, Northwest School of Medicine, Khyber Medical University, Peshawar, PAK
| | - Aamir Waheed
- Internal Medicine, Northampton General Hospital, Northampton, GBR
| | - Muhammad Aizaz
- Community Health Sciences, Peshawar Medical College, Peshawar, PAK
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Makihara K, Shimeda Y, Matsumura T. Influence of Concomitant Polypharmacy on Docetaxel-induced Febrile Neutropenia. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:135-141. [PMID: 35399310 DOI: 10.21873/cdp.10018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/31/2021] [Indexed: 01/18/2023]
Abstract
Background/Aim Docetaxel (DTX) is metabolized by liver cytochromes P450 (CYP) 3A4 (CYP3A4) and 3A5 (CYP3A5) CYP3A4 activity is considered the main factor affecting the effectiveness in DTX clearance. We, therefore, explored the association between DTX-induced febrile neutropenia (FN) and concomitant polypharmacy involving CYP3A4 inhibitors in cancer patients. Patients and Methods Among patients who received docetaxel, we compared the number of concomitant medications between patients with and without FN, and risk factors associated with FN were identified. Results The total number of concomitant CYP3A4 inhibitors and substrates used was significantly higher in patients with FN [mean: 2.1 (95% confidence interval (CI)=1.5-2.9)] than in those without FN [mean: 1.4 (95% CI=1.0-1.8)] (p=0.01). The only risk factor for FN was the use of ≥2 concomitant CYP3A4 inhibitors and substrates in total (OR=4.82, 95% CI=1.77-14.1; p=0.002). Conclusion Polypharmacy involving CYP3A4 inhibitors and substrates increases the risk of DTX-induced FN.
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Affiliation(s)
- Katsuya Makihara
- Department of Pharmacy, Yodogawa Christian Hospital, Osaka, Japan
| | - Yuka Shimeda
- Department of Pharmacy, Yodogawa Christian Hospital, Osaka, Japan
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Dai X, Karol MD, Hitron M, Hard ML, Goulet MT, McLaughlin CF, Brantley SJ. Napabucasin Drug-Drug Interaction Potential, Safety, Tolerability, and Pharmacokinetics Following Oral Dosing in Healthy Adult Volunteers. Clin Pharmacol Drug Dev 2021; 10:824-839. [PMID: 34107166 PMCID: PMC8453567 DOI: 10.1002/cpdd.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 04/10/2021] [Indexed: 12/05/2022]
Abstract
Napabucasin is an orally administered reactive oxygen species generator that is bioactivated by the intracellular antioxidant nicotinamide adenine dinucleotide phosphate:quinone oxidoreductase 1. Napabucasin induces cell death in cancer cells, including cancer stem cells. This phase 1 study (NCT03411122) evaluated napabucasin drug‐drug interaction potential for 7 cytochrome P450 (CYP) enzymes and the breast cancer resistance protein transporter/organic anion transporter 3. Healthy volunteers who tolerated napabucasin during period 1 received probe drugs during period 2, and in period 3 received napabucasin (240 mg twice daily; days 1‐11) plus a phenotyping cocktail containing omeprazole (CYP2C19), caffeine (CYP1A2), flurbiprofen (CYP2C9), bupropion (CYP2B6), dextromethorphan (CYP2D6), midazolam (CYP3A) (all oral; day 6), intravenous midazolam (day 7), repaglinide (CYP2C8; day 8), and rosuvastatin (breast cancer resistance protein/organic anion transporter 3; day 9). Drug‐drug interaction potential was evaluated in 17 of 30 enrolled volunteers. Napabucasin coadministration increased the area under the plasma concentration–time curve from time 0 extrapolated to infinity (geometric mean ratio [90% confidence interval]) of caffeine (124% [109.0%‐141.4%]), intravenous midazolam (118% [94.4%‐147.3%]), repaglinide (127% [104.7%‐153.3%]), and rosuvastatin (213% [42.5%‐1068.3%]) and decreased the area under the plasma concentration–time curve from time 0 extrapolated to infinity of dextromethorphan (71% [47.1%‐108.3%]), bupropion (79% [64.6%‐97.0%]), and hydroxybupropion (45% [15.7%‐129.6%]). No serious adverse events/deaths were reported. Generally, napabucasin is not expected to induce/inhibit drug clearance to a clinically meaningful degree.
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Affiliation(s)
- Xiaoshu Dai
- Clinical Pharmacology and Drug Metabolism, Sumitomo Dainippon Pharma Oncology, Inc., Cambridge, Massachusetts, USA
| | - Michael D Karol
- Clinical Pharmacology and Drug Metabolism, Sumitomo Dainippon Pharma Oncology, Inc., Cambridge, Massachusetts, USA
| | - Matthew Hitron
- Clinical Development, Sumitomo Dainippon Pharma Oncology, Inc., Cambridge, Massachusetts, USA
| | - Marjie L Hard
- Clinical Pharmacology, Nuventra, Inc., Durham, North Carolina, USA.,Current address: Praxis Precision Medicines, Cambridge, Massachusetts, USA
| | - Matthew T Goulet
- Clinical Pharmacology, Nuventra, Inc., Durham, North Carolina, USA.,Current address: Program Management Department, KSQ Therapeutics, Cambridge, Massachusetts, USA
| | | | - Scott J Brantley
- Clinical NCA & PK/PD, Nuventra, Inc., Durham, North Carolina, USA
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14
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Holle LM, Bilse T, Alabelewe RM, Kintzel PE, Kandemir EA, Tan CJ, Weru I, Chambers CR, Dobish R, Handel E, Tewthanom K, Saeteaw M, Dewi LKM, Schwartz R, Bernhardt B, Garg M, Chatterjee A, Manyau P, Chan A, Bayraktar-Ekincioglu A, Aras-Atik E, Harvey RD, Goldspiel BR. International Society of Oncology Pharmacy Practitioners (ISOPP) position statement: Role of the oncology pharmacy team in cancer care. J Oncol Pharm Pract 2021; 27:785-801. [PMID: 34024179 DOI: 10.1177/10781552211017199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care.
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Affiliation(s)
| | - Tegan Bilse
- Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | | | | | - Chia Jie Tan
- National University of Singapore, Singapore, Singapore
| | - Irene Weru
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Evelyn Handel
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | | | - Manit Saeteaw
- Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Warin Chamrap District, Thailand
| | | | | | | | - Manju Garg
- Alberta Health Services, Calgary, AB, Canada
| | | | | | - Alexandre Chan
- University of California Irvine, Irvine, School of Pharmacy & Pharmaceutical Sciences, Irvine, CA, USA
| | | | - Elif Aras-Atik
- Hacettepe University, Faculty of Pharmacy, Ankara, Turkey
| | | | - Barry R Goldspiel
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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15
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Zhao X, Xu R, Wang Y, Zhu W, Hu H, Shen Z, Guo C, Zhang J. Impacts of Pharmacists-Managed Oncology Outpatient Clinic on Resolving Drug-Related Problems in Ambulatory Neoplasm Patients: A Prospective Study in China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211009662. [PMID: 33847148 PMCID: PMC8047945 DOI: 10.1177/00469580211009662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pharmacists are health care professionals who are actively involved in identifying and solving drug-related problems (DRPs) in neoplasm patients. However, the effectiveness of pharmaceutical services at outpatient clinic for neoplasm patients have not been reported in China. This study aims to describe and investigate the impacts of pharmacists-managed oncology outpatient clinic on ambulatory neoplasm patients. We performed a descriptive, prospective study from June 6, 2018 to June 6, 2020. Firstly, we established a pharmacists-managed oncology outpatient clinic and a Pharmacists Work System of Medication Therapy Management (MTM) software with the cooperation of oncologists, pharmacists and software engineers in 2018. Subjects were neoplasm patients who visited the pharmacists-managed outpatient clinic. The pharmacists performed a comprehensive assessment of the patient’s medication and made planned interventions based on the DRPs identified. A total of 215 eligible patients with 707 visits were enrolled and recorded in the MTM software. A total of 316 DRPs (1.47 per patient) were identified. Adverse reactions, non-adherence, untreated indication, and drug interactions were the leading DRPs. 261 (82.6%) of the identified DRPs had been confirmed as resolved and 104 (78.2%) of adverse reactions were improved following pharmacist interventions and 2 to 3 course follow-up. Of the 382 planned interventions, 345 (90.3%) were accepted by patients or physicians. This is the first pharmacists-managed oncology outpatient clinic to describe the type of DRPs in neoplasm patients and evaluate the effectiveness of pharmacist interventions in China. Pharmacist interventions were efficacious in resolving DRPs and improving adverse reactions. We confirmed that pharmacists have an important role in ambulatory neoplasm patients care.
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Affiliation(s)
- Xincai Zhao
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rong Xu
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yonggang Wang
- Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wanhu Zhu
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haiyan Hu
- Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zan Shen
- Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cheng Guo
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianping Zhang
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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16
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Outcomes of patients with hematologic malignancies and COVID-19: a report from the ASH Research Collaborative Data Hub. Blood Adv 2020; 4:5966-5975. [PMID: 33278301 PMCID: PMC7724912 DOI: 10.1182/bloodadvances.2020003170] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
The ASH Research Collaborative COVID-19 Registry for Hematology collects data on patients with hematologic diseases and COVID-19. Among the first 250 patients, mortality was 28%, and in several patients, a decision was made to forgo intensive care unit admission.
Coronavirus disease 2019 (COVID-19) is an illness resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in late 2019. Patients with cancer, and especially those with hematologic malignancies, may be at especially high risk of adverse outcomes, including mortality resulting from COVID-19 infection. The ASH Research Collaborative COVID-19 Registry for Hematology was developed to study features and outcomes of COVID-19 infection in patients with underlying blood disorders, such as hematologic malignancies. At the time of this report, data from 250 patients with blood cancers from 74 sites around the world had been entered into the registry. The most commonly represented malignancies were acute leukemia (33%), non-Hodgkin lymphoma (27%), and myeloma or amyloidosis (16%). Patients presented with a myriad of symptoms, most frequently fever (73%), cough (67%), dyspnea (50%), and fatigue (40%). Use of COVID-19–directed therapies, such as hydroxychloroquine (n = 76) or azithromycin (n = 59), was common. Overall mortality was 28%. Patients with a physician-estimated prognosis from the underlying hematologic malignancy of <12 months at the time of COVID-19 diagnosis and those with relapsed/refractory disease experienced a higher proportion of moderate/severe COVID-19 disease and death. In some instances, death occurred after a decision was made to forgo intensive care unit admission in favor of a palliative approach. Taken together, these data support the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection. Batch submissions from sites with high incidence of COVID-19 infection are planned to support future analyses.
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Bibi R, Azhar S, Iqbal A, Jabeen H, Kalsoom UE, Iqbal MM, Nazeer M. Prevalence of potential drug-drug interactions in breast cancer patients and determination of their risk factors. J Oncol Pharm Pract 2020; 27:1616-1622. [PMID: 33086907 DOI: 10.1177/1078155220963212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer patients use numerous medications, which include cytotoxic chemotherapy drugs, hormonal agents and supportive medication, so they are more vulnerable to potential adverse drug interactions. This study aimed to evaluate frequency, severity, clinical importance and risk factors responsible for the Drug-drug interactions (DDIs) in a cohort of patients suffering from breast cancer. Data was obtained from 150 patients in the oncology ward (both inpatient and outpatient) with a confirmed diagnosis of breast cancer and currently receiving standard breast cancer-directed treatment. The data was recorded into a pre-designed form specifically made for this study through individual patient interviews and by reviewing the detailed medical chart records of the patients. DDIs were identified by using drug interaction software such as Medscape mobile application and Micromedex version 2.The results of this study showed that all patients were female. The mean numbers of drugs that patients used were 7. Potential drug interactions were identified in 92% of the patients. When drug groups were overviewed, 32% of interactions were between anti neoplastic drugs, 62.9% interactions were between the anti neoplastic agent and supportive care drugs and 5% of them were between anti-cancer drugs and drugs used to treat comorbidities. Major DDIs were found in 62.2% of patients, 25.3% of DDIs were moderate and 12.4% were minor. The number of drugs, comorbid diseases, and selection of chemo protocols were the risk factors for drug interactions. Most of the DDIs found in breast cancer therapy may have adverse consequences on patient health and therapeutic outcomes. Therefore, health care professionals should review the medication regimen of patients with breast cancer before starting any chemotherapy treatment.
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Affiliation(s)
- Rashida Bibi
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad, Pakistan
| | - Saira Azhar
- Department of Pharmacy, University of Sargodha, Sargodha, Pakistan
| | - Ayesha Iqbal
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad, Pakistan
| | - Hajera Jabeen
- Department of Breast Cancer, INOR, Abbottabad, Pakistan
| | - Umm-E Kalsoom
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad M Iqbal
- Department of Medicine, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Maria Nazeer
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad, Pakistan
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18
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Noor S, Ismail M, Khadim F. Potential drug-drug interactions associated with adverse clinical outcomes and abnormal laboratory findings in patients with malaria. Malar J 2020; 19:316. [PMID: 32867788 PMCID: PMC7461345 DOI: 10.1186/s12936-020-03392-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/25/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Hospitalized patients with malaria often present with comorbidities or associated complications for which a variety of drugs are prescribed. Multiple drug therapy often leads to drug-drug interactions (DDIs). Therefore, the current study investigated the prevalence, levels, risk factors, clinical relevance, and monitoring parameters/management guidelines of potential DDIs (pDDIs) among inpatients with malaria. METHODS A retrospective cohort study was carried out at two tertiary care hospitals. A total of 398 patients' profiles were evaluated for pDDIs using the Micromedex Drug-Reax®. Odds ratios were calculated to identify the strength of association between presence of DDIs and potential risk factors via logistic regression analysis. Further, the clinical relevance of frequent pDDIs was investigated. RESULTS Of 398 patients, pDDIs were observed in 37.2% patients, while major-pDDIs in 19.3% patients. A total of 325 interactions were found, of which 45.5% were of major- and 34.5% moderate-severity. Patients with the most common pDDIs were found with signs/symptoms and abnormalities in laboratory findings representing nephrotoxicity, hepatotoxicity, QT interval prolongation, and reduced therapeutic efficacy. The following drug pairs reported the highest frequency of adverse events associated with the interactions; calcium containing products-ceftriaxone, isoniazid-rifampin, pyrazinamide-rifampin, isoniazid-acetaminophen, and ciprofloxacin-metronidazole. The adverse events were more common in patients prescribed with the higher doses of interacting drugs. Multivariate regression analysis showed statistically significant association of pDDIs with 5-6 prescribed medicines (p = 0.01), > 6 prescribed medicines (p < 0.001), > 5 days of hospital stay (p = 0.03), and diabetes mellitus (p = 0.04). CONCLUSIONS PDDIs are commonly observed in patients with malaria. Healthcare professional's knowledge about the most common pDDIs could help in preventing pDDIs and their associated negative effects. Pertinent clinical parameters, such as laboratory findings and signs/symptoms need to be checked, particularly in patients with polypharmacy, longer hospital stay, and diabetes mellitus.
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Affiliation(s)
- Sidra Noor
- Department of Pharmacy, University of Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Ismail
- Department of Pharmacy, University of Peshawar, Khyber Pakhtunkhwa, Pakistan.
| | - Faiza Khadim
- Department of Pharmacy, University of Peshawar, Khyber Pakhtunkhwa, Pakistan
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19
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Faqeer N, Mustafa N, Abd Al-Jalil N, Qur'an T. Impact of clinical pharmacists in an inpatient medical oncology service: A prospective study at a comprehensive cancer center in Jordan. J Oncol Pharm Pract 2020; 27:897-901. [PMID: 32703083 DOI: 10.1177/1078155220943277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Clinical pharmacy is considered an integral discipline in the health care system for optimizing therapy and reducing drug-related problems. The objective of this study was to evaluate the impact of clinical pharmacists in optimizing management in a medical oncology service. METHODS A prospective study was conducted at King Hussein Cancer Center between July 2019 and September 2019 of patients admitted to the medical oncology service. The impact of clinical pharmacists was measured by evaluating their interventions, defined as actions that were expected to result in a change in patient management. Data were collected daily by routine review of patients' profiles and by recording clinical pharmacists' interventions. The data collected were baseline characteristics of patients, numbers and types of clinical pharmacists' interventions, their significance, medications involved, and rate of acceptance of clinical pharmacists' interventions by physicians. The significance of each intervention was assessed by two clinical pharmacists on a Hatoum scale. Physicians' acceptance was assessed by whether the recommendations were implemented. RESULTS During the study period, 748 patients were included, of whom 605 required a total of 1683 clinical interventions. The mean age was 56.3 years (±15.5 SD). Of the interventions, 39% resulted in initiation of a drug and 25% in drug discontinuations. The drug group most commonly associated with clinical pharmacists' interventions was antibiotics (26.5%). Physicians accepted 98% of the clinical pharmacists' interventions, and 92.4% of the interventions brought care to a more appropriate level and were considered significant. CONCLUSION Most patients in the medical oncology service required clinical pharmacists' interventions, as demonstrated by the high number of significant clinical pharmacists' interventions. Studies should be conducted to follow up these findings with respect to patient outcomes and cost savings.
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Affiliation(s)
- Nour Faqeer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Nour Mustafa
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | | | - Tasnim Qur'an
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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20
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Ismail M, Khan S, Khan F, Noor S, Sajid H, Yar S, Rasheed I. Prevalence and significance of potential drug-drug interactions among cancer patients receiving chemotherapy. BMC Cancer 2020; 20:335. [PMID: 32307008 PMCID: PMC7168989 DOI: 10.1186/s12885-020-06855-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Cancer patients often receive multiple drugs to maximize their therapeutic benefit, treat co-morbidities and counter the adverse effects of chemotherapy. Concomitant administration of multiple drugs increases the risk of drug interactions leading to compromised therapeutic efficacy or safety of therapy. The purpose of this study was to identify the prevalence, levels and predictors of potential drug-drug interactions (pDDIs) among cancer patients. Methods Six hundred and 78 patients receiving chemotherapy from two tertiary care hospitals were included in this cross-sectional study. Patient medication profiles were screened for pDDIs using the Micromedex® database. Logistic regression analysis was performed to identify the predictors of pDDIs. Results The overall prevalence of pDDIs was 78%, majority of patients had 1–2 pDDIs (39.2%). A total of 1843 pDDIs were detected. Major-pDDIs were most frequent (67.3%) whereas, a significant association of pDDIs was found between > 7 all prescribed drugs (p < 0.001) and ≥ 3 anti-cancer drugs (p < 0.001). Potential adverse outcomes of these interactions include reduced therapeutic effectiveness, QT interval prolongation, tendon rupture, bone marrow suppression and neurotoxicity. Conclusions Major finding of this study is the high prevalence of pDDIs signifying the need of strict patient monitoring for pDDIs among cancer patients. Patients at higher risk to pDDIs include those prescribed with > 7 any types of drugs or ≥ 3 anticancer drugs. Moreover, list of most frequently identified major and moderate interactions will aid health care professional in timely identification and prevention of pDDIs.
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Affiliation(s)
- Mohammad Ismail
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan.
| | - Sehrash Khan
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Fahadullah Khan
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sidra Noor
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Hira Sajid
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Shazia Yar
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Irum Rasheed
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
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21
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Biltaji E, Enioutina EY, Yellepeddi V, Rower JE, Sherwin CMT, Ward RM, Lemons RS, Constance JE. Supportive care medications coinciding with chemotherapy among children with hematologic malignancy. Leuk Lymphoma 2020; 61:1920-1931. [PMID: 32264729 PMCID: PMC7725403 DOI: 10.1080/10428194.2020.1749604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pharmacokinetic (PK) conflicts can arise between supportive care medications (SCM) and chemotherapy in children with hematologic malignancy (HM). In this retrospective study, medical records for children (28 days-18 years) diagnosed with HM and receiving an SCM antimicrobial were collected from a hospital network between 1 May 2000 and 31 December 2014. PK drug-gene associations were obtained from a curated pharmacogenomics database. Among 730 patients (median age of 7.5 (IQR 3.7-13.9) years), primarily diagnosed with lymphoid leukemia (52%), lymphoma (28%), or acute myeloid leukemia (16%), chemotherapy was administered in 2846 hospitalizations. SCM accounted for 90.5% (n = 448) of distinct drugs with 93% (n = 679) of children, receiving ≥5 different SCM/hospitalization. Same-day SCM/chemotherapeutic PK gene overlap occurred in 48.3% of hospitalizations and was associated with age (p = 0.026), number of SCM, HM subtype, surgery, and hematopoietic stem cell transplant (p < 0.0001). A high and variable SCM burden among children with HM receiving chemotherapy poses a risk for unanticipated PK conflicts.
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Affiliation(s)
- Eman Biltaji
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Elena Y Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Venkata Yellepeddi
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joseph E Rower
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Catherine M T Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH, USA
| | - Robert M Ward
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Richard S Lemons
- Division of Hematology and Oncology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jonathan E Constance
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Moghaddas A, Adib-Majlesi M, Sabzghabaee AM, Hajigholami A, Riechelmann R. Potential drug-drug Interactions in hospitalized cancer patients: A report from the Middle-East. J Oncol Pharm Pract 2020; 27:46-53. [PMID: 32183585 DOI: 10.1177/1078155220910209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients suffering from solid tumors use a wide range of cytotoxic drugs. In this study, we aimed to detect, document, and descriptively analyze the potential drug-drug interactions in hospitalized solid tumor's patients in a Middle Eastern referral oncology-hematology University-affiliated hospital. MATERIALS AND METHODS In this cross-sectional study, the medical record of solid tumor's patients who were admitted to the referral oncological center in Isfahan, Iran, during the six months period (2018) were considered. We included all patients who had received at least two chemotherapy or nonchemotherapy drugs simultaneously. The potential drug-drug interactions between chemotherapy and nonchemotherapy drugs were evaluated with Lexi-Interact ver.1.1 online software. RESULTS During the study period, a total of 141 cancer patients were recruited, and their drug therapy regiment was thoroughly analyzed. We detected 227 drug-drug interactions with moderate or major severity out of included patients in which 96, 71, 32, and 28 interactions were in the category of C, D, B, and X, respectively. One hundred and fourteen patients (80.8%) encountered at least one potential drug-drug interactions during their hospitalization. Mechanistically, most of drug-drug interactions (56.4%) were pharmacodynamics. Interaction between granisetron and metoclopramide were the top 10 detected interaction (11.4%). The interaction between docetaxel and carboplatin was the most frequent drug-drug interactions between oncology drugs (2.6% of total drug-drug interactions). CONCLUSION Potentially moderate or major drug-drug interactions frequently occur among solid tumor's cancer patients necessitate the establishment of a clinical pharmacy service for providing relevant pharmacotherapy consultations to prevent this potentially serious concern.
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Affiliation(s)
- Azadeh Moghaddas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Adib-Majlesi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali M Sabzghabaee
- Department of Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Hajigholami
- Department of Internal Medicine, Haematology Section, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rachel Riechelmann
- Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
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Azam C, Claraz P, Chevreau C, Vinson C, Cottura E, Mourey L, Pouessel D, Guibaud S, Pollet O, Le Goff M, Bardies C, Pelagatti V, Canonge JM, Puisset F. Association between clinically relevant toxicities of pazopanib and sunitinib and the use of weak CYP3A4 and P-gp inhibitors. Eur J Clin Pharmacol 2020; 76:579-587. [PMID: 31932871 DOI: 10.1007/s00228-020-02828-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Sunitinib and pazopanib, two tyrosine kinase inhibitors (TKI), may be targets of potential pharmacokinetic drug-drug interactions (P-PK-DDIs). While strong cytochrome P4503A (CYP3A4) inhibitors or inducers should cause a clinically relevant modification in plasma TKI concentrations, the effect of weak inhibitors is unknown. The objective of this study was to evaluate the association between weak P-PK-DDI and clinically relevant toxicity in real life. PATIENTS AND METHODS This was a single-center retrospective study including patients treated with sunitinib or pazopanib for any malignancies, for whom a PK-DDI analysis was performed before starting TKI. The primary endpoint was the correlation between P-PK-DDIs and a dose decrease after 1 month of treatment. The secondary endpoint was the correlation between PK-DDIs and drug withdrawal due to toxicity. RESULTS Seventy-six patients were assessed. A P-PK-DDI with weak CYP3A4 or P-gp inhibition was found in 14 patients. In patients with P-PK-DDI or without, the dose was reduced during the first month in 57.1% and 17.7% (p = 0.003) and the drug withdrawn in 42.8% and 11.3% (p = 0.011), respectively. In multivariate analysis, a significant correlation was found between P-PK-DDI (CYP3A4 and P-gp inhibitors) and dose reduction, and between drug withdrawal and PK-DDI (CYP3A4 inhibitors). CONCLUSION P-PK-DDI was correlated with dose reduction and drug withdrawal due to toxicity. The causality of this relationship warrants to be assessed; therefore, therapeutic drug monitoring is necessary in patients treated with TKI.
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Affiliation(s)
- Camille Azam
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Pauline Claraz
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Christine Chevreau
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Camille Vinson
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Ewa Cottura
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Loïc Mourey
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Damien Pouessel
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Selena Guibaud
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Olivia Pollet
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Magali Le Goff
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Catherine Bardies
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Véronique Pelagatti
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Jean Marie Canonge
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Centre Hospitalier Universitaire, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, France
| | - Florent Puisset
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France.
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Team 14, INSERM UMR1037, Université de Toulouse, 2 avenue Hubert Curien, CS53717, Toulouse CEDEX 1, France.
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Drug-drug interactions in patients undergoing chemoradiotherapy and the impact of an expert team intervention. Int J Clin Pharm 2019; 42:132-140. [PMID: 31865596 DOI: 10.1007/s11096-019-00949-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
Background Several studies have examined the drug-drug interaction patterns in different patient populations and treatment settings; however, there is a need, particularly in the field of oncology and radiotherapy, for evaluating methods targeted towards preventing potential drug-drug interactions. One of the measures proposed is identifying potential interactions using computer programs and their evaluation by pharmacologists or clinical pharmacists, thereby providing clinically relevant information to the treating physician regarding the required prescription changes. Objective To determine the prevalence of potential drug-drug interactions in patients receiving chemoradiotherapy and assess the usefulness of expert team recommendations in minimizing interactions. Setting Patients admitted to the radiotherapy and oncology ward of a tertiary care teaching hospital in Karnataka, India. Method We conducted a prospective, cross-sectional study of prescriptions written for patients receiving chemoradiotherapy. Prescriptions containing two or more drugs, at least one of the drugs being an anticancer drug, were analyzed. They were screened for potential drug-drug interactions using the Lexicomp® drug interaction software. The interactions were classified as X, drug combination to be avoided; D, modification of therapy to be considered; and C, therapy to be monitored, as per the Lexicomp criteria. Main outcome measure The number of drug-drug interactions detected that were accepted by the treating radio-oncologist as requiring prescription change before and after the prescription review by an expert team. Results Two hundred twenty-three prescriptions were screened for the presence of drug-drug interactions; 106 prescriptions (47.53%) containing 620 drugs and 211 drug-drug interactions were identified. Of the 211 interactions identified, 6.64% (14/211), 18.48% (39/211), and 74.88% (158/211) drug-drug interactions belonged to category X, D, and C, respectively. Twenty-seven (50.94%) of the 53 category X and D interactions identified were accepted the oncologist as requiring a change in the prescription; an additional 13 (24.53%) interactions were identified as significant by the expert team, and 11 (84.62%) of these were accepted by the oncologist. Conclusion A system of alerting the treating physician to a potential drug-drug interaction leads to avoidance of prescription of the interacting drug combination, and the assistance by an expert team adds significantly to avoidance of clinically relevant drug interactions.
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Monteiro CRDA, Schoueri JHM, Cardial DT, Linhares LDC, Turke KC, Steuer LV, Menezes LWDA, Argani IL, Sette C, Cubero DDIG, Giglio AD. Evaluation of the systemic and therapeutic repercussions caused by drug interactions in oncology patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2019; 65:611-617. [PMID: 31166436 DOI: 10.1590/1806-9282.65.5.611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/26/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Drug interaction is an important cause of global morbidity. It is of particular importance in cancer patients since they are often in use of polypharmacy, related to interactions between the drugs and the chemotherapeutics used. OBJECTIVE To evaluate the drug interaction between chemotherapy and other drugs in cancer patients. METHODS a cross-sectional study carried out in the outpatient oncology department of a public tertiary hospital. Two hundred thirty-five patients were included, and the drugs they were using were identified. Using the MedScape and Epocrates database, we evaluated the interactions between medications and chemotherapy by defining their frequency and dividing their severity from interaction into mild, close monitoring necessity and severe. RESULTS 161 patients had some drug interaction. We identified 9 types of mild interactions, 23 types of interactions with close monitoring necessity, and 2 types of serious interactions. The most frequent interactions were between fluorouracil and leucovorin (32 cases) and cyclophosphamide and doxorubicin (19 cases). Serious interactions were between aspirin and pemetrexed; and leucovorin and Bactrim. CONCLUSION In the present study, drug interactions were frequent, including serious interactions with a potential increase in morbidity and mortality. Thus, it is necessary for oncologists to draw up a therapeutic plan considering potential interactions between prescribed chemotherapy and current medications in use by patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Claudia Sette
- Faculty of Medicine of ABC, Santo André - SP, Brasil
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Pessoa TDL, Clemente Junior WS, Costa TXD, Bezerra PKDV, Martins RR. Drug interactions in maternal intensive care: prevalence, risk factors, and potential risk medications. EINSTEIN-SAO PAULO 2019; 17:eAO4521. [PMID: 31166484 PMCID: PMC6533079 DOI: 10.31744/einstein_journal/2019ao4521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/12/2018] [Indexed: 11/24/2022] Open
Abstract
Objective: To characterize severe potential drug interactions in maternal intensive care, and to determine their frequency, risk factors and potential risk medications. Methods: An observational and longitudinal study conducted between December 2014 and December 2015 in a maternal intensive care unit. Clinical data were collected and severe potential drug interactions were identified on pregnant inpatients. The drug interactions were classified by type, prevalence and exposure rate. A multivariate logistic regression model was used to identify the severe potential drug interactions and the related drugs (p<0.05). Results: A total of 95.1% of patients were exposed to, at least, one potential drug interaction; in that, 91.7% 33.9% were related to, respectively, moderate and severe potential drug interactions. The patients were exposed, on average, on 69.2% of days they were in the intensive care unit. The main drugs involved in more severe drug interactions were magnesium sulfate, metoclopramide, propranolol and diazepam. Conclusion: The severe potential drug interactions were observed in almost all patients of the study, and, approximately one third of those interactions were related to greater severity and resulted in exposure during long hospital stay. The higher number of prescribed drugs and its previous use of medications at home increase the occurrence of severe potential drug interactions.
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Riechelmann RP, Krzyzanowska MK. Drug interactions and oncological outcomes: a hidden adversary. Ecancermedicalscience 2019; 13:ed88. [PMID: 31123502 PMCID: PMC6467454 DOI: 10.3332/ecancer.2019.ed88] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Indexed: 12/16/2022] Open
Abstract
Patients with cancer are at particularly high risk of drug-drug interactions, with approximately 30% of them being exposed to potentially dangerous drug-drug combinations. Yet the real impact of such interactions on oncology practice remains mostly unknown, partly because of the challenges associated with disentangling the effects of harmful interactions from expected side effects of therapy or disease-related symptoms. Recently, some studies have looked at how oncologic outcomes are influenced by drug-drug interactions. In this editorial, we discuss the drug combinations that should be avoided, such as, for example, capecitabine and proton-pump inhibitors, and how research should be conducted in this neglected but clinically relevant topic.
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Affiliation(s)
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Kotlinska-Lemieszek A, Klepstad P, Haugen DF. Clinically Significant Drug-Drug Interactions Involving Medications Used for Symptom Control in Patients With Advanced Malignant Disease: A Systematic Review. J Pain Symptom Manage 2019; 57:989-998.e1. [PMID: 30776538 DOI: 10.1016/j.jpainsymman.2019.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT Most patients with advanced malignant disease need to take several drugs to control symptoms. This treatment raises risks of serious adverse effects and drug-drug interactions (DDIs). OBJECTIVES To identify studies reporting clinically significant DDIs involving medications used for symptom control, other than opioids used for pain management, in adult patients with advanced malignant disease. METHODS Systematic review with searches in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials, from the start of the databases (Embase from 1980) through June 21, 2018. In addition, reference lists of relevant full-text articles were hand-searched. RESULTS Of 9699 retrieved citations, 462 were considered potentially eligible. After full-text reading, 29 were included in the final analysis, together with 13 articles from reference lists. The 42 included publications were case reports, letters to the Editor, and one retrospective study. Drugs most often involved were antiepileptics, antidepressants, corticosteroids, and nonopioid analgesics. Clinical manifestations of identified DDIs included sedation, respiratory depression, serotonin syndrome, neuroleptic malignant syndrome, delirium, seizures, ataxia, liver and kidney failure, bleeding, cardiac arrhythmias, rhabdomyolysis, and others. The most common mechanisms eliciting DDIs were alteration of CYP450-dependent metabolism and overstimulation of serotonin receptors in the central nervous system. CONCLUSION Drugs used for symptom control in patients with advanced cancer may cause serious DDIs. Although there is limited evidence for the risk of clinically significant DDIs, physicians treating patients with cancer should try to limit polypharmacy, avoid drug combinations with a high risk of DDIs, and closely monitor patients for adverse drug reactions.
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Affiliation(s)
- Aleksandra Kotlinska-Lemieszek
- Palliative Medicine Chair and Department, Karol Marcinkowski University of Medical Sciences, Poznan, Poland; Hospice Palium, University Hospital of the Lord's Transfiguration, Poznan, Poland.
| | - Pål Klepstad
- Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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Potential Drug-drug Interactions at a Referral Pediatric Oncology Ward in Iran: A Cross-sectional Study. J Pediatr Hematol Oncol 2019; 41:e146-e151. [PMID: 30531601 DOI: 10.1097/mph.0000000000001346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incidence of drug-drug interactions (DDIs) has been widely reported; however, such reports in pediatric oncology patients still remain scarce. We studied frequency and demographic correlates of moderate and major DDIs at a pediatric oncology ward in Isfahan, Iran. All pediatric oncology patients admitted to the Omid hospital during a 6-month period (2017) who received at least 2 anticancer or non-anticancer drugs concomitantly were included in our study. Potential DDIs between anticancer and non-anticancer drugs during hospitalization was identified using Lexi-Interact on-line software. We detected 194 DDIs with moderate or major severity for our included 115 patients. Mechanistically, most of DDIs (56.4%) were pharmacodynamic. Systematic use of corticosteroids (82.0%), antimetabolites (77.0%), and antiemetic drugs (69.5%) were the most frequent medication classes responsible for detected DDIs. The interaction between aminoglycosides and the third generation cephalosporins was the most common (13.9%) non-anticancer DDI. The only identified interaction between 2 anticancer drugs was doxorubicin with cyclophosphamide. Age, sex, and the number of administered medications were associated with DDIs. Potential moderate or major DDIs occur frequently among pediatric cancer patients. More studies are needed to assess clinical and economic implications of DDIs in pediatric oncology patients.
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Sanchez L, Bacle A, Lamy T, Le Corre P. Potential drug-drug interactions and nephrotoxicity in hematopoietic stem cell transplant adult recipients during bone marrow transplantation unit stay. Cancer Chemother Pharmacol 2019; 83:827-835. [PMID: 30758649 DOI: 10.1007/s00280-019-03791-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/31/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Studies have documented potential drug-drug interactions (pDDIs) occurring in cancer patients mainly with solid malignancies, either in the ambulatory or hospital settings. While hematopoietic stem cell transplant (HSCT) patients during their bone marrow transplantation unit (BMTU) stay have rather complex medical regimens combining chemotherapy, anti-infectious agents, immunosuppressive agents, and supportive-care drugs, studies on potential DDIs are lacking. Our objective was to evaluate the prevalence and the density of pharmacokinetic and pharmacodynamic potential DDIs, and the evolution of the renal function in hematopoietic stem cell transplant (HSCT) adult recipients during their BMTU stay. METHODS Retrospective study in 31 adult patients consecutively admitted to the BMTU. RESULTS Prevalence of pharmacokinetic interactions was ten times lower than the pharmacodynamic interactions. The contraindications were rare, and only of pharmacokinetic origin. The main drugs involved in pharmacokinetic DDIs were ciclosporine, methotrexate, esomeprazole, tramadol, and vincristine. The median number of potential nephrotoxicity-related DDIs per patient was 7 and the median number of days during which nephrotoxicity-related DDIs potentially occurred was 77 days per patient. The decrease in glomerular filtration rate (GFR) throughout the BMTU stay (mean decrease of 13 ml/min) was correlated with the number of days of potential nephrotoxic drug interactions. CONCLUSIONS Potential DDIs in HCST patients in BMTU were quite common. The DDIs from pharmacokinetic origin were less frequent, but of higher grade, than those of pharmacodynamic origin. The decrease in GFR suggests that the density of potential nephrotoxic drug interactions may be an issue to be considered in these patients.
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Affiliation(s)
- Lydia Sanchez
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033, Rennes, France.,Pharmacia Del Carre López, 48012, Bilbao, Spain
| | - Astrid Bacle
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033, Rennes, France.,Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043, Rennes Cedex, France.,Univ Rennes, CHU Rennes, Inserm, EHESP, Irset-UMR_S 1085, 35000, Rennes, France
| | - Thierry Lamy
- Pôle Médecines Spécialisées, Service d'Hématologie Clinique, CHU de Rennes, 35033, Rennes, France.,Univ Rennes 1, INSERM, EFS Bretagne, UMR U1236, 35033, Rennes, France
| | - Pascal Le Corre
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033, Rennes, France. .,Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043, Rennes Cedex, France. .,Univ Rennes, CHU Rennes, Inserm, EHESP, Irset-UMR_S 1085, 35000, Rennes, France.
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Korucu FC, Senyigit E, Köstek O, Demircan NC, Erdogan B, Uzunoglu S, Cicin I. A retrospective study on potential drug interactions: A single center experience. JOURNAL OF ONCOLOGICAL SCIENCES 2018. [DOI: 10.1016/j.jons.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Fettah H, Moutaouakkil Y, Sefrioui MR, Moukafih B, Bousliman Y, Bennana A, Lamsaouri J, Makram S, Cherrah Y. Detection and analysis of drug-drug interactions among hospitalized cardiac patients in the Mohammed V Military Teaching Hospital in Morocco. Pan Afr Med J 2018; 29:225. [PMID: 30100979 PMCID: PMC6080962 DOI: 10.11604/pamj.2018.29.225.14169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/11/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Drug-drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. Patients with cardiovascular disorders are at higher risk for DDIs because of the types and number of drugs they receive. The aim of the present study was to assess the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. METHODS A prospective observational study from June 2016 to September 2016 was carried out in the cardiology department of a hospital in Morocco. Those patients who were taking at least two drugs and had a hospital stay of at least 48 hours were included in the study. The medications of the patients were analysed for possible interactions. All the prescriptions of the study population were screened for drug-drug interactions using a computerized DDI database system (Theriaque®). RESULTS During the study period, 138 patients were included; 360 interactions were detected among 94 patients, with an average number of drugs taken of 5.2. The prevalence of DDIs was estimated at 68.11%, the most common of which concerned Kardegic/Plavix (12.22%), Kardegic/Heparin (8.33%), and Lasilix/Spironolactone (5.83%). Among the 726 prescribed drugs, (372 [51.24%]) were drugs of the cardiovascular system, followed by blood and hematopoietic organ drugs (288 [39.67%]) according to the Anatomical Therapeutic Chemical Classification codes. These interactions were categorized on the basis of level of severity: interactions with major severity accounted for 11.11% (40) of the total DDIs while those with moderate and minor severity accounted for 37.22% (134) and 51.66% (186), respectively. CONCLUSION This study reports the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. This study shows that DDIs are frequent among hospitalized cardiac patients and highlights the need to screen prescriptions of cardiovascular patients for possible DDIs, as this helps in their detection and prevention.Pan African Medical Journal - ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)Pan African Medical Journal - ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net).
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Affiliation(s)
- Hicham Fettah
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Youssef Moutaouakkil
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Mohamed Reda Sefrioui
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Badreddine Moukafih
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Yassir Bousliman
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Ahmed Bennana
- Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat, Morocco
| | - Jamal Lamsaouri
- Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat, Morocco
| | - Sanaa Makram
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
| | - Yahia Cherrah
- Laboratory of Pharmacology, Toxicology, Faculty of Medicine and Pharmacy, Rabat Institute, University Mohamed V, Rabat-Morocco
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Advancing Treatment Approach to the Older Patient with Cancer Through Clinical Trials Participation. Surg Oncol Clin N Am 2017; 26:719-728. [DOI: 10.1016/j.soc.2017.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Multiple myeloma (MM) is a plasma cell neoplasm that affects elderly individuals with two-thirds of patients over 65 years at diagnosis. However, data available are derived from clinical trials conducted in younger patients. Fewer studies investigated treatment options in the elderly. This review summarizes the clinical outcomes and toxicities associated with therapeutic regimens in older patients including doublet, triplet and high dose therapyin newly diagnosed patients and relapsed patients with MM. We highlight the importance of an approach tailored to individuals, incorporates the geriatric frailty assessment, considers comorbiditiess and commits to early recognition and management of toxicities ranging from myelosuppression to polypharmacy. To date, no trial has prospectively investigated a tailored treatment paradigm in older patients based on frailty and/or comorbidities. As the population ages, the proportion of MM patients with advanced age will grow. Studies are indicated to determine optimal treatment approaches in this increasingly heterogeneous geriatric population.
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Affiliation(s)
- Evan Diamond
- a Division of Hematologic Oncology, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Oscar B Lahoud
- a Division of Hematologic Oncology, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Heather Landau
- a Division of Hematologic Oncology, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
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Vecchia S, Orlandi E, Confalonieri C, Damonti E, Riva A, Sartori A, Cavanna L. Prevalence study on potential drug–drug interaction in cancer patients in Piacenza hospital’s Onco-Haematology department. J Oncol Pharm Pract 2017; 24:490-493. [DOI: 10.1177/1078155217717324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Cancer patients can be a human model of potential drug interactions. Usually they receive a large number of different medications, including antineoplastic agents, drugs for comorbid illness and medication for supportive care, however information about these interactions are fragmented and poor. Objective We assessed a prospective study to evaluate the prevalence of drug interaction among patients hospitalized in the Onco-Haematology department, Hospital of Piacenza. Methods Data on drugs administered for cancer, comorbidities, or supportive care were collected from different computerized prescription software in use in the department; we compared them with a database to focus on the co-administration of drugs. A literature review was performed to identify major potential drug interaction and to classify them by level of severity and by strengths of scientific evidence. Results In this study 284 cancer patients were enrolled; patients had taken an average of seven drugs on each day of therapy plus chemotherapeutic agents, we identified 67 potential drug interactions. At least 53 patients had one potential drug interaction. Of all potential drug interactions 63 were classified as moderate severity and only four as major. In 55 cases chemotherapeutic agents were involved in possible interactions with supportive care drugs, meanwhile in 12 cases the potential drug interactions were between supportive care drugs. Conclusions In our centre, thanks to a computerized prescription software, integrated with caution alarm in case of possible interaction, we had a lower rate of potential drug interactions than the one from literature. It is possible to improve the software integrating the alarm with the potential drug interactions between chemotherapy agents and supportive care drugs.
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Affiliation(s)
- Stefano Vecchia
- Pharmacy Department, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - Elena Orlandi
- Onco-Haematology Department, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | | | - Enrico Damonti
- Pharmacy Department, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - Alessandra Riva
- Pharmacy Department, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - Alessia Sartori
- Pharmacy Department, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - Luigi Cavanna
- Onco-Haematology Department, Hospital Guglielmo da Saliceto, Piacenza, Italy
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Nightingale G, Hajjar E, Pizzi LT, Wang M, Pigott E, Doherty S, Prioli KM, Swartz K, Chapman AE. Implementing a pharmacist-led, individualized medication assessment and planning (iMAP) intervention to reduce medication related problems among older adults with cancer. J Geriatr Oncol 2017; 8:296-302. [DOI: 10.1016/j.jgo.2017.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/23/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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Is my older cancer patient on too many medications? J Geriatr Oncol 2017; 8:77-81. [DOI: 10.1016/j.jgo.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/03/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022]
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Alkan A, Yaşar A, Karcı E, Köksoy EB, Ürün M, Şenler FÇ, Ürün Y, Tuncay G, Ergün H, Akbulut H. Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients. Support Care Cancer 2016; 25:229-236. [DOI: 10.1007/s00520-016-3409-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
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Fernández de Palencia Espinosa MÁ, Díaz Carrasco MS, Sánchez Salinas A, de la Rubia Nieto A, Miró AE. Potential drug-drug interactions in hospitalised haematological patients. J Oncol Pharm Pract 2016; 23:443-453. [PMID: 27511216 DOI: 10.1177/1078155216664201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Frequently, haematological patients undergo highly complex and intensive treatment protocols, so a high risk of drug-drug interactions could be expected. Objectives To determine prevalence of clinically relevant drug-drug interactions, to identify the most frequent drug-drug interactions and associated risk factors. Methods A prospective, observational and descriptive study was carried out from November 2012 to February 2013. Twice a week, every patient's treatment sheet was collected. Each medication list was screened through two databases: Thomson MicromedexTM and Drug Interaction FactsTM. All identified potential drug-drug interactions with a moderate or higher severity rating were recorded. Summary statistics were used to describe patient and disease characteristics, most often prescribed drugs, and frequency, types and classification of drug-drug interactions. Multiple logistic regression models were used to identify risk factors associated with drug-drug interactions. Results A total of 2061 drug-drug interactions were detected in 317 treatment sheets from 58 patients. The prevalence of treatment sheets with drug-drug interactions by Micromedex and Drug Interaction Facts databases were 74.1% and 56.8%, respectively. Azole antifungals, immunosuppressive drugs, antiemetics, antidepressants, acid suppressants and corticosteroids were the most frequent involved drugs. In multivariate analysis, the main risk factor associated with increased odds for drug-drug interactions was a higher number of non-antineoplastic drugs. Conclusions The prevalence of drug-drug interactions was common, with immunosuppressant and azole antifungal agents being the most commonly involved drugs. The factor having the greatest influence on drug-drug interactions was a higher number of non-antineoplastic drugs.
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Sharma M, Loh KP, Nightingale G, Mohile SG, Holmes HM. Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol 2016; 7:346-53. [PMID: 27498305 DOI: 10.1016/j.jgo.2016.07.010] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/22/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in geriatrics, and particularly in geriatric oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods.
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Affiliation(s)
- Manvi Sharma
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
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Affiliation(s)
- Rachel Riechelmann
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, University of Sao Paulo, São Paulo, Brazil. E-mail:
| | - Daniel Girardi
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, University of Sao Paulo, São Paulo, Brazil. E-mail:
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Abraham I, Canais L, Larriva M, McBride A, Diri R, MacDonald K. What does it take to provide cancer patients with comprehensive medication therapy management services for oral chemotherapy? Expert Opin Drug Saf 2016; 15:413-5. [DOI: 10.1517/14740338.2016.1158249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
| | | | - Marti Larriva
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Banner University Medical Center, Tucson, AZ, USA
| | - Ali McBride
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Banner University Medical Center, Tucson, AZ, USA
| | - Reem Diri
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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Murtaza G, Khan MYG, Azhar S, Khan SA, Khan TM. Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients. Saudi Pharm J 2016; 24:220-5. [PMID: 27013915 PMCID: PMC4792893 DOI: 10.1016/j.jsps.2015.03.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/13/2015] [Indexed: 11/25/2022] Open
Abstract
Drug-drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug-drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug-drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug-drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p < 0.001), hospital stay of 7 days or longer (p < 0.001) and taking 7 or more drugs (p < 0.001). We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.
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Affiliation(s)
- Ghulam Murtaza
- Department of Pharmacy, COMSATS Institute of Information and Technology, Abbottabad 22060, Pakistan
| | | | - Saira Azhar
- Department of Pharmacy, COMSATS Institute of Information and Technology, Abbottabad 22060, Pakistan
| | - Shujaat Ali Khan
- Department of Pharmacy, COMSATS Institute of Information and Technology, Abbottabad 22060, Pakistan
| | - Tahir M Khan
- School of Pharmaceutical Science, Monash University, Sunway Campus, 45700 Selangor, Malaysia
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Potential drug–drug interactions in oncological adult inpatients at a Spanish hospital: epidemiology and risk factors. Int J Clin Pharm 2015; 37:1021-7. [DOI: 10.1007/s11096-015-0195-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/05/2015] [Indexed: 10/23/2022]
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Nightingale G, Hajjar E, Swartz K, Andrel-Sendecki J, Chapman A. Evaluation of a Pharmacist-Led Medication Assessment Used to Identify Prevalence of and Associations With Polypharmacy and Potentially Inappropriate Medication Use Among Ambulatory Senior Adults With Cancer. J Clin Oncol 2015; 33:1453-9. [DOI: 10.1200/jco.2014.58.7550] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The use of multiple and/or inappropriate medications in seniors is a significant public health problem, and cancer treatment escalates its prevalence and complexity. Existing studies are limited by patient self-report and medical record extraction compared with a pharmacist-led comprehensive medication assessment. Patients and Methods We retrospectively examined medication use in ambulatory senior adults with cancer to determine the prevalence of polypharmacy (PP) and potentially inappropriate medication (PIM) use and associated factors. PP was defined as concurrent use of five or more and less than 10 medications, and excessive polypharmacy (EPP) was defined as 10 or more medications. PIMs were categorized by 2012 Beers Criteria, Screening Tool of Older Person's Prescriptions (STOPP), and the Healthcare Effectiveness Data and Information Set (HEDIS). Results A total of 248 patients received a geriatric oncology assessment between January 2011 and June 2013 (mean age was 79.9 years, 64% were women, 74% were white, and 87% had solid tumors). Only 234 patients (evaluated by pharmacists) were included in the final analysis. Mean number of medications used was 9.23. The prevalence of PP, EPP, and PIM use was 41% (n = 96), 43% (n = 101), and 51% (n = 119), respectively. 2012 Beers, STOPP, and HEDIS criteria classified 173 occurrences of PIMs, which were present in 40%, 38%, and 21% of patients, respectively. Associations with PIM use were PP (P < .001) and increased comorbidities (P = .005). Conclusion A pharmacist-led comprehensive medication assessment demonstrated a high prevalence of PP, EPP, and PIM use. Medication assessments that integrate both 2012 Beers and STOPP criteria and consider cancer diagnosis, prognosis, and cancer-related therapy are needed to optimize medication use in this population.
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Affiliation(s)
- Ginah Nightingale
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Emily Hajjar
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Kristine Swartz
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Jocelyn Andrel-Sendecki
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Andrew Chapman
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
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Morgan NA, Rowett D, Currow DC. Analysis of drug interactions at the end of life. BMJ Support Palliat Care 2015; 5:281-6. [PMID: 25888521 DOI: 10.1136/bmjspcare-2014-000767] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 03/11/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND As death approaches, patients are at their most frail, but an increasing symptom burden often necessitates an increase in medications, putting them at higher risk for drug-drug interactions. OBJECTIVES To assess the potential for drug-drug interactions in routine prescribing at the end of life. METHODS An Australian retrospective multicentre case-note review of 266 consecutive adult patients who were referred to specialist palliative care, with data available on 166. Medications used in the last 2 weeks of life were screened for potential interactions using the 'Stockley's Drug Interactions' software. RESULTS The mean number of medications prescribed was 10.8, median 9 (IQR 6-14); all patients received at least one medication. In this study, 72% of patients were at risk of 1 or more potential drug-drug interaction. The mean number of potential interactions was 4.4, with a median of 2.5 (IQR 0-7) per patient. There were only 4/166 (2.4%) prescribed medications with an associated clinical record of an adverse drug reaction. CONCLUSIONS Potential drug-drug interactions are common for this group of patients. Some interactions may be recognised as an acceptable risk when the prescription is written. Further research is necessary to determine the best way to improve recognition of potential drug-drug interactions and the rates of morbidity or accelerated mortality associated with this. It is likely that palliative care services will need to implement multiple strategies including greater use of computerised prescribing software, and greater closer liaison with clinical pharmacists.
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Affiliation(s)
- N A Morgan
- Department of Modbury Hospice, Modbury Hospital, Adelaide, South Australia, Australia
| | - D Rowett
- Drug and Therapeutics Information Service, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - D C Currow
- Department of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
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Stoll P, Kopittke L. Potential drug-drug interactions in hospitalized patients undergoing systemic chemotherapy: a prospective cohort study. Int J Clin Pharm 2015; 37:475-84. [PMID: 25711852 DOI: 10.1007/s11096-015-0083-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adverse drug-drug interactions (DDI) are a major cause of morbidity and mortality in susceptible populations. Cancer patients are a population at high risk for DDI especially because they commonly receive several drugs concomitantly. The knowledge about the most common interactions between drugs used in oncology inpatients is essential to reduce drug-related problems and increase the safety and efficacy of the therapy. OBJECTIVE To assess the frequency of potential DDI throughout the hospital stay of cancer patients undergoing systemic chemotherapy, describe their epidemiology, and identify risk factors for major DDI. Setting An oncology-hematology inpatient unit of a public hospital in southern Brazil. METHOD Drug prescriptions were prospectively reviewed throughout the hospital stay of patients admitted for systemic chemotherapy. Descriptive statistics and Poisson regression were used for data analysis. MAIN OUTCOME MEASURE Potential DDI and their characteristics. RESULTS The cohort consisted of 113 patients, who used a mean of 8.9 ± 2.7 drugs/day. All patients had at least one potential DDI (median, 7.0/patient; 25th-75th percentile, 3.5-12.0), and 46 % of the patients had at least one DDI classified as major, i.e. that it may result in death, hospitalization, permanent injury, or therapeutic failure. Only 13.7 % of all interactions involved antineoplastic agents, identified in 62.8 % of patients. Most interactions were of moderate severity, 6.4 % were major, and 8.5 % had a recommendation for therapy modification. Multivariate analysis revealed mean number of drugs prescribed [relative risk (RR) for each additional drug: 1.12; 95 % confidence interval (CI) 1.07-1.17; P < 0.01] and age ≥60 years (RR 1.48; 95 % CI 1.03-2.14; P < 0.01) as independent risk factors for major DDI. CONCLUSION Potential DDI were highly frequent in this cohort. Older age and number of drugs prescribed were more likely to lead to major interactions. Prospective surveillance is required to detect adverse DDI, aiming primarily at reducing the risk of toxicity or treatment failure.
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Affiliation(s)
- Paula Stoll
- Grupo Hospitalar Conceição, Ave. Francisco Trein, 596, Porto Alegre, Rio Grande do Sul (RS), Brazil,
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Abstract
Objective: The aim of this study was to determine oncology nurses awareness of drug interactions. Methods: This descriptive study was conducted with nurses working in the oncology clinics who are a member of Oncology Nursing Association of Turkey. A total of 115 nurses (response rate %20) were responded to the online survey that consists of 28 questions. Results: The mean age of the nurses was 33 ± 6.8. The majority of nurses work in university hospital (60%) as a clinical nurse (62.6%) and have a Bachelor Degree in Nursing (63.5%). The mean working years in oncology was 4 years. Half of them stated receiving information on drug interactions mostly through in-service education and courses/congresses in last 5 years. The majority of them (84.3%) indicated that they are considering the possibility of drug interactions when they are scheduling the medication administration time. More than half of the responders (59.1%) encountered drug interactions; however, few explored drug interactions with food, drinks, and nutritional supplements. Their practices to assess possibility of drug interactions were reviewing the drug prospectus (78.3%); consulting with their colleagues (58.3%) and searching on the available website (42.6%) and looking at the drug interaction (39.1%). More than half (65.2%) stated lack of any system to identify drug interactions in their workplace. Nearly half of them indicated to including the drug interaction into patient education mostly for food-drug (73.9%) and drug-drug (63.5%) interactions. Conclusions: Almost all indicated the needs for further education on drug interactions and suggested to have guideline/packet guide.
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Affiliation(s)
- Azize Karahan
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
| | - Sevcan Avcı Isik
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
| | - Sultan Kav
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
| | - Aysel Abbasoglu
- Department of Nursing, Baskent University, Faculty of Health Sciences, Ankara, Turkey
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Roblek T, Vaupotic T, Mrhar A, Lainscak M. Drug-drug interaction software in clinical practice: a systematic review. Eur J Clin Pharmacol 2014; 71:131-42. [PMID: 25529225 DOI: 10.1007/s00228-014-1786-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/18/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Several electronic databases which report the prevalence of drug-drug interactions (DDIs) are used as a tool for evaluation of potentially harmful DDIs. The aim of our review was to evaluate the usability and appropriateness of commercially available electronic databases which assess the prevalence of potential DDIs. METHODS The systematic electronic literature search was conducted with the following search terms: "database" AND "software," and "drug-drug interactions" AND "database," and the inclusion and exclusion criteria were applied in order to identify the publications of interest. RESULTS A total of 3766 papers were identified by systematic search. After applying inclusion and exclusion criteria, 38 publications were included in the analysis. The most commonly used software in the included studies was Micromedex® Drug-Reax, for which some authors argue to be the most reliable due to highest sensitivity. It gives information about clinical consequences of DDIs, classifies underlying mechanism and onset of the adverse outcome (either rapid, or delayed) as well as severity (such as minor, moderate, or major), and provides the level of evidence which supports this information. This data is also provided by Drug Interaction Facts®, Lexi-Interact®, and Pharmavista®. A small number of studies which compared assessment of DDIs with electronic database and the clinician's assessment showed large discrepancy in number and relevance of detected DDIs. The overlap was in some cases as low as 11 %. CONCLUSION The deficiency of clinical relevance of detected DDIs should be addressed in the upcoming research as it would provide more relevant information to the prescribers' in clinical practice.
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Affiliation(s)
- Tina Roblek
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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Farzanegan B, Alehashem M, Bastani M, Baniasadi S. Potential drug-drug interactions in cardiothoracic intensive care unit of a pulmonary teaching hospital. J Clin Pharmacol 2014; 55:132-6. [DOI: 10.1002/jcph.421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/02/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Behrooz Farzanegan
- Tracheal Diseases Research Center; National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Maryam Alehashem
- Tracheal Diseases Research Center; National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Marjan Bastani
- Pharmaceutical Sciences Branch; Islamic Azad University; Tehran Iran
| | - Shadi Baniasadi
- Virology Research Center; National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences; Tehran Iran
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