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Turossi-Amorim ED, Camargo B, Schuelter-Trevisol F. Prevalence of Potential Pharmacological Interactions in Patients Undergoing Systemic Chemotherapy in a Tertiary Hospital. Hosp Pharm 2022; 57:646-653. [PMID: 36081531 PMCID: PMC9445545 DOI: 10.1177/00185787211073464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Introduction: Pharmacological interactions are frequently observed in patients with chronic diseases, and their occurrence is proportional to the amount of medication used daily. Patients undergoing chemotherapy treatment commonly have comorbidities, which favor a greater prevalence of polypharmacy, increasing the risk of drug interactions. Therefore, the aim of this study was to estimate the prevalence of drug interactions in patients undergoing intravenous chemotherapy treated at a hospital oncology service in southern Brazil. Methods: This was an observational study with a cross-sectional design that was carried out with the analysis of secondary data obtained through the review of medical records. The population assessed consisted of all cancer patients who received intravenous chemotherapy from October to December 2020. Results: Out of the 297 patients included in the study, 231 (77.8%) had at least 1 potential pharmacological interaction. In total, 1044 drug interactions were found that were classified according to severity, resulting in 18 (1.7%) contraindicated drug-drug interactions (DDI), 699 (67%) severe, 281 (26.9%) moderate, and 46 (4.4%) minor interactions. There was an association between polypharmacy and the prevalence of drug interactions. Conclusion: The results demonstrate that a large percentage of patients undergoing chemotherapy are susceptible to drug interactions. Thus, it is necessary that prescribers consider all drugs used by patients and, when possible, prescribe alternative drugs that have less potential for interaction in order to prevent drug interactions adverse effects and provide a better prognosis for patients.
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Affiliation(s)
| | - Bruna Camargo
- University of Southern Santa Catarina, Tubarao, Brazil
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Bibi R, Azhar S, Iqbal A, Jabeen H, Kalsoom UE, Iqbal MM, Nazeer M. Prevalence of potential drug-drug interactions in breast cancer patients and determination of their risk factors. J Oncol Pharm Pract 2020; 27:1616-1622. [PMID: 33086907 DOI: 10.1177/1078155220963212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer patients use numerous medications, which include cytotoxic chemotherapy drugs, hormonal agents and supportive medication, so they are more vulnerable to potential adverse drug interactions. This study aimed to evaluate frequency, severity, clinical importance and risk factors responsible for the Drug-drug interactions (DDIs) in a cohort of patients suffering from breast cancer. Data was obtained from 150 patients in the oncology ward (both inpatient and outpatient) with a confirmed diagnosis of breast cancer and currently receiving standard breast cancer-directed treatment. The data was recorded into a pre-designed form specifically made for this study through individual patient interviews and by reviewing the detailed medical chart records of the patients. DDIs were identified by using drug interaction software such as Medscape mobile application and Micromedex version 2.The results of this study showed that all patients were female. The mean numbers of drugs that patients used were 7. Potential drug interactions were identified in 92% of the patients. When drug groups were overviewed, 32% of interactions were between anti neoplastic drugs, 62.9% interactions were between the anti neoplastic agent and supportive care drugs and 5% of them were between anti-cancer drugs and drugs used to treat comorbidities. Major DDIs were found in 62.2% of patients, 25.3% of DDIs were moderate and 12.4% were minor. The number of drugs, comorbid diseases, and selection of chemo protocols were the risk factors for drug interactions. Most of the DDIs found in breast cancer therapy may have adverse consequences on patient health and therapeutic outcomes. Therefore, health care professionals should review the medication regimen of patients with breast cancer before starting any chemotherapy treatment.
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Affiliation(s)
- Rashida Bibi
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad, Pakistan
| | - Saira Azhar
- Department of Pharmacy, University of Sargodha, Sargodha, Pakistan
| | - Ayesha Iqbal
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad, Pakistan
| | - Hajera Jabeen
- Department of Breast Cancer, INOR, Abbottabad, Pakistan
| | - Umm-E Kalsoom
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad M Iqbal
- Department of Medicine, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Maria Nazeer
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad, Pakistan
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Hsu CD, Hinton SP, Reeder-Hayes KE, Sanoff HK, Lund JL. Association between Concomitant Use of Hydrochlorothiazide and Adverse Chemotherapy-Related Events among Older Women with Breast Cancer Treated with Cyclophosphamide. Cancer Epidemiol Biomarkers Prev 2020; 29:520-523. [PMID: 31871107 PMCID: PMC7007357 DOI: 10.1158/1055-9965.epi-19-1079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/15/2019] [Accepted: 12/12/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The pharmacy reference database, Micromedex, lists concomitant hydrochlorothiazide and cyclophosphamide use as a potential, major drug-drug interaction (DDI), although only one small, single-center study supports this claim. Our objective was to estimate associations between this potential DDI and two adverse chemotherapy-related events, neutropenia-related hospitalizations and treatment regimen discontinuation, among a cohort of women with breast cancer initiating adjuvant chemotherapy containing cyclophosphamide. METHODS Using linked Surveillance, Epidemiology, and End Results Program (SEER)-Medicare data, we included women 66 years and older with breast cancer diagnosis between 2007 and 2011, who initiated a regimen containing cyclophosphamide. Risk ratios (RR) and 95% confidence intervals for adverse outcomes comparing women exposed versus unexposed to the potential DDI were assessed using modified multivariable Poisson regression adjusting for potential confounders. RESULTS In total, 27% of women receiving cyclophosphamide treatment were exposed to concomitant hydrochlorothiazide, of which 11% experienced a neutropenia-related hospitalization and 21% discontinued their chemotherapy regimen prior to completion. Adjusted risks of both adverse events were similar between those exposed and unexposed to the potential DDI [neutropenia-related hospitalization: adjusted RR (aRR) = 0.92 (0.70-1.21); treatment discontinuation: aRR = 1.00 (0.96-1.05)]. CONCLUSIONS Our results do not support an association between concomitant hydrochlorothiazide use and two clinically relevant adverse chemotherapy-related events. IMPACT Our results support reassessing and potentially lowering severity of this potential interaction in drug reference databases.
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Affiliation(s)
- Christine D Hsu
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sharon Peacock Hinton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine E Reeder-Hayes
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hanna K Sanoff
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Arakawa Y, Arakawa A, Vural S, Mahajan R, Prinz JC. Renal clearance and intracellular half-life essentially determine methotrexate toxicity: A case series. JAAD Case Rep 2018; 5:98-100. [PMID: 30581945 PMCID: PMC6297265 DOI: 10.1016/j.jdcr.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Yukiyasu Arakawa
- Department of Dermatology, University Clinics, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Akiko Arakawa
- Department of Dermatology, University Clinics, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Secil Vural
- Department of Dermatology, University Clinics, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jörg Christoph Prinz
- Department of Dermatology, University Clinics, Ludwig-Maximilian-University of Munich, Munich, Germany
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Singh H, Singh B. Drug-drug interactions in cancer chemotherapy: an observational study in a tertiary health care centre. Drug Metab Pers Ther 2017; 32:219-223. [PMID: 29135452 DOI: 10.1515/dmpt-2017-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 09/04/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the occurrence of drug-drug interactions (DDIs) in patients on cancer chemotherapy, with the identification of risk factors for these DDIs. METHODS This was a cross-sectional, descriptive study carried out at the Department of Onco-Radiation at Guru Gobind Singh Medical College, Faridkot, Punjab. The DDIs were recorded with the help of a drug interaction/interplay information software. RESULTS In total, 354 interactions were identified from 283 patient records. The mean age of the patients in the study was 49.05±14.35 years. According to the mechanism of interaction, 306 (86.44%) drug interactions were classified as pharmacokinetic and 48 (13.56%) as pharmacodynamic in nature. CONCLUSIONS Sensitization of the treating oncologist and the establishment of alerts, such as electronic alerts or a novel fully digital computerized technology that gives a warning when a health expert enters a patient's prescription orders into the electronic medical documentation, can be helpful in controlling DDIs.
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Affiliation(s)
- Harminder Singh
- Department of Pharmacology, Guru Gobind Singh Medical College, Baba Farid University of Health Sciences, Sadiq Road, Faridkot, Punjab 151203, India
| | - Baltej Singh
- Biostatistician, Guru Gobind Singh Medical College, Baba Farid University of Health Sciences, Faridkot, Punjab, India
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van Leeuwen RWF, Swart EL, Boven E, Boom FA, Schuitenmaker MG, Hugtenburg JG. Potential drug interactions in cancer therapy: a prevalence study using an advanced screening method. Ann Oncol 2011; 22:2334-41. [PMID: 21343376 DOI: 10.1093/annonc/mdq761] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In cancer patients, drug interactions may intensify adverse events or reduce antitumour effects. We assessed the prevalence of potential drug interactions (PDIs) among ambulatory cancer patients on i.v. treatment using an advanced screening method. PATIENTS AND METHODS Data on drugs used for comorbidities, anticancer agents, over-the-counter (OTC) drugs, and comorbidities were collected by means of a structured interview among the patients and review of medical charts. PDIs were identified using electronic (Drug Interaction Facts software, version 4.0) and manual screening methods (peer-reviewed reports). RESULTS In this study, 278 patients were enrolled. We identified 348 PDIs. Of all patients, 161 (58%) had at least one PDI. Of all PDIs, 34% was classified as major and 60% as moderate. Coumarins, quinolones, antiepileptics, and hydrochlorothiazide were frequently part of a PDI. Interactions that potentially cause QT interval prolongation, gastrointestinal toxicity, and central nervous system depression were also common. In multivariate analysis, an increasing number of drugs [odds ratio (OR) = 1.4, confidence interval (CI) 1.23-1.52; P < 0.001] and the use of an OTC drug (OR = 0.56, CI 0.32-0.97; P = 0.045) were risk factors. CONCLUSIONS PDIs are common in patients treated for an (haemato-) oncological disease. Screening for potential interactions should take place routinely before administering chemotherapy.
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Affiliation(s)
- R W F van Leeuwen
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
BACKGROUND Drug-drug interactions (DDIs) comprise an important problem in medical oncology practice. We systematically reviewed the frequency of DDIs in oncology. METHODS We searched PubMed for eligible articles and on-line databases for abstracts of major oncology meetings. RESULTS Eight studies reported on the frequency of DDIs: six evaluated the frequency of potential DDIs, while two studies reported on real DDIs, i.e. interactions that had clinical consequences. Studies of potential DDIs found that approximately one-third of patients are exposed to dangerous drug doublets, with the most common ones involving warfarin and anticonvulsants. One study of real DDIs found that 2% of hospitalized cancer patients had a DDI as the cause of admission. CONCLUSIONS Drug interactions comprise an important issue in oncology, with approximately one-third of ambulatory cancer patients being at risk of DDIs. Data are limited on the clinical consequences of drug interactions among cancer patients.
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Affiliation(s)
- R P Riechelmann
- Internal Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Riechelmann RP, Tannock IF, Wang L, Saad ED, Taback NA, Krzyzanowska MK. Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst 2007; 99:592-600. [PMID: 17440160 DOI: 10.1093/jnci/djk130] [Citation(s) in RCA: 219] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cancer patients receive numerous medications, including antineoplastic agents, drugs for supportive care, and medications for comorbid illnesses. Therefore, they are at risk for drug interactions and duplicate prescribing. METHODS A questionnaire eliciting information on demographics and medications taken in the previous 4 weeks was given to adult outpatients receiving systemic anticancer therapy for solid tumors. The Drug Interaction Facts software, version 4.0, was used to identify potential drug interactions and to classify them by level of severity (major, moderate, or minor) and the strength of scientific evidence for them (using categories [1-5] of decreasing certainty). Summary statistics and logistic regression were used to analyze the data. All statistical tests were two-sided. RESULTS The survey was completed by 405 patients. We observed 276 potential drug interactions, and at least one potential interaction was identified in 109 patients (27%; 95% confidence interval [CI] = 23% to 31%). Of the potential interactions, 25 (9%) were classified as major and 211 (77%) as moderate. Nearly half (49%) of potential interactions were supported by level 1 or 2 scientific evidence. Most potential drug interactions (87%) involved non-anticancer agents such as warfarin, antihypertensive drugs, corticosteroids, and anticonvulsants, but some (n = 36, 13%) involved antineoplastic agents. In multivariable analysis, increased risk of receiving drug combinations in which there were potential drug interactions was associated with receipt of increasing numbers of drugs (odds ratio [OR] = 1.4 per additional drug, 95% CI = 1.26 to 1.58, P<.001 from the Wald chi-square test), type of medication (drugs to treat comorbid conditions versus supportive care medications only; OR = 8.6, 95% CI = 2.9 to 25, P<.001), and the presence of brain tumors. Thirty-two (8%) patients were exposed to duplicate medications, most often corticosteroids, proton pump inhibitors, or benzodiazepines. CONCLUSION Potential drug interactions were common among cancer patients and most often involved medications to treat comorbid conditions. Duplicate medications were infrequent.
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Affiliation(s)
- Rachel P Riechelmann
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, ON, M5G 2M9, Canada
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Jansman FGA, Jansen AJA, Coenen JLL, de Graaf JC, Smit WM, Sleijfer DT, Brouwers JRB. Assessing the clinical significance of drug interactions with fluorouracil in patients with colorectal cancer. Am J Health Syst Pharm 2005; 62:1788-93. [PMID: 16120738 DOI: 10.2146/ajhp040584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Frank G A Jansman
- Department of Clinical Pharmacy, Isala Klinieken, Zwolle, The Netherlands
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Charney SC, Bergman PJ, Hohenhaus AE, McKnight JA. Risk factors for sterile hemorrhagic cystitis in dogs with lymphoma receiving cyclophosphamide with or without concurrent administration of furosemide: 216 cases (1990-1996). J Am Vet Med Assoc 2003; 222:1388-93. [PMID: 12762384 DOI: 10.2460/javma.2003.222.1388] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine incidence and identify predisposing factors for sterile hemorrhagic cystitis (SHC) in dogs with lymphoma that were treated with cyclophosphamide and to evaluate whether furosemide administered i.v. concurrently with cyclophosphamide decreased the incidence of SHC. DESIGN Retrospective study. ANIMALS 216 dogs with lymphoma. PROCEDURE Medical records of dogs with lymphoma that received cyclophosphamide chemotherapy in accordance with 1 of 2 protocols, with or without concurrent i.v. administration of furosemide, were examined. Data for the 2 groups were analyzed to determine the incidence and predisposing factors (age, breed, sex, weight, previous or preexisting disease, previous or preexisting urinary tract infection, neutropenia, azotemia, dose, and number of cyclophosphamide treatments) for cyclophosphamide-associated SHC. RESULTS Cyclophosphamide-associated SHC developed in 12 of 133 (9%) dogs that had not received concurrent administration of furosemide and cyclophosphamide treatments; of the 83 dogs that had received furosemide, only 1 (1.2%) developed SHC. Dogs receiving cyclophosphamide and furosemide concurrently were significantly less likely to develop SHC than dogs that did not receive furosemide. Dogs with previous or preexisting immune-mediated disease were significantly more likely to develop cyclophosphamide-associated SHC. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of results suggested an association between i.v. administration of furosemide concurrently with cyclophosphamide and decreased incidence of cyclophosphamide-associated SHC. Incidence of cyclophosphamide-associated SHC was similar in treated dogs that did not receive concurrent furosemide to that observed for other studies in which cyclophosphamide was administered orally. Cyclophosphamide-associated SHC appeared to develop early during the course of chemotherapy when furosemide was not administered concurrently with cyclophosphamide.
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Affiliation(s)
- Sarah C Charney
- Donaldson-Atwood Cancer Clinic, Department of Medicine, The Animal Medical Center, 510 E 62nd St, New York, NY 10021, USA
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Small cell lung cancer in the elderly. Factors influencing the results of chemotherapy: a review. Lung Cancer 1989. [DOI: 10.1016/0169-5002(89)90004-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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