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Oriaifo OG, Opadeyi AO, Oriaifo TO, Isah AO. Predictors of potential clinically harmful drug-drug interactions at the medical wards in the University of Benin Teaching Hospital, Benin City. Clin Transl Sci 2024; 17:e13790. [PMID: 38571339 PMCID: PMC10992988 DOI: 10.1111/cts.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/01/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
Drug-drug interactions are preventable causes of adverse events. Different factors have been recognized as important predictors of drug-drug interactions but few studies have addressed these predictors in patients admitted into medical wards of a tertiary hospital in Nigeria hence this study. This was a retrospective study conducted using case records of patients admitted into the medical wards between January 1 and December 31, 2020. Patients were selected using a systematic random sampling method. Socio-demographic details including age, gender, number of comorbidities, and number of medications prescribed and diagnosis were collected on days 1, 3, and at discharge. Potential drug-drug interactions were checked using Lexi-interact® software. Analysis was set at p < 0.05. A total of 430 case records were included in this study based on the inclusion criteria. Lexi-interact recorded a prevalence of (217) 50.5% on day 1, (146) 34.0% on day 3, and (290) 67.4% at discharge. A significant association (p < 0.05) was found between the potential drug-drug interactions (DDI) and an increased number of medicines prescribed on all the days of admission. Also, patients without certain infectious or parasitic diseases have reduced odds of developing DDI. There is a need for continuous monitoring of medications from admission to discharge especially in the elderly, those on multiple medications, certain infectious or parasitic diseases, and comorbidities as these impact on DDIs.
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Affiliation(s)
| | - Abimbola Olubukunola Opadeyi
- Department of Clinical Pharmacology and TherapeuticsUniversity of BeninBenin CityNigeria
- Department of MedicineUniversity of Benin Teaching HospitalBenin CityEdo StateNigeria
| | | | - Ambrose Ohumagho Isah
- Department of Clinical Pharmacology and TherapeuticsUniversity of BeninBenin CityNigeria
- Department of MedicineUniversity of Benin Teaching HospitalBenin CityEdo StateNigeria
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2
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Verbič MD, Brvar M, Kos MK. Adverse drug reactions in the ambulatory internal patients at the emergency department: Focus on causality assessment and drug-drug interactions. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:195-210. [PMID: 37307369 DOI: 10.2478/acph-2023-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/14/2023]
Abstract
A non-interventional retrospective study in ambulatory patients was conducted at the emergency department of the Division of internal medicine. In 2 months, 266 suspected adverse drug reactions (ADRs) were identified in 224/3453 patients (6.5 %). In 158/3453 patients (4.6 %), an ADR was the reason for emergency department visit and in 49 patients (1.4 %), ADRs led to hospitalisation. A causality assessment algorithm was developed, which included Naranjo algorithm and levels of ADR recognition by the treating physician and the investigators. Using this algorithm, 63/266 ADRs (23.7 %) were classified as "certain", whereas using solely the Naranjo score calculation, only 19/266 ADRs (7.1 %) were assessed as "probable" or "certain", and the rest of ADRs (namely, 247/266 = 92.9 %) were assessed as "possible". There were 116/266 (43.6 %) ADRs related to potential drug-drug interactions (DDIs), stated in at least one of the literature sources used. Based on the causality relationship, the rate of the clinically expressed DDIs was 19.0 %, or 12/63 "certain" ADR cases. Of these, 10 cases presented serious DDI-related ADRs. In summary, ADR causality assessment based exclusively on Naranjo algorithm demonstrated low sensitivity at an ambulatory emergency setting. Additional clinical judgment, including the opinion of the treating physician, proved necessary to avoid under-rating of the causality relationship, and enabled the determination of clinically expressed DDIs.
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Affiliation(s)
- Matej Dobravc Verbič
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
| | - Miran Brvar
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 2University of Ljubljana, Faculty of Medicine, Centre for Clinical Physiology Ljubljana, Slovenia
| | - Mojca Kerec Kos
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
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3
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Vanzela AS, Silva AC, Borges TL, Castilho ECD, Miasso AI, Zanetti ACG, Alonso JB, Vedana KGG. Predictors of drug-drug interactions of medications prescribed to patients admitted due to suicidal behavior. Heliyon 2022; 8:e08850. [PMID: 35198752 PMCID: PMC8844659 DOI: 10.1016/j.heliyon.2022.e08850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Drug-drug interactions among people with suicidal behavior is a challenging topic, considering the harm it poses for patients already vulnerable and the lack of literature on the thematic. This aspect must not be neglected in research and clinical practice, and thus requires thorough investigation. OBJECTIVE to investigate predictors of drug-drug interaction of prescribed drugs and the prescription of two or more drugs for people admitted due to suicidal behavior in a psychiatric emergency department (short-stay hospital ward). METHOD A cross-sectional study with retrospective approach, carried out in a Brazilian psychiatric emergency unit in 2015. Data about first and last medical prescriptions were collected from 127 patients' files. Descriptive statistics and the Zero Adjusted Logarithmic Distribution (ZALG) model were adopted, with the significance level α = 0.05. RESULTS Potential drug-drug interactions were found in most of the first and last prescriptions. The sample majority were female, with previous suicide attempts, being discharged from the hospital with three drugs (or more) prescribed, and without referral to any health service. Age and comorbidities were predictors of more drug prescriptions and the amount of prescribed drugs was the most important predictor of drug-drug interactions (quantity and severity). CONCLUSIONS the variables associated with drug-drug interactions and prescription of two or more drugs among people with suicidal behavior needs to be investigated in different contexts and addressed in interventions with the aim to promote patient safety.
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Affiliation(s)
- Amanda Sarah Vanzela
- Master's Student in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Aline Conceição Silva
- Doctoral Student in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil.,PhD in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Tatiana Longo Borges
- PhD in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | | | - Adriana Inocenti Miasso
- Associate Professor, Department of Psychiatric Nursing and Human Sciences, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Associate Professor, Department of Psychiatric Nursing and Human Sciences, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Jonas Bodini Alonso
- Statistician, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Kelly Graziani Giacchero Vedana
- Associate Professor, Department of Psychiatric Nursing and Human Sciences, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
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4
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Papotti B, Marchi C, Adorni MP, Potì F. Drug-drug interactions in polypharmacy patients: The impact of renal impairment. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100020. [PMID: 34909655 PMCID: PMC8663981 DOI: 10.1016/j.crphar.2021.100020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney functions, usually accompanied by other comorbidities including cardiovascular diseases (hypertension, heart failure and stroke) and diabetes mellitus. Therefore, multiple pharmacological prescriptions are very common in these patients. Epidemiological and clinical observations have shown that polypharmacy may increase the probability of adverse drug reactions (ADRs), possibly through a higher risk of drug-drug interactions (DDIs). Renal impairment may further worsen this scenario by affecting the physiological and biochemical pathways underlying pharmacokinetics and ultimately modifying the pharmacodynamic responses. It has been estimated that the prevalence of DDIs in CKD patients ranged between 56.9% and 89.1%, accounting for a significant increase in healthcare costs, length and frequency of hospitalization, with a detrimental impact on health and quality of life of these patients. Despite these recognized high-risk conditions, scientific literature released on this topic is still limited. Basing on the most commonly prescribed therapies in patients with CKD, the present short review summarizes the current state of knowledge of the putative DDIs occurring in CKD patients undergoing polytherapy. The most relevant underlying mechanisms and their clinical significance are also debated.
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Affiliation(s)
- Bianca Papotti
- University of Parma, Department of Food and Drug, 43124, Parma, Italy
| | - Cinzia Marchi
- University of Parma, Department of Food and Drug, 43124, Parma, Italy
| | - Maria Pia Adorni
- University of Parma, Department of Medicine and Surgery – Unit of Neurosciences, 43125, Parma, Italy
- Corresponding author. Department of Medicine and Surgery, Unit of Neurosciences, University of Parma, Parma, Italy.
| | - Francesco Potì
- University of Parma, Department of Medicine and Surgery – Unit of Neurosciences, 43125, Parma, Italy
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Lalagkas PN, Poulentzas G, Tsiolis L, Berberoglou E, Hadjipavlou-Litina D, Douros A, Kontogiorgis C, Constantinides T. Investigating Potential Drug-Drug Interactions from Greek e-Prescription Data. Curr Drug Saf 2021; 17:114-120. [PMID: 34397333 DOI: 10.2174/1574886316666210816115811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence of potential drug-drug interactions (pDDIs) is indicative of the prevalence of actual drug-drug interactions and prescription quality. However, they are significantly understudied in Greece. OBJECTIVE To determine the prevalence of pDDIs among outpatients and identify factors associated with their occurrence. METHODS Anonymous e-prescription data between 2012 and 2017 were obtained from community pharmacies in Thessaloniki, Greece. Patients taking more than one medication for at least three months were included. pDDIs were identified and categorized depending on their clinical significance using Drug Interactions Checker. Crude and adjusted odds ratios (ORs) with accompanying 95% confidence intervals (CIs) of risk factors of pDDIs occurrence were identified using multivariable logistic regression. RESULTS During the study period, 6,000 anonymous e-prescriptions (1,000 per year) satisfying the inclusion criteria, were collected. The overall prevalence of major pDDIs was 17.4% (63.0% for moderate pDDIs). The most common major pDDIs were between amlodipine and simvastatin (22.8% of major interactions) followed by clopidogrel and omeprazole (6.4% of major interactions). Polypharmacy (≥5 concomitantly received medications) was associated with an increased risk of major pDDIs (adjusted OR, 5.72; 95% CI, 4.87-6.72); no associations were observed regarding age, sex and number of prescribing physicians. CONCLUSION The prevalence of pDDIs in this study was higher than previously reported in other European countries, with polypharmacy being a potential risk factor. Those results argue for a need for improvement in the area of prescribing in Greece.
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Affiliation(s)
- Panagiotis-Nikolaos Lalagkas
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Poulentzas
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Lampros Tsiolis
- Division of Pharmaceutical Chemistry, Department of Pharmacy, Aristotle University of Thessaloniki, Greece
| | - Eleftherios Berberoglou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitra Hadjipavlou-Litina
- Division of Pharmaceutical Chemistry, Department of Pharmacy, Aristotle University of Thessaloniki, Greece
| | - Antonios Douros
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodoros Constantinides
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Negishi A, Oshima S, Horii N, Mutoh M, Inoue N, Numajiri S, Ohshima S, Kobayashi D. Adverse Drug Events Caused by Drugs Contraindicated for Coadministration Reported in the Japanese Adverse Drug Event Report Database and Recognized by Reporters. Biol Pharm Bull 2021; 44:932-936. [PMID: 33967165 DOI: 10.1248/bpb.b20-00986] [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: 11/22/2022]
Abstract
The "INTERACTIONS" section of package inserts aims to provide alert-type warnings in clinical practice; however, these also include many drug-drug interactions that occur rarely. Moreover, considering that drug-drug interaction alert systems were created based on package inserts, repeated alerts can lead to alert fatigue. Although investigations have been conducted to determine prescriptions that induce drug-drug interactions, no studies have focused explicitly on the adverse events induced by drug-drug interactions. We, therefore, sought to investigate the true occurrence of adverse events caused by drug pair contraindications for coadministration in routine clinical practice. Toward this, we created a list of drug combinations that were designated as "contraindications for coadministration" and extracted the cases of adverse drug events from the Japanese Adverse Drug Event Report database that occurred due to combined drug usage. We then calculated the reporters' recognition rate of the drug-drug interactions. Out of the 2121 investigated drug pairs, drug-drug interactions were reported in 43 pairs, 23 of which included an injected drug and many included catecholamines. Warfarin potassium and miconazole (19 reports), azathioprine and febuxostat (11 reports), and warfarin potassium and iguratimod (six reports) were among the 20 most-commonly reported oral medication pairs that were contraindicated for coadministration, for which recognition rates of drug-drug interactions were high. Although these results indicate that only a few drug pair contraindications for coadministration were associated with adverse drug events (43 pairs out of 2121 pairs), it remains necessary to translate these findings into clinical practice.
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Affiliation(s)
- Akio Negishi
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University
| | - Shinji Oshima
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University
| | - Norimitsu Horii
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University.,Josai University Pharmacy
| | - Mizue Mutoh
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University
| | - Naoko Inoue
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University.,Josai University Pharmacy
| | - Sachihiko Numajiri
- Student Learning Assistance Center, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University
| | - Shigeru Ohshima
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University.,Josai University Pharmacy
| | - Daisuke Kobayashi
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University.,Josai University Pharmacy
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Gonzaga de Andrade Santos TN, Mendonça da Cruz Macieira G, Cardoso Sodré Alves BM, Onozato T, Cunha Cardoso G, Ferreira Nascimento MT, Saquete Martins-Filho PR, Pereira de Lyra D, de Oliveira Filho AD. Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis. PLoS One 2020; 15:e0235353. [PMID: 32609783 PMCID: PMC7329110 DOI: 10.1371/journal.pone.0235353] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients. METHODS PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: "drug interactions," "clinically relevant," and "hospital." In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish. RESULTS From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0-19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose. CONCLUSIONS This systematic review showed that, despite the significant prevalence of potential DDIs reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction. The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, consequently, contribute to patient safety.
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Affiliation(s)
| | - Givalda Mendonça da Cruz Macieira
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Bárbara Manuella Cardoso Sodré Alves
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Thelma Onozato
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Geovanna Cunha Cardoso
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Mônica Thaís Ferreira Nascimento
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Divaldo Pereira de Lyra
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Alfredo Dias de Oliveira Filho
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
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Aleksic DZ, Jankovic SM, Mlosavljevic MN, Toncev GL, Miletic Drakulic SD, Stefanovic SM. Potential Drug-drug Interactions in Acute Ischemic Stroke Patients at the Neurological Intensive Care Unit. Open Med (Wars) 2019; 14:813-826. [PMID: 31737786 PMCID: PMC6843487 DOI: 10.1515/med-2019-0093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/22/2019] [Indexed: 11/15/2022] Open
Abstract
Background Clinically relevant potential drug-drug interactions are considered preventable adverse drug reactions. Objective The aim of this study was to ascertain the frequency of potential drug-drug interactions in acute ischemic stroke patients and to explore factors associated with occurrence of potentially contraindicated drug-drug interactions. Methods This observational retrospective cohort and nested case-control study was carried out among patients treated for acute ischemic stroke at the Neurological Intensive Care Unit in the Clinical Centre Kragujevac, Serbia. The potentially drug-drug interactions for each day of hospitalization were identifi ed using Micromedex® soft ware. Based on the existence or absence of potentially contraindicated drug-drug interactions, the participants were divided into a group of cases (n=111) and the control group (n=444). Results A total of 696 patients were analysed. All patients had a minimum of one potential drug-drug interaction during hospitalization. The most common drugs involved in potential drug-drug interactions were aspirin (8.02%), diclofenac (7.49%) and warfarin (7.14%). The number of medications prescribed for simultaneous use during hospitalisation and the use of antipsychotics in therapy signifi cantly increased the likelihood of potentially contraindicated drug-drug interactions aft er adjustment by means of logistic regression for 1.2 and 3 times, respectively. Conclusions This study suggests that patients with acute ischemic stroke are frequently exposed to potential drug-drug interactions. It is essential to identify potentially drug-drug interactions in these patients as early as possible in order to prevent adverse drug reactions and ensure safe recovery. Besides, full attention should be paid when adding each new medication in therapy, particularly when a neurologist decides to prescribe antipsychotics, such as risperidone.
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Affiliation(s)
- Dejan Z. Aleksic
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Kragujevac, Serbia
- E-mail:
| | - Slobodan M. Jankovic
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pharmacology and toxicology, Kragujevac, Serbia
| | - Milos N. Mlosavljevic
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pharmacology and toxicology, Kragujevac, Serbia
| | - Gordana L. Toncev
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Neurology, Kragujevac, Serbia
| | | | - Srdjan M. Stefanovic
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia
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9
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Gimenes FRE, Baysari M, Walter S, Moreira LA, de Carvalho REFL, Miasso AI, Faleiros F, Westbrook J. Are patients with a nasally placed feeding tube at risk of potential drug-drug interactions? A multicentre cross-sectional study. PLoS One 2019; 14:e0220248. [PMID: 31365563 PMCID: PMC6668811 DOI: 10.1371/journal.pone.0220248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/11/2019] [Indexed: 12/05/2022] Open
Abstract
Aims The primary aims were to determine the rate of potential drug-drug interactions (pDDIs) in patients with nasally placed feeding tubes (NPFT) and the factors significantly associated with pDDIs. The secondary aim was to assess the change in pDDIs for patients between admission and discharge. Material and methods This multicentre study applied a cross-sectional design and was conducted in six Brazilian hospitals, from October 2016 to July 2018. Data from patients with NPFT were collected through electronic forms. All regular medications prescribed were recorded. Medications were classified according to the World Health Organization (WHO) Anatomical Therapeutic Chemical code. Drug-drug interaction screening software was used to screen patients’ medications for pDDIs. Negative binomial regression was used to account for the over dispersed nature of the pDDI count. Since the number of pDDIs was closely related to the number of prescribed medications, we modelled the rate of pDDIs with the count of pDDIs as the numerator and the number of prescribed medications as the denominator; six variables were considered for inclusion: time (admission or discharge), patient age, patient gender, age-adjusted Charlson Comorbidity Index (CCI) score, type of prescription (electronic or handwritten) and patient care complexity. To account for correlation within the two time points (admission and discharge) for each patient a generalised estimating equations approach was used to adjust the standard error estimates. To test the change in pDDI rate between admission and discharge a full model of six variables was fitted to generate an adjusted estimate. Results In this study, 327 patients were included. At least one pDDI was found in more than 91% of patients on admission and discharge and most of these pDDIs were classified as major severity. Three factors were significantly associated with the rate of pDDIs per medication: patient age, patient care complexity and prescription type (handwritten vs electronic). There was no evidence of a difference in pDDI rate between admission and discharge. Conclusion Patients with a NPFT are at high risk of pDDIs. Drug interaction screening tools and computerized clinical decision support systems could be effective risk mitigation strategies for this patient group.
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Affiliation(s)
- Fernanda Raphael Escobar Gimenes
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Melissa Baysari
- Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Scott Walter
- Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Leticia Alves Moreira
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Adriana Inocenti Miasso
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Faleiros
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
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10
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Peres HA, Leira Pereira LR, Viana CM, Foss-Freitas MC. Patient's lack of understanding producing insulin drug-interactions in Southeast Brazilian primary care clinics. Diabetes Metab Syndr 2019; 13:1131-1136. [PMID: 31336455 DOI: 10.1016/j.dsx.2019.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/18/2019] [Indexed: 11/15/2022]
Abstract
UNLABELLED Detrimental drug-drug interactions (DDIs) in Diabetic patients could be from the simultaneous use of multiple drugs, polypharmacy. Brazilian public health studies evaluating the practical knowledge about drug interactions are scarce. This study's objective is to identify drug interactions and prevalence of detrimental DDIs in diabetic patients attending Brazilian basic health system clinics. METHODS Patients using insulin between the age of 18-90 years were selected to complete the MedTake questionnaire, to evaluate the indication, dosage, regimen and drug interaction. The MedTake test was employed. For each medicine, the test was scored as the percentage of correct actions and compared with printed instructions one single researcher downloaded all the data was from the municipality's computerized system. RESULTS The median age of recruits was 60.2 ± 14.3 and MedTake test scores were low 60.3 ± 20. One hundred patients missed the correct dose question, 40 missed why they were prescribed the drug, indication and 65 missed the therapeutic regimen. These diabetes patients did not know the DDIs between insulin combined with other medicines. Drugs that had more interaction with insulin were: acetylsalicylic acid (40%), enalapril (18%), losartan (32%) and hydrochlorothiazide (23%). CONCLUSIONS Diabetes patients without practical knowledge about insulin interacting with other pharmaceutical drugs that can produce DDIs with other medicines illustrates a need to develop education programs for diabetics.
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Affiliation(s)
- Heverton Alves Peres
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
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11
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Evaluation of Potential Drug-Drug Interactions with Medications Prescribed to Geriatric Patients in a Tertiary Care Hospital. J Aging Res 2018; 2018:5728957. [PMID: 30402286 PMCID: PMC6198551 DOI: 10.1155/2018/5728957] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives The drugs most commonly implicated in major potential interactions are those used in the day-to-day clinical management of elderly patients with chronic diseases. This study is planned to evaluate the profile of drug-drug interactions in the medications prescribed to elderly population and also to identify the possible predictors for potential drug-drug interactions in the elderly. Methods This cross-sectional study included patients aged above 60 years with a minimum of two drugs in the prescriptions. Data were collected from medical prescriptions and patients' medical records. The data collected included demographic characteristics such as age, gender, height, weight, educational status, socioeconomic status, medical history, and medications prescribed. The prescriptions were analyzed for the potential drug interactions using Lexi-Interact™ Online, an online software to check drug-drug interactions. Results A total of 209 patients were included in the study, among them 104 (49.8%) were males and 105 (50.2%) were females. The mean number of medications received was 6.53 ± 2.15 per prescription. Around 138 (66%) patients received more than six medications. The mean number of potential drug interactions seen in the prescription of these patients was 3.17 ± 2.78. Around 18.2% patients had more than five drug interactions. Major drug interactions were observed in 21.42% of cases. Around 3.02% of drug interactions belonged to risk category X, i.e., to be avoided. Logistic regression analysis showed that age above 70 years was associated with the presence of drug interactions. Increased number of medication was independently associated with the occurrence of drug interactions. The presence of drug interactions was not associated with increased number of comorbidities. Conclusion A significant number of potential drug-drug interactions were seen in the prescriptions of elderly patients. Increasing age and polypharmacy were identified as the predictors of potential drug interactions.
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Castilho ECD, Reis AMM, Borges TL, Siqueira LDC, Miasso AI. Potential drug-drug interactions and polypharmacy in institutionalized elderly patients in a public hospital in Brazil. J Psychiatr Ment Health Nurs 2018; 25:3-13. [PMID: 28892271 DOI: 10.1111/jpm.12431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Older individuals constitute an increasing proportion of the population, and therefore, are the major consumers of drugs. The elderly, especially those with mental disabilities, frequently develop chronic diseases and start using numerous drugs. Drug-drug interactions (DDIs) are a major clinical problem in the elderly population, and previous studies have focused only on antidepressants and others types of drugs used to treat mental health conditions. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: This study shows that in hospitalized elderly patients with mental disorders (aged 60-69 years), polypharmacy (≥5 drugs) and the use of drugs that act on the cardiovascular, respiratory and nervous systems can lead to potential drug-drug interactions. Moreover, it was reported that the prevalence of drug-drug interactions in elderly patients with mental disorders was high during their hospitalization in a public hospital in Brazil. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should know the factors associated with drug-drug interactions in hospitalized elderly patients with mental disorders to choose appropriate strategies for avoiding treatment failure and adverse events in patients. ABSTRACT Introduction Despite the impact on patient safety and the fact that prevalence is higher in older patients, previous research did not analyse drug-drug interactions (DDIs) in view of nursing care of elderly psychiatric patients. Aim To identify potential drug-drug interactions and polypharmacy in prescriptions of aged inpatients with psychiatric disorders and analyse associated factors. Methods In this retrospective cross-sectional study, we analysed the medical records of institutionalized patients diagnosed with psychiatric disorders (n = 94), aged >60 years, and prescribed multiple medications. Drug prescriptions were checked at admission, midway through and the last prescription. Factors associated with DDI occurrence were assessed using multivariable logistic regression analysis. Results A DDI prevalence potential of 67.0%, 74.5% and 80.8% occurred in patients at admission, midway through hospitalization and the last prescription, respectively. Most of the prescribed drugs were nervous system agents. A high percentage of serious and contraindicated potential DDIs occurred. Age between 60 and 69 years, use of cardiovascular and respiratory system drugs, and the number of medications contributed significantly to DDI. Implications for mental health nursing Knowledge on the factors associated with DDIs in patients with mental disorders can contribute to the improvement of effectiveness and safety of nursing care.
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Affiliation(s)
- E C D Castilho
- Psychiatric Nursing and Human Sciences Department, Ribeirao Preto Nursing School of the University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - A M M Reis
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - T L Borges
- Psychiatric Nursing and Human Sciences Department, Ribeirao Preto Nursing School of the University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - L D C Siqueira
- Grande Dourados University Hospital, Dourados, MS, Brazil
| | - A I Miasso
- Psychiatric Nursing and Human Sciences Department, Ribeirao Preto Nursing School of the University of Sao Paulo, Ribeirao Preto, SP, Brazil
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Jazbar J, Locatelli I, Horvat N, Kos M. Clinically relevant potential drug-drug interactions among outpatients: A nationwide database study. Res Social Adm Pharm 2017; 14:572-580. [PMID: 28716467 DOI: 10.1016/j.sapharm.2017.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/06/2017] [Accepted: 07/10/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Adverse drug events due to drug-drug interactions (DDIs) represent a considerable public health burden, also in Slovenia. A better understanding of the most frequently occurring potential DDIs may enable safer pharmacotherapy and minimize drug-related problems. OBJECTIVES The aim of this study was to evaluate the prevalence and predictors of potential DDIs among outpatients in Slovenia. METHODS An analysis of potential DDIs was performed using health claims data on prescription drugs from a nationwide database. The Lexi-Interact Module was used as the reference source of interactions. The influence of patient-specific predictors on the risk of potential clinically relevant DDIs was evaluated using logistic regression model. RESULTS The study population included 1,179,803 outpatients who received 15,811,979 prescriptions. The total number of potential DDI cases identified was 3,974,994, of which 15.6% were potentially clinically relevant. Altogether, 9.3% (N = 191,213) of the total population in Slovenia is exposed to clinically relevant potential DDIs, and the proportion is higher among women and the elderly. After adjustment for cofactors, higher number of medications and older age are associated with higher odds of clinically relevant potential DDIs. The burden of DDIs is highest with drug combinations that increase risk of bleeding, enhance CNS depression or anticholinergic effects or cause cardiovascular complications. CONCLUSION The current study revealed that 1 in 10 individuals in the total Slovenian population is exposed to clinically relevant potential DDIs yearly. Taking into account the literature based conservative estimate that approximately 1% of potential DDIs result in negative health outcomes, roughly 1800 individuals in Slovenia experience an adverse health outcome each year as a result of clinically relevant potential interactions alone.
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Affiliation(s)
- Janja Jazbar
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Igor Locatelli
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Nejc Horvat
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Mitja Kos
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia.
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Muhič N, Mrhar A, Brvar M. Comparative analysis of three drug-drug interaction screening systems against probable clinically relevant drug-drug interactions: a prospective cohort study. Eur J Clin Pharmacol 2017; 73:875-882. [PMID: 28299402 DOI: 10.1007/s00228-017-2232-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/27/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Drug-drug interaction (DDI) screening systems report potential DDIs. This study aimed to find the prevalence of probable DDI-related adverse drug reactions (ADRs) and compare the clinical usefulness of different DDI screening systems to prevent or warn against these ADRs. METHODS A prospective cohort study was conducted in patients urgently admitted to medical departments. Potential DDIs were checked using Complete Drug Interaction®, Lexicomp® Online™, and Drug Interaction Checker®. The study team identified the patients with probable clinically relevant DDI-related ADRs on admission, the causality of which was assessed using the Drug Interaction Probability Scale (DIPS). Sensitivity, specificity, and positive and negative predictive values of screening systems to prevent or warn against probable DDI-related ADRs were evaluated. RESULTS Overall, 50 probable clinically relevant DDI-related ADRs were found in 37 out of 795 included patients taking at least two drugs, most common of them were bleeding, hyperkalemia, digitalis toxicity, and hypotension. Complete Drug Interaction showed the best sensitivity (0.76) for actual DDI-related ADRs, followed by Lexicomp Online (0.50), and Drug Interaction Checker (0.40). Complete Drug Interaction and Drug Interaction Checker had positive predictive values of 0.07; Lexicomp Online had 0.04. We found no difference in specificity and negative predictive values among these systems. CONCLUSION DDI screening systems differ significantly in their ability to detect probable clinically relevant DDI-related ADRs in terms of sensitivity and positive predictive value.
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Affiliation(s)
- Neža Muhič
- Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, 1000, Ljubljana, Slovenia
| | - Ales Mrhar
- Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, 1000, Ljubljana, Slovenia
| | - Miran Brvar
- Centre for Clinical Toxicology and Pharmacology, Division of Internal Medicine, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Zaloska cesta 4, 1000, Ljubljana, Slovenia.
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Dohle S, Dawson IGJ. Putting knowledge into practice: Does information on adverse drug interactions influence people's dosing behaviour? Br J Health Psychol 2017; 22:330-344. [PMID: 28160354 DOI: 10.1111/bjhp.12231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/04/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Adverse drug events relating to drug-drug interactions are a common cause of patient harm. Central to avoiding this harm is the patients' understanding that certain drug combinations present a synergistic risk. Two studies tested whether providing individuals with information about a drug combination that presents a synergistic (cf. additive) risk would elicit higher perceived risk and, therefore, would result in greater precaution in terms of dosing behaviour. DESIGN Both studies employed an experimental design. METHODS Participants were presented with a scenario describing how two symptoms of an infection could each be treated by a different drug. In Experiment 1, information about the effects of combining the two drugs was varied: (1) no information, (2) combination elicits an additive risk, or (3) combination elicits a synergistic risk. In Experiment 2, the size of the risk (small or large) and the participant's role (patient or doctor) was also varied. RESULTS In both experiments, perceived risk and negative affect increased in response to information about the increased probability of side effects from the drug-drug interaction. Despite these increases, participants did not adjust their drug dosing behaviour in either experiment: Dosing was similar when these interactions were large or small, or when they were due to synergistic or additive effects. CONCLUSIONS People may struggle to transfer their knowledge of drug-drug interaction risks into decision-making behaviours. Care should be taken not to assume that holding accurate risk perceptions of a drug's side effect will result in decisions that help avoid adverse drug events. Statement of contribution What is already known on this subject? Adverse effects of drug-drug interactions are a cause of hospital admissions and increase morbidity and mortality. Patients' understanding that certain drug combinations present a synergistic risk is crucial to avoid harm. It is not clear whether synergistic drug interactions increase risk perception and influence dosing decisions. What does this study add? Perceived risk and negative affect increased in response to synergistic risk information. Despite these increases, participants did not adjust their drug dosing behaviour. People struggle to transfer their knowledge of drug-related risks into behavioural decisions.
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Oshikoya KA, Oreagba IA, Godman B, Oguntayo FS, Fadare J, Orubu S, Massele A, Senbanjo IO. Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future. Expert Rev Clin Pharmacol 2016; 9:1505-1515. [PMID: 27592636 DOI: 10.1080/17512433.2016.1232619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Information regarding the incidence of drug-drug interactions (DDIs) and adverse drug events (ADEs) among paediatric patients in Nigeria is limited. METHODS Prospective clinical audit among paediatric outpatients in four general hospitals in Nigeria over a 3-month period. Details of ADEs documented in case files was extracted. RESULTS Among 1233 eligible patients, 208 (16.9%) received prescriptions with at least one potential DDI. Seven drug classes were implicated with antimalarial combination therapies predominating. Exposure mostly to a single potential DDI, commonly involved promethazine, artemether/lumefantrine, ciprofloxacin and artemether/lumefantrine. Exposure mostly to major and serious, and moderate and clinically significant, potential DDIs. Overall exposure similar across all age groups and across genders. A significant association was seen between severity of potential DDIs and age. Only 48 (23.1%) of these patients presented at follow-up clinics with only 15 reporting ADEs. CONCLUSION There was exposure to potential DDIs in this population. However, potential DDIs were associated with only a few reported ADEs.
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Affiliation(s)
- Kazeem Adeola Oshikoya
- a Pharmacology Department , Lagos State University College of Medicine , Ikeja , Nigeria
| | - Ibrahim Adekunle Oreagba
- b Pharmacology, Therapeutic and Toxicology Department , College of Medicine, University of Lagos , Idiaraba , Nigeria
| | - Brian Godman
- c Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,d Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , United Kingdom
| | - Fisayo Solomon Oguntayo
- b Pharmacology, Therapeutic and Toxicology Department , College of Medicine, University of Lagos , Idiaraba , Nigeria
| | - Joseph Fadare
- e Department of Pharmacology , Ekiti State University , Ado-Ekiti , Nigeria
| | - Samuel Orubu
- f Faculty of Pharmacy , Niger Delta University , Wilberforce Island , Nigeria
| | - Amos Massele
- g Department of Clinical Pharmacology , School of Medicine, University of Botswana , Gaborone , Botswana
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Badiu R, Bucsa C, Mogosan C, Dumitrascu D. Statin drug-drug interactions in a Romanian community pharmacy. Med Pharm Rep 2016; 89:273-8. [PMID: 27152080 PMCID: PMC4849387 DOI: 10.15386/cjmed-569] [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: 09/04/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background and aim Statins are frequently prescribed for patients with dyslipidemia and have a well-established safety profile. However, when associated with interacting dugs, the risk of adverse effects, especially muscular toxicity, is increased. The objective of this study was to identify, characterize and quantify the prevalence of the potential drug-drug interactions (pDDIs) of statins in reimbursed prescriptions from a community pharmacy in Bucharest. Methods We analyzed the reimbursed prescriptions including statins collected during one month in a community pharmacy. The online program Medscape Drug Interaction Checker was used for checking the drug interactions and their classification based on severity: Serious – Use alternative, Significant – Monitor closely and Minor. Results 132 prescriptions pertaining to 125 patients were included in the analysis. Our study showed that 25% of the patients who were prescribed statins were exposed to pDDIs: 37 Serious and Significant interactions in 31 of the statins prescriptions. The statins involved were atorvastatin, simvastatin and rosuvastatin. Conclusions Statin pDDIs have a high prevalence and patients should be monitored closely in order to prevent the development of adverse effects that result from statin interactions.
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Affiliation(s)
- Raluca Badiu
- Drug Information Research Center Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Bucsa
- Drug Information Research Center Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Mogosan
- Drug Information Research Center Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Dumitrascu
- 2 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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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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Price SD, Holman CDJ, Sanfilippo FM, Emery JD. Impact of specific Beers Criteria medications on associations between drug exposure and unplanned hospitalisation in elderly patients taking high-risk drugs: a case-time-control study in Western Australia. Drugs Aging 2014; 31:311-25. [PMID: 24615204 DOI: 10.1007/s40266-014-0164-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Certain broad medication classes have previously been associated with high rates of hospitalisation due to related adverse events in elderly Western Australians, based on clinical coding recorded on inpatient summaries. Similarly, some medications from the Beers Criteria, considered potentially inappropriate in older people, have been linked with an increased risk of unplanned hospitalisation in this population. OBJECTIVE Our objective was to determine whether risk estimates of drug-related hospitalisations are altered in elderly patients taking 'high-risk drugs' (HRDs) when specific Beers potentially inappropriate medications (PIMS) are taken into consideration. METHODS Using the pharmaceutical claims of 251,305 Western Australians aged ≥65 years (1993-2005) linked with other health data, we applied a case-time-control design to estimate odds ratios (ORs) for unplanned hospitalisations associated with anticoagulants, antirheumatics, opioids, corticosteroids and four major cardiovascular drug groups, from which attributable fractions (AFs), number and proportion of drug-related admissions were derived. The analysis was repeated, taking into account exposure to eight specific PIMs, and results were compared. RESULTS A total of 1,899,699 index hospitalisations were involved. Of index subjects, 12-57 % were exposed to each HRD at the time of admission, although the proportions taking both an HRD and one of the selected PIMs were much lower (generally ≤2 %, but as high as 8 % for combinations involving temazepam and for most PIMs combined with hypertension drugs). Included PIMs (indomethacin, naproxen, temazepam, oxazepam, diazepam, digoxin, amiodarone and ferrous sulphate) all tended to increase ORs, AFs and drug-related hospitalisation estimates in HRD combinations, although this was less evident for opioids and corticosteroids. Indomethacin had the greatest overall impact on HRD ORs/AFs. Indomethacin (OR 1.40; 95 % confidence interval [CI] 1.27-1.54) and naproxen (OR 1.22; 1.14-1.31) were associated with higher risks of unplanned hospitalisation than other antirheumatics (overall OR 1.09; 1.06-1.12). Similarly, among cardiac rhythm regulators, amiodarone (OR 1.22; 1.13-1.32) was riskier than digoxin (OR 1.08; 1.04-1.13). For comparisons of drug-related hospitalisation estimates, temazepam yielded the greatest absolute increases, especially with hypertension drugs. CONCLUSIONS Indomethacin and temazepam should be prescribed cautiously in elderly patients, especially in drug combinations. Furthermore, it appears other antirheumatics should be favoured over indomethacin/naproxen and, in situations where both drugs may be appropriate, digoxin over amiodarone. Our methodology may help assess the safety of new medications in drug combinations in preliminary pharmacovigilance investigations.
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Affiliation(s)
- Sylvie D Price
- School of Population Health (M431), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia,
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Ahn EK, Cho SY, Shin D, Jang C, Park RW. Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department. Healthc Inform Res 2014; 20:280-7. [PMID: 25405064 PMCID: PMC4231178 DOI: 10.4258/hir.2014.20.4.280] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 10/19/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To reveal differences in drug-drug interaction (DDI) alerts and the reasons for alert overrides between admitting departments. METHODS A retrospective observational study was performed using longitudinal Electronic Health Record (EHR) data and information from an alert and logging system. Adult patients hospitalized in the emergency department (ED) and general ward (GW) during a 46-month period were included. For qualitative analyses, we manually reviewed all reasons for alert overrides, which were recorded as free text in the EHRs. RESULTS Among 14,780,519 prescriptions, 51,864 had alerts for DDIs (0.35%; 1.32% in the ED and 0.23% in the GW). The alert override rate was higher in the ED (94.0%) than in the GW (57.0%) (p < 0.001). In an analysis of the study population, including ED and GW patients, 'clinically irrelevant alert' (52.0%) was the most common reason for override, followed by 'benefit assessed to be greater than the risk' (31.1%) and 'others' (17.3%). The frequency of alert overrides was highest for anti-inflammatory and anti-rheumatic drugs (89%). In a sub-analysis of the population, 'clinically irrelevant alert' was the most common reason for alert overrides in the ED (69.3%), and 'benefit assessed to be greater than the risk' was the most common reason in the GW (61.4%). CONCLUSIONS We confirmed that the DDI alerts and the reasons for alert overrides differed by admitting department. Different strategies may be efficient for each admitting department.
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Affiliation(s)
- Eun Kyoung Ahn
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Soo-Yeon Cho
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Dahye Shin
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Chul Jang
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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Roblek T, Trobec K, Mrhar A, Lainscak M. Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease. Arch Med Sci 2014; 10:920-32. [PMID: 25395943 PMCID: PMC4223137 DOI: 10.5114/aoms.2014.46212] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/10/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Polypharmacy is common in patients with chronic heart failure (HF) and/or chronic obstructive pulmonary disease (COPD), but little is known about the prevalence and significance of drug-drug interactions (DDIs). This study evaluates DDIs in hospitalized patients. MATERIAL AND METHODS We retrospectively screened medical charts over a 6-month period for diagnosis of chronic HF and/or COPD. Potential DDIs were evaluated using Lexi-Interact software. RESULTS Seven hundred and seventy-eight patients were included in the study (median age 75 years, 61% men). The median number of drugs on admission and discharge was 6 (interquartile range (IQR) 4-9) and 7 (IQR 5-), respectively (p = 0.10). We recorded 6.5 ±5.7 potential DDIs per patient on admission and 7.2 ±5.6 on discharge (p = 0.2). From admission to discharge, type-C and type-X potential DDIs increased (p < 0.05 for both). Type X interactions were rare (< 1%), with the combination of a β-blocker and a β2 agonist being the most common (64%). There were significantly more type-C and type-D potential DDIs in patients with chronic HF as compared to patients with COPD (p < 0.001). Patients with concomitant chronic HF and COPD had more type-C and type-X potential DDIs when compared to those with individual disease (p < 0.005). An aldosterone antagonist and ACE inhibitor/ARB were prescribed to 3% of chronic HF patients with estimated glomerular filtration rate < 30 ml/(min × 1.73 m(2)). CONCLUSIONS The DDIs are common in patients with chronic HF and/or COPD, but only a few appear to be of clinical significance. The increase in potential DDIs from admission to discharge may reflect better guideline implementation rather than poor clinical practice.
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Affiliation(s)
- Tina Roblek
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Trobec
- Hospital Pharmacy, Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia
| | - Ales Mrhar
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Mitja Lainscak
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Division of Cardiology, Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia
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Bhagavathula AS, Berhanie A, Tigistu H, Abraham Y, Getachew Y, Khan TM, Unakal C. Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia. Asian Pac J Trop Biomed 2014; 4:S204-8. [PMID: 25183081 DOI: 10.12980/apjtb.4.2014c1172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital. METHOD A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors. RESULT In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications. CONCLUSION We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.
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Affiliation(s)
| | - Alemayehu Berhanie
- Department of Clinical Pharmacy Research, School of Pharmacy, University of Gondar, Ethiopia
| | - Habtamu Tigistu
- Faculty of Pharmacy, School of Pharmacy, Gondar, University of Gondar Ethiopia
| | - Yishak Abraham
- Faculty of Pharmacy, School of Pharmacy, Gondar, University of Gondar Ethiopia
| | - Yosheph Getachew
- Faculty of Pharmacy, School of Pharmacy, Gondar, University of Gondar Ethiopia
| | - Tahir Mehmood Khan
- Jeffery Chee School of Medicine and Health Sciences, Monash University, Sunway Campus, 46150, Selangor Darul Ehsan, Malaysia
| | - Chandrashekhar Unakal
- Department of Medical Microbiology, School of Medicine and Health Sciences, University of Gondar, Ethiopia
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Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug-drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf 2014; 23:489-97. [DOI: 10.1002/pds.3592] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Supinya Dechanont
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; Naresuan University; Phitsanulok Thailand
| | - Sirada Maphanta
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; Naresuan University; Phitsanulok Thailand
| | - Bodin Butthum
- Faculty of Medicine; Naresuan University; Phitsanulok Thailand
| | - Chuenjid Kongkaew
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; Naresuan University; Phitsanulok Thailand
- Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences; Naresuan University; Phitsanulok Thailand
- Center of Excellence for Environmental Health and Toxicology; Naresuan University; Phitsanulok Thailand
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Ahn EK, Kam HJ, Park DK, Jung EY, Lee Y, Park RW. Differences among admitting departments in alerts and alert overrides for drug-drug interaction. Pharmacoepidemiol Drug Saf 2014; 23:390-7. [DOI: 10.1002/pds.3591] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 01/13/2014] [Accepted: 01/16/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Eun Kyoung Ahn
- Department of Biomedical Informatics; Ajou University School of Medicine; Suwon Korea
| | - Hye Jin Kam
- Samsung Advanced Institute of Technology; Samsung Electronics; Suwon Korea
| | - Dong Kyun Park
- Center for u-Healthcare; Gachon University Gil Medical Center; Incheon Korea
| | - Eun Young Jung
- Center for u-Healthcare; Gachon University Gil Medical Center; Incheon Korea
| | - Youngho Lee
- Department of Information Technology; Gachon University of Medicine and Science; Incheon Korea
| | - Rae Woong Park
- Department of Biomedical Informatics; Ajou University School of Medicine; Suwon Korea
- Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
- Center for Pharmacoepidemiology Research and Training; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
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Wilbur K, Hazi H, El-Bedawi A. Drug-Related Hospital Visits and Admissions Associated with Laboratory or Physiologic Abnormalities-A Systematic-Review. PLoS One 2013; 8:e66803. [PMID: 23826139 PMCID: PMC3694970 DOI: 10.1371/journal.pone.0066803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Countless studies have demonstrated that many emergency-room visits and hospital admissions are drug-related and that a significant proportion of these drug-related visits (DRVs) are preventable. It has not been previously studied which DRVs could be prevented through enhanced monitoring of therapy. The objective of the study was to determine the incidence of DRVs attributed to laboratory or physiologic abnormalities. Three authors independently performed comprehensive searches in relevant health care databases using pre-determined search terms. Articles discussing DRV associated with poisoning, substance abuse, or studied among existing in-patient populations were excluded. Study country, year, sample, design, duration, DRV identification method, proportion of DRVs associated with laboratory or physiologic abnormalities and associated medications were extracted. The three authors independently assessed selected relevant articles according to the Strengthening the reporting of observational studies in epidemiology (STROBE) as applicable according to the studies' methodology. The initial literature search yielded a total of 1,524 articles of which 30 articles meeting inclusion criteria and reporting sufficient laboratory or physiologic data were included in the overall analysis. Half employed prospective methodologies, which included both chart review and patient interview; however, the overwhelming majority of identified studies assessed only adverse drug reactions (ADRs) as a drug-related cause for DRV. The mean (range) prevalence of DRVs found in all studies was 15.4% (0.44%–66.7%) of which an association with laboratory or physiologic abnormalities could be attributed to a mean (range) of 29.4% (4.3%–78.1%) of cases. Most laboratory-associated DRVs could be linked to immunosuppressant, antineoplastic, anticoagulant and diabetes therapy, while physiologic-associated DRVs were attributed to cardiovascular therapies and NSAIDs. Significant proportions of laboratory and physiologic abnormalities contribute to DRVs and are consistently linked to specific drugs. These therapies are potential targets for enhanced medication monitoring initiatives to proactively avert potential DRVs.
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Affiliation(s)
- Kerry Wilbur
- College of Pharmacy, Qatar University, Doha, Qatar
- * E-mail:
| | - Huda Hazi
- College of Pharmacy, Qatar University, Doha, Qatar
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Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, southern Brazil. PLoS One 2012; 7:e47062. [PMID: 23071711 PMCID: PMC3468464 DOI: 10.1371/journal.pone.0047062] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few cross-sectional studies involving adults and elderly patients with major DDIs have been conducted in the primary care setting. The study aimed to investigate the prevalence of potential drug-drug interactions (DDIs) in patients treated in primary care. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional study involving patients aged 45 years or older was conducted at 25 Basic Health Units in the city of Maringá (southern Brazil) from May to December 2010. The data were collected from prescriptions at the pharmacy of the health unit at the time of the delivery of medication to the patient. After delivery, the researcher checked the electronic medical records of the patient. A total of 827 patients were investigated (mean age: 64.1; mean number of medications: 4.4). DDIs were identified in the Micromedex® database. The prevalence of potential DDIs and major DDIs was 63.0% and 12.1%, respectively. In both the univariate and multivariate analyses, the number of drugs prescribed was significantly associated with potential DDIs, with an increasing risk from three to five drugs (OR = 4.74; 95% CI: 2.90-7.73) to six or more drugs (OR = 23.03; 95% CI: 10.42-50.91). Forty drugs accounted for 122 pairs of major DDIs, the most frequent of which involved simvastatin (23.8%), captopril/enalapril (16.4%) and fluoxetine (16.4%). CONCLUSIONS/SIGNIFICANCE This is the first large-scale study on primary care carried out in Latin America. Based on the findings, the estimated prevalence of potential DDIs was high, whereas clinically significant DDIs occurred in a smaller proportion. Exposing patients to a greater number of prescription drugs, especially three or more, proved to be a significant predictor of DDIs. Prescribers should be more aware of potential DDIs. Future studies should assess potential DDIs in primary care over a longer period of time.
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Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. Expert Opin Drug Saf 2011; 11:83-94. [PMID: 22022824 DOI: 10.1517/14740338.2012.631910] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Drug-drug interactions (DDIs) arise in numerous different ways, involving pharmacokinetic or pharmacodynamic mechanisms. Adverse drug reactions are a possible consequence of DDIs and health operators are often unaware of the clinical risks of certain drug combinations. Many papers on drug interactions have been published in recent years, but most of them focused on potential DDIs while few studies have been conducted on actual interactions. AREAS COVERED This paper reviews the epidemiology of actual DDIs in outpatients as well as in hospital settings and in spontaneous reporting databases. The incidence of actual DDIs is consistently lower than that of potential DDIs. However, the absolute number of patients involved is high, representing a significant proportion of adverse drug reactions. The importance of risk factors such as age, polypharmacy and genetic polymorphisms is also evaluated. The relevance and efficacy of tools for recognizing and preventing DDIs are discussed. EXPERT OPINION Potential DDIs far outnumber actual drug interactions. The potential for an adverse interaction to occur is often theoretical, and clinically important adverse effects occur only in the presence of specific risk factors. Several studies have shown the efficacy of computers in early detection of DDIs. However, a correct risk-benefit evaluation by the prescribing physician, together with a careful clinical, physiological and biochemical monitoring of patients, is essential. Future directions of drug interaction research include the increasing importance of pharmacogenetics in preventing DDIs and the evaluation of interactions with biological drugs.
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Affiliation(s)
- Lara Magro
- University of Verona, Faculty of Medicine, Department of Public Health and Community Medicine, Section of Pharmacology, p.le L.A. Scuro 10, 37134 Verona, Italy
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Pirmohamed M. Drug-drug interactions and adverse drug reactions: separating the wheat from the chaff. Wien Klin Wochenschr 2010; 122:62-4. [PMID: 20213370 DOI: 10.1007/s00508-010-1309-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Munir Pirmohamed
- The Wolfson Centre for Personalised Medicine, Department of Pharmacology, University of Liverpool, Liverpool, Great Britain.
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