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Alorfi NM, Alqurashi RS, Algarni AS. Assessment of community pharmacists' knowledge about drug-drug interactions in Jeddah, Saudi Arabia. Front Pharmacol 2023; 14:1209318. [PMID: 37324452 PMCID: PMC10267452 DOI: 10.3389/fphar.2023.1209318] [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: 04/20/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023] Open
Abstract
Background: Drug-drug interactions (DDIs) have the potential to result in severe adverse drug events and profoundly affect patient outcomes. The pivotal role community pharmacists assume in recognizing and effectively managing these interactions necessitates a comprehensive understanding and heightened awareness of their implications. Such knowledge and awareness among community pharmacists are fundamental for ensuring the delivery of safe and efficacious care to patients. Aim: This study aimed to assess the knowledge of community pharmacists in Jeddah, Saudi Arabia, regarding drug-drug interactions (DDIs). Method: A cross-sectional survey was administered to a cohort of 147 community pharmacists through the utilization of a self-administered questionnaire. The questionnaire encompassed a comprehensive range of 30 multiple-choice questions, encompassing various facets pertaining to drug-drug interactions (DDIs). Results: A total of 147 community pharmacists working in Jeddah City, Saudi Arabia, completed the survey. The majority of them were male (89.1%, n = 131), and had bachelor's degrees in pharmacy. Results showed that the lowest correct response of DDIs was between Theophylline/Omeprazole, while the highest was between amoxicillin and acetaminophen. Results revealed that among the 28 drug pairs, only six pairs were determined correctly by most participants. The study found that majority of the studied community pharmacist could not determine the correct answer on drug-drug interaction knowledge, as also seen with the measured below half mean DDIs knowledge of 38.22 ± 22.0 (min = 0, max = 89.29, median = 35.71). Conclusion: The study highlights the need for ongoing training and education programs for community pharmacists in Saudi Arabia to enhance their knowledge and understanding of DDIs, ultimately leading to improved patient care and safety.
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Létinier L, Bezin J, Jarne A, Pariente A. Drug-Drug Interactions and the Risk of Emergency Hospitalizations: A Nationwide Population-Based Study. Drug Saf 2023; 46:449-456. [PMID: 37046156 DOI: 10.1007/s40264-023-01283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Several studies suggest a significant risk of hospitalization because of drug-drug interactions in the general population. However, to our knowledge, this risk has never been measured precisely in a large population. OBJECTIVE We aimed to estimate the risk of emergency hospitalization associated with exposure to the contraindicated concomitant use of interacting drugs in the general population. METHODS A self-controlled case-series analysis was carried out on a cohort of 150,000 subjects randomly selected from the French national health insurance database, between 01/01/2016 and 31/12/2016. Exposure to the contraindicated concomitant use of interacting drugs was defined as the overlapping period of dispensings of drugs contraindicated because of clinically meaningful drug-drug interactions. The main outcome, incidence rate ratios, comparing the incidence rate of emergency hospitalizations during each category of exposure time periods with that during the reference period, was estimated using the conditional Poisson regression model. RESULTS Over the study period, 967 subjects were exposed to at least one contraindicated concomitant use of interacting drug and 177 had been exposed and presented at least one emergency hospitalization. Compared to the unexposed follow-up time, the risk of emergency hospitalization increased during exposure to contraindicated concomitant use of interacting drug periods (incidence rate ratio: 2.41; 95% confidence interval 1.55-3.76). This could translate into 7200 (4500-8900) potentially preventable emergency hospitalizations yearly in France. CONCLUSIONS We evidenced an almost 2.5-fold increase in the risk of emergency hospitalizations during periods of exposure to contraindicated concomitant use of interacting drugs, with a potential public health impact exceeding 7000 preventable hospitalizations yearly in France. These results confirm the need to reinforce training in prescription practices and tools for prevention concerning contraindicated concomitant use of interacting drugs. These would especially concern drugs involved in an increase in long QT syndrome when associated such as citalopram, and highly prescribed drugs with a risk of overdose if co-prescribed with cytochrome P450 inhibitors, such as antigout and lipid-lowering drugs.
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Affiliation(s)
- Louis Létinier
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France.
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France.
| | - Julien Bezin
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France
| | - Ana Jarne
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France
| | - Antoine Pariente
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France
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Spanakis M, Ioannou P, Tzalis S, Chouzouri F, Patelarou E, Kofteridis DP, Antoniou KM, Schiza SE, Patelarou A, Tzanakis N. Evaluation of Drug Interactions in Hospitalized Patients with Respiratory Disorders in Greece. Adv Respir Med 2023; 91:74-92. [PMID: 36825942 PMCID: PMC9952796 DOI: 10.3390/arm91010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
Background: Patients with respiratory disorders often have additional diseases and are usually treated with more than one medication to manage their respiratory conditions as well as additional comorbidities. Thus, they are frequently exposed to polypharmacy (≥5 drugs), which raises the risk for drug-drug interactions (DDIs) and adverse drug reactions (ADRs). In this work, we present the results regarding the prevalence of DDIs in hospitalized patients with respiratory disorders in Greece. Methods: A 6-month descriptive single-center retrospective observational study enrolled 102 patients with acute or chronic respiratory disorders. Clinical characteristics and medication regimens were recorded upon admission, hospitalization, and discharge. The prevalence of DDIs and their clinical significance was recorded and analyzed. Results: Unspecified acute lower respiratory tract infection (25%), exacerbations of chronic obstructive pulmonary disease (12%) and pneumonia (8%) were the most frequent reasons for admission. Cardiovascular disorders (46%), co-existing respiratory disorders (32%), and diabetes (25%) were the most prevalent comorbidities. Polypharmacy was noted in 61% of patients upon admission, 98% during hospitalization, and 63% upon discharge. Associated DDIs were estimated to be 55% upon admission, 96% throughout hospitalization, and 63% on discharge. Pharmacodynamic (PD) DDIs were the most prevalent cases (81%) and referred mostly to potential risk for QT-prolongation (31.4% of PD-DDIs) or modulation of coagulation process as expressed through the international normalized ratio (INR) (29.0% of DDIs). Pharmacokinetic (PK) DDIs (19% of DDIs) were due to inhibition of Cytochrome P450 mediated metabolism that could lead to elevated systemic drug concentrations. Clinically significant DDIs characterized as "serious-use alternative" related to 7% of cases while 59% of DDIs referred to combinations that could be characterized as "use with caution-monitor". Clinically significant DDIs mostly referred to medication regimens upon admission and discharge and were associated with outpatient prescriptions. Conclusions: Hospitalized patients with respiratory disorders often experience multimorbidity and polypharmacy that raise the risk of DDIs. Clinicians should be conscious especially if any occurring arrhythmias, INR modulations, and prolonged or increased drug action is associated with DDIs.
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Affiliation(s)
- Marios Spanakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research & Technology-Hellas (FORTH), GR-70013 Heraklion, Crete, Greece
- Correspondence:
| | - Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Sotiris Tzalis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Flora Chouzouri
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Evridiki Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Katerina M. Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Sophia E. Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Nikos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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Spanakis M, Ioannou P, Tzalis S, Papakosta V, Patelarou E, Tzanakis N, Patelarou A, Kofteridis DP. Drug-Drug Interactions among Patients Hospitalized with COVID-19 in Greece. J Clin Med 2022; 11:jcm11237172. [PMID: 36498745 PMCID: PMC9740400 DOI: 10.3390/jcm11237172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
The modulation of the pharmacological action of drugs due to drug-drug interactions (DDIs) is a critical issue in healthcare. The aim of this study was to evaluate the prevalence and the clinical significance of potential DDIs in patients admitted to the University Hospital of Heraklion in Greece with coronavirus disease 2019 (COVID-19). Cardiovascular disorders (58.4%) and diabetes (types I and II) (29.6%) were the most common comorbidities. A high occurrence of DDIs was observed, and clinically significant DDIs that may hamper response to treatment represented 40.3% of cases on admission, 21% during hospitalization, and 40.7% upon discharge. Polypharmacy and comorbidities were associated with a higher prevalence of DDIs in a statistically significant way (p < 0.05, 95% CI). Clinically significant DDIs and increased C-reactive protein values upon admission were associated with prolonged hospitalization. The results reveal that patients admitted due to COVID-19 in Greece often have an additional burden of DDIs that healthcare teams should approach and resolve.
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Affiliation(s)
- Marios Spanakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
- Correspondence:
| | - Petros Ioannou
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Sotiris Tzalis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Vasiliki Papakosta
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Evridiki Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece
| | - Nikos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
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Alkhalid ZN, Birand N. Determination and comparison of potential drug-drug interactions using three different databases in northern cyprus community pharmacies. Niger J Clin Pract 2022; 25:2005-2009. [PMID: 36537458 DOI: 10.4103/njcp.njcp_448_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Drug interactions are common drug-related problems that can lead to adverse drug reactions and hospitalization. AIMS The objectives of the study were to determine the potential drug-drug interactions (pDDIs) in Northern Cyprus community pharmacies and to compare three electronic databases regarding the frequency, mechanism, and severity of drug-drug interactions. MATERIAL AND METHODS A retrospective observational study was conducted between July 1 and September 30, 2021, in Northern Cyprus community pharmacies using the Drugs.com, Lexicomp, and Medscape databases. The Mann-Whitney U-test was used to determine the difference between the values of the databases. Pearson's correlation was used to determine the association between DDIs and polypharmacy. RESULTS A total of 558 (52.1%) of 1072 prescriptions were included in the study. Drugs.com, Lexicomp, and Medscape databases detected 185, 176, and 213 potential drug-drug interactions in patients' prescriptions, respectively. There was a statistically significant difference in moderate drug interactions between the Medscape and Lexicomp databases (p = 0.02). Pearson's correlation showed a weak association (Medscape: r = 0.296, Lexicomp: r = 0.341, Drugs.com: r = 0.289, P = 0.0001) between pDDIs and polypharmacy. The assessment of agreement on severity of pDDIs characterized by Drugs.com and Lexicomp databases using the Kappa index was moderate agreement (0.509, P = 0.0001), while Drugs.com and Medscape databases using the Kappa index were moderate agreement (0.442, P = 0.0001), and Lexicomp and Medscape databases using the Kappa index were fair agreement (0.365, P = 0.0001). CONCLUSIONS This study showed that Medscape detected more potential DDIs than Drugs.com and Lexicomp. Therefore, we propose that more than one database should be used to evaluate and identify pDDIs in pharmacy.
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Affiliation(s)
- Z N Alkhalid
- Department of Clinical Pharmacy, Near East University, Faculty of Pharmacy, Nicosia, North Cyprus, Mersin, Turkey
| | - N Birand
- Department of Clinical Pharmacy, Near East University, Faculty of Pharmacy, Nicosia, North Cyprus, Mersin, Turkey
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A Prospective Study of Medication Surveillance of a Pediatric Tertiary Care Hospital in Lahore, Pakistan. Pediatr Rep 2022; 14:312-319. [PMID: 35736660 PMCID: PMC9230244 DOI: 10.3390/pediatric14020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 12/10/2022] Open
Abstract
PURPOSE Several studies have shown that polypharmacy is the main cause of drug interactions, and the prevalence and the level of the severity varied with the duration of stay in the hospital, sex and race of the patients. The aims of this investigation were to identify the drug-drug interactions in hospitalized pediatric patients associated with polypharmacy, and to categorize the drug interactions in pharmacokinetic or pharmacodynamic interactions according to their level of severity. METHODS A cross-sectional, prospective analytical study was performed at a pediatric tertiary care hospital in Lahore, Pakistan for the duration of 4 months, which included prescription orders for 300 patients. Data were collected from patient medical files about previous and current medication history. Drug interactions were analyzed using interaction checker on Medscape and categorized according to the severity levels. RESULTS Out of 300 patients, the occurrence of drug interactions was found in 157 (52.3%) patients, while in 143 (47.7%), no interaction was found. Among these interactions, 50.7% were pharmacodynamic interactions, and 49.30% were pharmacokinetic interactions. Eighty-one percent of prescription orders with drug interactions contained more than three drugs, and 11.9% of interactions were severe. The majority of interactions were of amikacin-vancomycin, piroxicam-captopril and captopril-ciprofloxacin. CONCLUSION Most of the interactions were moderate among patients with multiple drug prescriptions. The drug interactions can be minimized by providing special patient monitoring and adequate management with prior knowledge of these drug interaction.
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Hamadouk RM, Albashair ED, Mohammed FM, Yousef BA. The Practice of the Community Pharmacists in Managing Potential Drug-Drug Interactions: A Simulated Patient Visits. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2022; 11:71-84. [PMID: 35313632 PMCID: PMC8934170 DOI: 10.2147/iprp.s355675] [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: 01/01/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Drug-drug interactions (DDIs) can cause treatment failure and serious adverse drug reactions, leading to morbidity and mortality. Due to their significant effects on the patient's health, community pharmacists (CPs) competence in detecting and preventing these interactions is essential to provide optimal health services. Thus, this study aimed to explore the performance of the CPs in situations involving the presence of potential DDIs. Methods A cross-sectional, simulated patient study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used to evaluate the performance of the CPs. Ten final year B. Pharm. students were selected to act as simulated patients (SPs); they were trained for two weeks to familiarize their roles. All encounters were documented immediately after leaving the pharmacy by the SPs in the data collection form. Results All planned SPs visits were completed, resulting in 470 visits. None of the CPs asked about the patients' medication history in both scenarios. After the SPs provided information about the drug used currently by the patient, 13.6% and 23.4% of the CPs had identified the potential DDIs in scenario 1 and scenario 2, respectively. In scenario 1, 59.4% distinguished the interaction of simvastatin with both drugs, while, in scenario 2, 74.5% recognized the interaction of warfarin with both drugs. In identifying DDIs, around half of the CPs were dependent on their knowledge or using drug interaction checker programs. The most common intervention made by the CPs was referring the patient to the prescriber (56.3% CPs in scenario 1 and 60% CPs in scenario 2). Conclusion CPs practice in identifying and managing potential DDIs was poor. The current CPs practices need substantial improvement. Therefore, professional education and the use of software programs in community pharmacies should be encouraged.
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Affiliation(s)
- Riham M Hamadouk
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Esra D Albashair
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Fatimah M Mohammed
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Bashir A Yousef
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
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Risk Factors for the Occurrence of Potential Drug-Drug Interactions in Surgical Patients. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Drug-drug interactions are defined as modifications of the drug action that result from the simultaneous administration of another individual drug or several drugs. Nowadays, potential drug-drug interactions (DDIs) are most frequently detected and analyzed using personal digital assistant software programs (online interaction checker tools).
Objective: To determine the risk factors for the emergence of all drug-drug interactions in surgical patients with particular emphasis on clinically significant interactions.
Patients and methods: This was a retrospective cohort analysis of patients treated at the Surgical Clinic of the Clinical Center Kragujevac. Three interaction checkers were used to reveal drug-drug interactions: Medscape, Epocrates and Micromedex.
Results: The study included total of 200 patients, aged 58.54±17.08 years. Average number of drug-drug interactions per patient was between 10.50±9.10 (Micromedex) and 18.75±17.14 (Epocrates). Number of prescribed drugs, antidepressive therapy, antiarrhythmic therapy, number of pharmacological/therapeutic subgroups (2nd level of ATC classification) prescribed, delirium or dementia, diabetes, heart failure, and number of physicians who prescribed drugs to single patient were identified as risk factors for drug-drug interactions while length of hospitalization in days and age of patient in years emerged as protective factors.
Conclusion: Drug-drug interactions are relatively common in surgical patients and predisposed by factors such as number of prescribed drugs or drug group per patient, number of physicians who prescribed drugs, antidepressive therapy, antiarrhythmic therapy, presence of delirium or dementia, diabetes and heart failure. On the other hand, prolonged hospitalization and higher age are factors that reduce the risk of interactions in surgical patients.
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Abbas A, Al-Shaibi S, Sankaralingam S, Awaisu A, Kattezhathu VS, Wongwiwatthananukit S, Owusu YB. Determination of potential drug-drug interactions in prescription orders dispensed in a community pharmacy setting using Micromedex ® and Lexicomp ®: a retrospective observational study. Int J Clin Pharm 2021; 44:348-356. [PMID: 34811600 DOI: 10.1007/s11096-021-01346-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Background Community pharmacists have a role in identifying drug-drug interactions (DDIs) when processing prescription orders and dispensing medications to patients. The harmful effects of DDIs can be prevented or minimized by using an electronic DDI checker to screen for potential DDIs (pDDIs). However, different DDI checkers have variable rates of detecting pDDIs. Aim To estimate the prevalence of pDDIs in prescriptions dispensed in a community pharmacy setting using two electronic DDI databases and to evaluate the association between the pDDIs and contributory factors. Method Eligible prescription orders dispensed by a community pharmacy chain in Qatar from January to July 2020 were included in this retrospective observational study. For each prescription, Micromedex® and Lexicomp® were simultaneously used to identify pDDIs, and the interactions categorized based on severity and risk rating. Results Seven hundred-twenty prescriptions met the inclusion criteria, of which Micromedex® and Lexicomp® respectively identified 125 prescriptions (17.4%) and 230 prescriptions (31.9%) as having at least one pDDI. Moderate strength of agreement was found between Lexicomp® and Micromedex® in identifying pDDIs (Cohen's Kappa = 0.546). Micromedex® classified 61.6% of DDIs as major severity, while Lexicomp® classified 30.8% as major severity. The number of concurrent medications per prescription was significantly and positively associated with pDDI. Conclusion This study demonstrates a high prevalence of pDDIs among prescriptions dispensed in a community pharmacy setting. It is advisable that community pharmacists in Qatar, who typically do not have access to computerized patient profiles, use these DDI checkers to ensure all pDDIs are communicated to respective prescribers for appropriate action.
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Affiliation(s)
- Afraa Abbas
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Samaher Al-Shaibi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Sowndramalingam Sankaralingam
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | | | - Supakit Wongwiwatthananukit
- Department of Pharmacy Practice, The Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, Hilo, HI, USA
| | - Yaw B Owusu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
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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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Prevalence and Clinical Significance of Drug-Drug and Drug-Dietary Supplement Interactions among Patients Admitted for Cardiothoracic Surgery in Greece. Pharmaceutics 2021; 13:pharmaceutics13020239. [PMID: 33572247 PMCID: PMC7914879 DOI: 10.3390/pharmaceutics13020239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Drug interactions represent a major issue in clinical settings, especially for critically ill patients such as those with cardiovascular disease (CVD) who require cardiothoracic surgery (CTS) and receive a high number of different medications. Methods: A cross-sectional study aimed at evaluating the exposure and clinical significance of drug–drug (DDIs) and drug–dietary supplement interactions (DDSIs) in patients admitted for CTS in the University Hospital of Crete Greece. DDIs were evaluated regarding underlying pharmacological mechanisms upon admission, preoperation, postoperation, and discharge from CTS clinic. Additionally, upon admission, the use of dietary supplements (DSs) and if patients had informed their treating physician that they were using these were recorded with subsequent analysis of potential DDSIs with prescribed medications. Results: The study employed 76 patients who were admitted for CTS and accepted to participate. Overall, 166 unique DDIs were identified, with 32% of them being related to pharmacokinetic (PK) processes and the rest (68%) were related to possible alterations of pharmacodynamic (PD) action. CVD medications and drugs for central nervous system disorders were the most frequently interacting medications. In total, 12% of the identified DDIs were of serious clinical significance. The frequency of PK-DDIs was higher during admission and discharge, whereas PD-DDIs were mainly recorded during pre- and postoperation periods. Regarding DS usage, 60% of patients were using DSs and perceived them as safe, and the majority had not informed their treating physician of this or sought out medical advice. Analysis of medical records showed 30 potential combinations with prescribed medications that could lead in DDSIs due to modulation of PK or PD processes, and grapefruit juice consumption was involved in 38% of them. Conclusions: An increased burden of DDIs and DDSIs was identified mostly upon admission for patients in CTS clinics in Greece. Healthcare providers, especially prescribing physicians in Greece, should always take into consideration the possibility of DDIs and the likely use of DS products by patients to promote their well-being; this should only be undertaken after receiving medical advice and an evidenced-based evaluation.
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Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239101. [PMID: 33291233 PMCID: PMC7730015 DOI: 10.3390/ijerph17239101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) require specialized therapeutic interventions. The decreased renal function that modulates the physiology and presence of comorbidities is often associated with variations in the pharmacological response, thus increasing the risk of adverse drug events or reactions (ADE/ADRs) from co-administered drugs. METHODS A cross-sectional study to record comorbidities, drug-drug interactions (DDIs), ADE/ADRs in patients with chronic kidney disease of stage five in Greece. The study enrolled 60 patients of mean age 64.8 ± 12.9 years, undergoing hemodialysis three times a week. Demographic and social factors, comorbidities, laboratory test data, medication regimens, DDIs and the reporting of ADE/ADRs were analyzed. RESULTS Cardiovascular diseases and diabetes were the main comorbidities. In total, 50 different DDIs of various clinical significance were identified. CNS, GI-track, and musculoskeletal-system-related ADE/ADRs were most often reported by patients. ADE/ADRs as clinical outcome from DDIs were associated in 64% of the total identified DDIs. There was a positive trend between number of medications, ADE/ADRs report and DDIs. CONCLUSIONS The impact of ADE/ADRs in ESRD patients should be always considered. Guidelines as well as continuous training in the context of evidence-based clinical practice by healthcare personnel on therapy administration and prevention of adverse events are important.
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Rasool MF, Rehman AU, Imran I, Abbas S, Shah S, Abbas G, Khan I, Shakeel S, Ahmad Hassali MA, Hayat K. Risk Factors Associated With Medication Errors Among Patients Suffering From Chronic Disorders. Front Public Health 2020; 8:531038. [PMID: 33330300 PMCID: PMC7710866 DOI: 10.3389/fpubh.2020.531038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/13/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction: Medication error is unintentional and can be reduced by reducing the risk factors. Patients suffering from chronic diseases are at an increased risk of medication errors. Objective: This work aims to assess the risk factors associated with medication errors among patients suffering from chronic disorders in hospitals of South Punjab, Pakistan. Methodology: Multiple logistic regression analysis was used to assess the impact of different risk factors on the prevalence of medication errors in patients suffering from chronic diseases. Results: A greater risk for the occurrence of medication errors was associated with age ≥60 years (odds ratio, OR = 1.9; 95% CI = 1.3–3.1; p = 0.001), overburdened healthcare system (OR = 2.2; 95% CI = 1.64–3.56; p < 0.000), number of prescribed drugs ≥5 (OR = 1.74; 95% CI = 1.02–2.64; p < 0.000), comorbidities (OR = 2.6; 95% CI = 1.72–3.6; p = 0.003), Charlson comorbidity index (OR = 1.31; 95% CI = 0.49–1.84; p = 0.004), and multiple prescribers to one patient (OR = 1.12; 95% CI = 0.64–1.76; p = 0.001). Conclusion: Older age, overburdened healthcare system, number of prescribed drugs, comorbidities, Charlson comorbidity index, and multiple prescribers to one patient are significant risk factors for the occurrence of medication errors.
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Affiliation(s)
- Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees Ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan.,Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Sameen Abbas
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Ghulam Abbas
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Irfanullah Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Sadia Shakeel
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.,Department of Pharmacy Practice, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohamed Azmi Ahmad Hassali
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Cardoso TC, Simoens S, Itria A, Dewulf NDLS. Cost analysis of a medication dispensing service in community pharmacy in Brazil. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000418715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Nusair MB, Al-Azzam SI, Arabyat RM, Amawi HA, Alzoubi KH, Rabah AA. The prevalence and severity of potential drug-drug interactions among adult polypharmacy patients at outpatient clinics in Jordan. Saudi Pharm J 2019; 28:155-160. [PMID: 32042253 PMCID: PMC7000309 DOI: 10.1016/j.jsps.2019.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/29/2019] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the prevalence of potential drug-drug interactions (pDDIs) among polypharmacy patients in Jordan using Lexicomp®. Additionally, this study aims to categorize and rate the identified pDDIs according to interaction risk, severity, and reliability. Methods A descriptive cross-sectional study was conducted at six different hospitals representing different public health sectors in Jordan (ministry of health, royal medical services, and university-affiliated hospitals). Polypharmacy patients from outpatient clinics (e.g., cardiology,& and internal medicine) were identified, recruited, and interviewed by clinical pharmacists. pDDIs were assessed using the Lexicomp® mobile application and classified according to interaction risk rating, severity, and reliability rating. Furthermore, the prevalence of pDDIs across chronic medical conditions was assessed. P-value <0.05 was considered as significant. Results A total of 801 patients with polypharmacy were identified. The average number of drugs per patient was 6.6 ± 1.96, with an average of 4.2 ± 3.0 pDDIs per patient. Potential drug-drug interactions were detected in 769 patients (96%), with a total of 3359 interactions. Blood pressure lowering agents were involved in 39.9% of the pDDIs. Cardiovascular system drugs contributed to the largest share of pDDIs (46.6%). While diuretics had the major share of interactions among cardiovascular system drugs (16.2%), drugs used in diabetes had the highest share across all groups (17.1%). The majority of pDDIs were of “C” risk rating with a moderate interaction severity, whilst 1.6% of pDDIs could have been avoided in the first place as the concurrent administration of these agents is contraindicated (i.e., risk rating X). Patients with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, gout, and chronic kidney disease were associated with the highest number of potential drug-drug interactions. Conclusion Our study showed that 96% of polypharmacy patients at outpatient clinics have at least one pDDI. Almost half of the detected interactions involved cardiovascular medications. The majority of these pDDIs had moderate severity, with no more than 10% of the interactions requiring therapy modification.
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Affiliation(s)
- Mohammad B. Nusair
- Faculty of Pharmacy, Yarmouk University, Irbid 21110, Jordan
- Corresponding author at: Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid 21110, Jordan
| | - Sayer I. Al-Azzam
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | | | - Haneen A. Amawi
- Faculty of Pharmacy, Yarmouk University, Irbid 21110, Jordan
| | - Karem H. Alzoubi
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Asma A. Rabah
- Faculty of Pharmacy, Yarmouk University, Irbid 21110, Jordan
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Spanakis M, Sfakianakis S, Kallergis G, Spanakis EG, Sakkalis V. PharmActa: Personalized pharmaceutical care eHealth platform for patients and pharmacists. J Biomed Inform 2019; 100:103336. [PMID: 31689550 DOI: 10.1016/j.jbi.2019.103336] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 09/17/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
Community pharmacists are critically placed in the patient care chain being an extended frontline within primary healthcare networks across Europe. They are trained to ensure safe and effective medication use, a crucial and responsible role, extending beyond the common misconception limited to just providing timely access to medicines for the population. Technology-wise, eHealth being committed to an effective, networked, patient-centered and accessible healthcare would prove a real asset in this direction by achieving improved therapy adherence with better outcomes and direct contribution to a cost-effective healthcare system. In this work, we present PharmActa, a personalized eHealth platform that addresses key features of pharmaceutical care and enhances communication of pharmacists with patients for optimizing pharmacotherapy. PharmActa empowers patients by providing pharmaceutical care services, such as drug interactions tools, reminders for assisting adhesion and compliance, information regarding adverse drug reactions, as well as pharmacovigilance along with related tools for healthcare management. In addition, it allows the pharmacists to review the medication history in order to provide personalized pharmaceutical care services; thus enhancing their role as healthcare providers. Finally, a mechanism allowing such a system to be interconnected with a developed medical repository following European and International interoperability standards, is also presented. Thus far, the evaluation results presented in this work indicate that PharmActa can be of great benefit to healthcare professionals, especially pharmacists and patients.
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Affiliation(s)
- Marios Spanakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece.
| | - Stelios Sfakianakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - George Kallergis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Emmanouil G Spanakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Vangelis Sakkalis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
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Truong TTA, Phan NK, Vo QV, Diep HG, Vuong HTK, Le TV, Nguyen PM, Nguyen T. Drug-related problems in prescribing for coronary artery diseases in Vietnam: cross-sectional study. Trop Med Int Health 2019; 24:1335-1340. [PMID: 31520568 DOI: 10.1111/tmi.13310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To determine the prevalence, patterns and determinants of drug-related problems (DRPs) in prescribing for coronary artery diseases (CADs) in Vietnam. METHODS Retrospective cross-sectional study on outpatients with CADs at a general hospital in Can Tho, Vietnam. DRPs were classified according to Pharmaceutical Care Network Europe definitions. We determined the prevalence and patterns of DRPs. Logistic regression was used to identify the determinants of DRPs. RESULTS Among 683 patients (mean age 63.4; 64.3% female), the prevalence of DRPs was 61.1%. DRPs comprised inappropriate indication (3.5%), inappropriate dosage (22.2%), wrong frequency of use (24.2%), wrong time of taking medications (4.1%), taking medications at the wrong time around meals (19.2%) and drug interactions (19.3%). Patients who took ≥ 5 drugs were more likely to have DRPs (adjusted odds ratio = 1.96; 95% confidence interval = 1.31-2.93). Patients without health insurance were more likely to have inappropriate indication (ORa = 2.93; 95%CI = 1.28-6.70). Taking medications at inappropriate times around meals was common among men (ORa = 1.82; 95%CI = 1.23-2.69) and among those with health insurance (ORa = 1.66; 95%CI = 1.05-2.63). Patients < 65 years old were more likely to be prescribed inappropriate doses (ORa = 1.67; 95%CI = 1.15-2.45). Prescriptions with ≥ 5 drugs were more likely to be taken at inappropriate frequency (ORa = 1.87; 95%CI = 1.09-3.21) and to cause drug interactions (ORa = 6.48; 95%CI = 2.59-16.24). CONCLUSIONS DRPs are common among patients with CADs in Vietnam. The number of DRPs increases with the number of drugs in prescriptions. Further studies should identify other potential determinants of DRPs and effective interventions to improve prescribing practice in Vietnam.
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Affiliation(s)
- Thu T A Truong
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Ngan K Phan
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Quyen V Vo
- Department of Information Technology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Han G Diep
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Huyen T K Vuong
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thanh V Le
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Phuong M Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
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18
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Létinier L, Cossin S, Mansiaux Y, Arnaud M, Salvo F, Bezin J, Thiessard F, Pariente A. Risk of Drug-Drug Interactions in Out-Hospital Drug Dispensings in France: Results From the DRUG-Drug Interaction Prevalence Study. Front Pharmacol 2019; 10:265. [PMID: 30967779 PMCID: PMC6438853 DOI: 10.3389/fphar.2019.00265] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Drug interactions could account for 1% of hospitalizations in the general population and 2-5% of hospital admissions in the elderly. However, few data are available on the drugs concerned and the potential severity of the interactions encountered. We thus first aimed to estimate the prevalence of dispensings including drugs Contraindicated or Discommended because of Interactions (CDI codispensings) and to identify the most frequently involved drug pairs. Second, we aimed to investigate whether the frequency of CDI codispensings appeared higher or lower than the expected for the drugs involved. Methods: We carried out a study using a random sample of all drugs dispensings registered in a database of the French Health Insurance System between 2010 and 2015. The distribution of the drugs involved was described considering active principles, detailing the 20 most frequent ones for both contraindicated or discommended codispensings (DCs). To investigate whether the frequency of CDI codispensings appeared higher or lower than the expected for the drugs involved, we developed a specific indicator, the Drug-drug interaction prevalence study-score (DIPS-score), that compares for each drug pair the observed frequency of codispensing to its expected probability. The latter is determined considering the frequencies of dispensings of the individual drugs constituting a pair of interest. Results: We analyzed 6,908,910 dispensings: 13,196 (0.2%) involved contraindicated codispensings (CCs), and 95,410 (1.4%) DCs. For CCS, the most frequently involved drug pair was "bisoprolol+flecainide" (n = 5,036); four out of five of the most represented pairs involved cardiovascular drugs. For DCS, the most frequently involved drug pair was "ramipril+spironolactone" (n = 4,741); all of the five most represented pairs involved cardiovascular drugs. The drug pair involved in the CC with the highest score value was "citalopram+hydroxyzine" (DIPS-score: 3.7; 2.9-4.6); that with the lowest score was "clarithromycin+simvastatin" (DIPS-score: 0.2; 0.2-0.3). DIPS-score median value was 0.4 for CCs and 0.6 for DCs. Conclusion: This high prevalence of CDI codispensings enforces the need for further risk-prevention actions regarding drug-drug interactions (DDIs), especially for arrhythmogenic or anti-arrhythmic drugs. In this perspective, the DIPS-score we develop could ease identifying the interactions that are poorly considered by clinicians/pharmacists and targeting interventions.
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Affiliation(s)
- Louis Létinier
- Inserm, UMR 1219, Team Pharmacoepidemiology, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France.,Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Sébastien Cossin
- Inserm, UMR 1219, Team ERIAS, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France.,Service d'Information Médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Yohann Mansiaux
- Inserm, UMR 1219, Team Pharmacoepidemiology, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Mickaël Arnaud
- Inserm, UMR 1219, Team Pharmacoepidemiology, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Francesco Salvo
- Inserm, UMR 1219, Team Pharmacoepidemiology, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France.,Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Julien Bezin
- Inserm, UMR 1219, Team Pharmacoepidemiology, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Frantz Thiessard
- Inserm, UMR 1219, Team ERIAS, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France.,Service d'Information Médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Antoine Pariente
- Inserm, UMR 1219, Team Pharmacoepidemiology, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France.,Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
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Spanakis M, Sfakianakis S, Sakkalis V, Spanakis EG. PharmActa: Empowering Patients to Avoid Clinical Significant Drug⁻Herb Interactions. MEDICINES (BASEL, SWITZERLAND) 2019; 6:E26. [PMID: 30781500 PMCID: PMC6473432 DOI: 10.3390/medicines6010026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 12/27/2022]
Abstract
Herbal medicinal products (HMPs) are the subject of increasing interest regarding their benefits for health. However, a serious concern is the potential appearance of clinically significant drug⁻herb interactions in patients. This work provides an overview of drug⁻herb interactions and an evaluation of their clinical significance. We discuss how personalized health services and mobile health applications can utilize tools that provide essential information to patients to avoid drug⁻HMP interactions. There is a specific mention to PharmActa, a dedicated mobile app for personalized pharmaceutical care with information regarding drug⁻HMPs interactions. Several studies over the years have shown that for some HMPs, the potential to present clinically significant interactions is evident, especially for many of the top selling HMPs. Towards that, PharmActa presents how we can improve the way that information regarding potential drug⁻herb interactions can be disseminated to the public. The utilization of technologies focusing on medical information and context awareness introduce a new era in healthcare. The exploitation of eHealth tools and pervasive mobile monitoring technologies in the case of HMPs will allow the citizens to be informed and avoid potential drug⁻HMPs interactions enhancing the effectiveness and ensuring safety for HMPs.
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Affiliation(s)
- Marios Spanakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, GR-70013 Crete, Greece.
| | - Stelios Sfakianakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, GR-70013 Crete, Greece.
| | - Vangelis Sakkalis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, GR-70013 Crete, Greece.
| | - Emmanouil G Spanakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, GR-70013 Crete, Greece.
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Kuscu F, Ulu A, Inal AS, Suntur BM, Aydemir H, Gul S, Ecemis K, Komur S, Kurtaran B, Ozkan Kuscu O, Tasova Y. Potential Drug-Drug Interactions with Antimicrobials in Hospitalized Patients: A Multicenter Point-Prevalence Study. Med Sci Monit 2018; 24:4240-4247. [PMID: 29924770 PMCID: PMC6040237 DOI: 10.12659/msm.908589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Improper use of antimicrobials can cause adverse drug events and high costs. The purpose of this study was to investigate the frequency and potential drug–drug interactions associated with antimicrobials among hospitalized patients. Material/Methods This study was conducted on the same day in 5 different hospitals in Turkey. We included patients aged ≥18 years who received at least 1 antimicrobial drug and at least 1 of any other drug. The Micromedex® online drug reference system was used to control and describe the interactions. Drug interactions were classified as contraindicated, major, moderate, and minor. Results Potential drug–drug interactions with antimicrobials were 26.4% of all interactions. Five (42%) of 12 contraindicated interactions and 61 (38%) of 159 major interactions were with antimicrobials. Quinolones, triazoles, metronidazole, linezolid, and clarithromycin accounted for 173 (25.7%) of 673 prescribed antimicrobials, but were responsible for 141 (92.1%) of 153 interactions. In multivariate analysis, number of prescribed antimicrobials (odds ratio: 2.3001, 95% CI: 1.6237–3.2582), number of prescribed drugs (odds ratio: 1.2008, 95% CI: 1.0943–1.3177), and hospitalization in the university hospital (odds ratio: 1.7798, 95% CI: 1.0035–3.1564) were independent risk factors for developing drug interactions. Conclusions Due to risk of drug interactions, physicians should be more cautious when prescribing antimicrobials, particularly when prescribing quinolones, linezolid, azoles, metronidazole, and macrolides.
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Affiliation(s)
- Ferit Kuscu
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Aslihan Ulu
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ayse S Inal
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Bedia M Suntur
- Department of Infectious Diseases and Clinical Microbiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Hande Aydemir
- Department of Infectious Diseases and Clinical Microbiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Serdar Gul
- Department of Infectious Diseases and Clinical Microbiology, Kırıkkale University Faculty of Medicine, Kirikkale, Turkey
| | - Kenan Ecemis
- Department of Infectious Diseases and Clinical Microbiology, Kahta State Hospital, Adiyaman, Turkey
| | - Suheyla Komur
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozlem Ozkan Kuscu
- Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Yesim Tasova
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Faculty of Medicine, Adana, Turkey
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Radwan A, Sweileh A, Shraim W, Hroub A, Elaraj J, Shraim N. Evaluation of community pharmacists’ knowledge and awareness of food–drug interactions in Palestine. Int J Clin Pharm 2018; 40:668-675. [DOI: 10.1007/s11096-018-0640-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 04/19/2018] [Indexed: 11/30/2022]
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22
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Ferreira TXAM, Prudente LR, Dewulf NDLS, Provin MP, Cardoso TC, Silveira ÉAD, Amaral RG. Impact of a drug dispensing model at a Community Pharmacy in Goiânia, Goiás, Brazil. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000400143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Spanakis M, Spanakis EG, Kondylakis H, Sfakianakis S, Genitsaridi I, Sakkalis V, Tsiknakis M, Marias K. Addressing drug-drug and drug-food interactions through personalized empowerment services for healthcare. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:5640-5643. [PMID: 28269534 DOI: 10.1109/embc.2016.7592006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Personalized healthcare systems support the provision of timely and appropriate information regarding healthcare options and treatment alternatives. Especially for patients that receive multi-drug treatments a key issue is the minimization of the risk of adverse effects due to drug-drug interactions (DDIs). DDIs may be the result of doctor prescribed drugs but also due to self-medication of conventional drugs, alternative medicines, food habits, alcohol or smoking. It is therefore crucial for personalized health systems, apart from assisting physicians for optimal prescription practices, to also provide appropriate information for individual users for drug-drug interactions or similar information regarding risks for modulation of the ensuing treatment. In this manuscript we describe a DDI service including drug-food, drug-herb and other lifestyle-related factors, developed in the context of a personalized patient empowerment platform. The solution enables guidance to patients for their medication on how to reduce the risk of unwanted drug interactions and side effects in a seamless and transparent way. We present and analyze the implemented services and provide examples on using an alerting service to identify potential DDIs in two different chronic diseases, congestive heart failure and osteoarthritis.
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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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Prado MAMBD, Francisco PMSB, Barros MBDA. Diabetes em idosos: uso de medicamentos e risco de interação medicamentosa. CIENCIA & SAUDE COLETIVA 2016; 21:3447-3458. [DOI: 10.1590/1413-812320152111.24462015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/29/2015] [Indexed: 11/22/2022] Open
Abstract
Resumo Caracterizar o perfil sociodemográfico e de saúde dos idosos segundo diabetes referido, avaliar o conhecimento e a prática quanto às opções de tratamento, bem como descrever o uso de medicamentos e potenciais riscos de interação medicamentosa (IM) neste subgrupo. Estudo transversal com 1.517 idosos de Campinas em 2008. Estimaram-se as prevalências de diabetes e verificaram-se as associações pelo teste de Rao-Scott. As potenciais IM foram avaliadas pela base de dados Micromedex®. A prevalência de diabetes referida pelos idosos foi de 21,7% sem diferença significativa entre os sexos. Verificou-se maior percentual de idosos diabéticos com 70 anos ou mais, com menor escolaridade, renda familiar per capita inferior a 1 salário mínimo e que não realizavam atividade ocupacional. O número médio de medicamentos foi de 3,9 nos 3 dias anteriores. Identificaram-se 413 possíveis interações, sendo que 53,1%, 7,8% e 7,2% dos idosos apresentaram risco de IM moderadas, menores e graves, respectivamente. Ressalta-se a importância da adoção de dieta saudável e prática de atividade física para redução do peso, controle da doença e de complicações. Evidencia-se a necessidade de atenção ao risco potencial das IM e o uso de medicamentos inapropriados ao idoso.
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Toivo T, Mikkola J, Laine K, Airaksinen M. Identifying high risk medications causing potential drug–drug interactions in outpatients: A prescription database study based on an online surveillance system. Res Social Adm Pharm 2016; 12:559-68. [DOI: 10.1016/j.sapharm.2015.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
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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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Kennedy-Dixon TG, Gossell-Williams M, Hall J, Anglin-Brown B. The prevalence of major potential drug-drug interactions at a University health centre pharmacy in Jamaica. Pharm Pract (Granada) 2015; 13:601. [PMID: 26759615 PMCID: PMC4696118 DOI: 10.18549/pharmpract.2015.04.601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/13/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify major potential drug-drug interactions (DDIs) on prescriptions filled at the University Health Centre Pharmacy, Mona Campus, Jamaica. METHODS This investigation utilised a cross-sectional analysis on all prescriptions with more than one drug that were filled at the Health Centre Pharmacy between November 2012 and February 2013. Potential DDIs were identified using the online Drug Interactions Checker database of Drugs.com. RESULTS During the period of the study, a total of 2814 prescriptions were analysed for potential DDIs. The prevalence of potential DDIs found during the study period was 49.82%. Major potential DDIs accounted for 4.7 % of the total number of interactions detected, while moderate potential DDIs and minor potential DDIs were 80.8 % and 14.5 % respectively. The three most frequently occurring major potential DDIs were amlodipine and simvastatin (n=46), amiloride and losartan (n=27) and amiloride and lisinopril (n=16). CONCLUSION This study has highlighted the need for educational initiatives to ensure that physicians and pharmacists collaborate in an effort to minimise the risks to the patients. These interactions are avoidable for the most part, as the use of online tools can facilitate the selection of therapeutic alternatives or guide decisions for closer patient monitoring and thus reduce the risks of adverse events.
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Affiliation(s)
- Tracia-Gay Kennedy-Dixon
- Chief Pharmacist, University Health Centre, University of the West Indies . Mona Campus. Kingston ( Jamaica ).
| | - Maxine Gossell-Williams
- Department of Basic Medical Sciences, University of the West Indies . Mona Campus. Kingston ( Jamaica ).
| | - Jannel Hall
- Department of Basic Medical Sciences, University of the West Indies . Mona Campus. Kingston ( Jamaica ).
| | - Blossom Anglin-Brown
- Clinical Director, University Health Centre, University of the West Indies . Mona Campus, Kingston ( Jamaica ).
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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: 108] [Impact Index Per Article: 10.8] [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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Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Drug-drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. ACTA ACUST UNITED AC 2014; 22:52. [PMID: 24965959 PMCID: PMC4079175 DOI: 10.1186/2008-2231-22-52] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/20/2014] [Indexed: 12/21/2022]
Abstract
Drug-drug interactions (DDIs) are an important type of adverse drug events. Yet overall incidence and pattern of DDIs in Iran has not been well documented and little information is available about the strategies that have been used for their prevention. The purpose of this study was to systematically review the literature on the incidence and pattern of DDIs in Iran as well as the used strategies for their prevention. PubMed, Scopus, electronic Persian databases, and Google Scholar were searched to identify published studies on DDIs in Iran. Additionally, the reference lists of all retrieved articles were reviewed to identify additional relevant articles. Eligible studies were those that analyzed original data on the incidence of DDIs in inpatient or outpatient settings in Iran. Articles about one specific DDI and drug interactions with herbs, diseases, and nutrients were excluded. The quality of included studies was assessed using quality assessment criteria. Database searches yielded 1053 potentially eligible citations. After removing duplicates, screening titles and abstracts, and reading full texts, 34 articles were found to be relevant. The quality assessment of the included studies showed a relatively poor quality. In terms of study setting, 18 and 16 studies have been conducted in inpatient and outpatient settings, respectively. All studies focused on potential DDIs while no study assessed actual DDIs. The median incidence of potential DDIs in outpatient settings was 8.5% per prescription while it was 19.2% in inpatient settings. The most indicated factor influencing DDIs incidence was patient age. The most involved drug classes in DDIs were beta blockers, angiotensin-converting-enzyme inhibitors (ACEIs), diuretic agents, and non-steroidal anti-inflammatory drugs (NSAIDs). Thirty-one studies were observational and three were experimental in which the strategies to reduce DDIs were applied. Although almost all studies concluded that the incidence of potential DDIs in Iran in both inpatient and outpatient settings was relatively high, there is still no evidence of the incidence of actual DDIs. More extensive research is needed to identify and minimize factors associated with incidence of DDIs, and to evaluate the effects of preventive interventions especially those that utilize information technology.
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Affiliation(s)
| | | | | | | | | | - Saeid Eslami
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Abstract
Abstract
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Potential drug-drug interactions in internal medicine wards in hospital setting in Pakistan. Int J Clin Pharm 2013; 35:455-62. [PMID: 23483444 DOI: 10.1007/s11096-013-9764-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Multiple drugs therapies may be the potential source of drug-drug interactions that can result in alteration of therapeutic response and/or increase untoward effects of many drugs. OBJECTIVE To identify the frequency and levels of potential drug-drug interactions (pDDIs) in internal medicine wards and their association with patients' age, gender, length of hospital stay and number of prescribed medications; and to describe management of frequently identified major or moderate pDDIs. SETTING Internal medicine wards of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. METHOD Micromedex Drug-Reax system was used to screen patient's profiles for pDDIs. Logistic regression was applied to determine the odds ratio for specific risk factors of pDDIs i.e., age, gender, hospital-stay and number of medications. MAIN OUTCOME MEASURE Overall prevalence and prevalence of contraindicated, major, moderate and minor pDDIs; levels of pDDIs; frequently identified major or moderate interactions; and odds ratios for risk factors. RESULTS Total, 188 interacting drug-combinations were identified that contributed to 675 pDDIs. Of 400 patients, 52.8% patients were presented with at least one pDDI (overall prevalence), 21.3% with at least one major-pDDI, and 44.3% with at least one moderate-pDDI. Of 675 pDDIs, most were of moderate (63.6%) or major severity (23%); good (61.2%) or fair (25.5%) type of scientific evidence; and delayed onset (50.2%). Most frequently identified major or moderate interactions resulted in 45.3% of all pDDIs. Their potential adverse outcomes included hepatotoxicity, bleeding, ototoxicity, nephrotoxicity, hypoglycemia, hyperglycemia, risk of thrombosis, hypotension, cardiac arrhythmias and reduction in therapeutic-effectiveness. There was significant association of the occurrence of pDDIs with patients' age of 60 years or more (OR = 2.1; 95% CI = 1.3-3.3; p = 0.003), hospital stay of 6 days or longer (OR = 2.6; 95% CI = 1.5-4.5; p = 0.001), and seven or more number of prescribed medications (OR = 5.9; 95% CI = 3.6-9.6; p < 0.001). CONCLUSION The present study has recorded a high prevalence of pDDIs in internal medicine wards. Patients with old age, longer hospital stay and increased number of prescribed medications were at higher risk.
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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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Brulhart MI, Wermeille JP. Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes. Int J Clin Pharm 2011; 33:549-57. [PMID: 21442282 DOI: 10.1007/s11096-011-9506-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 03/14/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to assess implementation of a pharmaceutical care model for the multidisciplinary care of elderly patients in nursing homes. SETTING Prospective study, medication review, from January 2007 to December 2009 in ten nursing homes affiliated to the Pharmacie interjurassienne (PIJ), Switzerland. METHOD Medication use data were collected and reviewed by a pharmacist, focusing on drug indication, dosing, side effects, renal/hepatic elimination and interactions. Drug-related problems (DRPs) were discussed face-to-face with the responsible physician and a nurse. The pharmaceutical care issues were formulated and medication interventions proposed during this meeting. DRPs and interventions were documented using the Pharmaceutical Care Network Europe scheme version 5.00 (PCNE V5.00). The economic impact of the service was estimated through a retrospective evaluation of annual drug costs. A satisfaction evaluation was conducted among practitioners and nurses. MAIN OUTCOME MEASURES DRPs, interventions, treatment changes implemented. RESULTS Drug therapy of 329 patients was reviewed. The number of medicines per patient ranged from 2 to 27 (mean 12.8). A total of 1,225 DRPs were detected and discussed with the physician and the nurse. Medication review led to 343 medical evaluations secondary to drug-drug interactions and 803 treatment adaptations: 373 drugs were stopped, 197 dosages changed, 95 instructions for use amended, 86 drug choices were altered, 35 drug formulations changed and 17 new drugs started. According to the Anatomical Classification System, the main classes involved in interventions were related to Alimentary tract and metabolism (n = 285), Nervous system (n = 189) and Cardiovascular system (n = 115). Since the outset of the PIJ, the annual drug costs decreased in nursing homes with medication review including a pharmacist, whereas it was stable in the other nursing homes. The satisfaction evaluation showed a very positive appreciation by practitioners and nurses. CONCLUSION The study showed an efficient pharmaceutical care model, well accepted by physicians and nurses. It also indicated that for elderly patients, continuous drug review contributed to improved drug therapy, reduced unnecessary polypharmacy and reduced pharmaceutical costs.
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Affiliation(s)
- Melanie Isabelle Brulhart
- Pharmacie interjurassienne, Hospitals and Nursing homes of Jura and Jura bernois SA, Beausite 49, 2740 Moutier, Switzerland.
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Peterson GM. Drug Interaction Dilemmas. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2011. [DOI: 10.1002/j.2055-2335.2011.tb00052.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory M Peterson
- Unit for Medication Outcomes Research and Education, School of PharmacyUniversity of Tasmania Hobart Tas. 7001
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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