Potential drug–drug interactions in oncological adult inpatients at a Spanish hospital: epidemiology and risk factors

Determination of drug-drug interaction in breast cancer patients receiving doxorubicin and cyclophosphamide regimen

INTRODUCTION

Drug interactions constitute a significant issue in cancer treatment. Therefore, it is important to assess and analyze all cancer patients' therapies prior to the initiation of chemotherapy.

METHODS

A retrospective observational study was conducted at the Near East University Hospital Oncology Department located in North Cyprus between June 2019 and December 2021. The aim of the study was to determine the nature, type, and frequency of potential drug-drug interactions in breast cancer patients receiving a doxorubicin and cyclophosphamide regimen using Drugs.com, Lexicomp, and Micromedex databases while comparing the three electronic databases, according to the frequency, mechanism, and severity of drug-drug interactions.

RESULTS

The study included 40 patients (44.4%) out of 90 patients diagnosed with breast cancer, as 50 patients (55.6%) who did not match the criteria were excluded. According to the Lexicomp database, 12 patients (30%) with breast cancer had 14 potential drug-drug interactions, according to the Drugs.com database, 15 patients (37.5%) with breast cancer had 22 potential drug-drug interactions, and according to the Micromedex database, 13 patients (32.5%) with breast cancer had 15 potential drug-drug interactions. Pearson correlation indicated a weak association (Lexicomp: r = 0.475, p = 0.002 and Micromedex: r = 0.491, p = 0.001) and a moderate association (Drugs.com: r = 0.500, p = 0.001) between potential drug-drug interactions and five or more medications.

CONCLUSION

This study showed that the Drugs.com database detected more potential drug interactions between chemotherapy and nonchemotherapy than the Lexicomp and Micromedex databases. Comprehensive drug review, use of electronic health record systems, and collaboration between healthcare providers such as pharmacists and physicians may be necessary strategies to minimize potential drug-drug interactions and optimize cancer treatment in patients with breast cancer.

Concordance analysis of two databases to search for potential drug interactions in onco-hematologic patients

INTRODUCTION

Potential drug interactions exert a significant impact on patient safety, especially within intricate onco-hematological treatments, potentially resulting in toxicity or treatment failures. Despite the availability of databases for potential drug interaction investigation, persistent heterogeneity in concordance rates and classifications exists. The additional variability in database agreement poses further complexity, notably in critical contexts like onco-hematology.

AIM

To analyze the concordance of two databases for researching potential drug interaction in prescriptions for hematological patients at a University Hospital in the Midwest region of Brazil.

METHOD

Cross-sectional study developed in a Brazilian hospital. The search for potential drug interaction was conducted in Micromedex® and UpToDate®. The variables were: the presence of potential drug interaction, severity, mechanism, management, and documentation. Data was analyzed in terms of frequency (absolute and relative), Cohen's kappa, and Fleiss kappa.

RESULTS

The presence of potential drug interaction, showed a lack of concordance between the databases (k = -0.115 [95% CI: 0.361-0.532], p = 0.003). Regarding the mechanism, a strong agreement was observed (k = 0.805, p < 0.001 [95% CI: 0.550-0.941]). The management concordance showed a fair agreement, 46.8% (k = 0.22, p < 0.001 [95% CI: 0.099-0.341]). Stratifying the categories, significant concordance was observed in "Adjustment of dose + Monitoring" (k = 0.302, p = 0.018) and "Monitoring" (k = 0.417, p = 0.001), while other categories did not reach statistical significance.

CONCLUSION

Our study emphasizes the variability in potential drug interaction research, revealing disparities in severity classification, management recommendations, and documentation practices across databases.

A. Incidence, Patterns, and Severity of Potential Drug Interactions Among Cancer Patients on Chemotherapy in a Tertiary Care Hospital

Objective

To study the incidence of potential drug−drug interactions (DDIs) and evaluate their pattern and severity in cancer inpatients.

Materials and Methods

A detailed clinical data and prescriptions of 150 inpatients with different malignancies were subjected to DDI screening using Micromedex software. The frequency of potential DDIs and their types, patterns, and severity were investigated.

Results

A total of 360 potential DDIs were present in 111 (74%) of 150 inpatients, dominated by female (67.33%) and breast cancer (30%) patients. The incidence of severe interactions was 63.88%, moderate interactions 35.83%, and mild interactions 0.27%. The potential mechanisms of DDIs were 38.33% pharmacodynamic, 48.33% pharmacokinetic, and 13.33% unspecified. The drug interactions were found to be positively correlated ( p < 0.01) with the 6–10 number of prescribed medicines.

Conclusion

According to this study, the number of medicines prescribed to cancer inpatients increased the chance of DDIs. As a result, the drug surveillance program could save a sizable number of patients from the potentially hazardous clinical effects of DDIs.

Prevalence of potential drug-drug interactions in outpatients on treatment with parenteral antineoplastic drugs

Background As live expectancy and cancer incidence growing, polypharmacy in oncology patients is also increasing, raising the risk of developing potential drug-drug interactions.Objective To assess the prevalence of clinically relevant potential drug-drug interactions among cancer patients who receive parenteral treatment at our outpatient clinic. Method Retrospective observational study which included randomly selected patients who had received parenteral treatment from November 1st 2016 to January 31st 2017. Interactions were checked in 3 databases, and classified as clinically relevant or not and in three categories of severity: contraindicated, consider modification or monitor. Results A total of 273 patients were included; of which seventy three (26.7%) had at least one clinically relevant potential drug-drug interaction. Amongst them, 54 (74%) had at least one classified as monitor treatment, 50 (68.5%) as contraindicated and 26 (35.6%) as consider modification. The number of chronic prescriptions was associated with a higher risk of drug interactions. Conclusion Around one in four patients on treatment with parenteral antineoplastic drugs presented a clinically relevant potential drug-drug interaction. A systematic assessment of drug-drug interactions should be implemented to reduce the risk of clinically relevant drug-drug interactions.

Potential drug-drug interactions and nephrotoxicity in hematopoietic stem cell transplant adult recipients during bone marrow transplantation unit stay

PURPOSE

Studies have documented potential drug-drug interactions (pDDIs) occurring in cancer patients mainly with solid malignancies, either in the ambulatory or hospital settings. While hematopoietic stem cell transplant (HSCT) patients during their bone marrow transplantation unit (BMTU) stay have rather complex medical regimens combining chemotherapy, anti-infectious agents, immunosuppressive agents, and supportive-care drugs, studies on potential DDIs are lacking. Our objective was to evaluate the prevalence and the density of pharmacokinetic and pharmacodynamic potential DDIs, and the evolution of the renal function in hematopoietic stem cell transplant (HSCT) adult recipients during their BMTU stay.

METHODS

Retrospective study in 31 adult patients consecutively admitted to the BMTU.

RESULTS

Prevalence of pharmacokinetic interactions was ten times lower than the pharmacodynamic interactions. The contraindications were rare, and only of pharmacokinetic origin. The main drugs involved in pharmacokinetic DDIs were ciclosporine, methotrexate, esomeprazole, tramadol, and vincristine. The median number of potential nephrotoxicity-related DDIs per patient was 7 and the median number of days during which nephrotoxicity-related DDIs potentially occurred was 77 days per patient. The decrease in glomerular filtration rate (GFR) throughout the BMTU stay (mean decrease of 13 ml/min) was correlated with the number of days of potential nephrotoxic drug interactions.

CONCLUSIONS

Potential DDIs in HCST patients in BMTU were quite common. The DDIs from pharmacokinetic origin were less frequent, but of higher grade, than those of pharmacodynamic origin. The decrease in GFR suggests that the density of potential nephrotoxic drug interactions may be an issue to be considered in these patients.