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Hailesilase GG, Kidane AM, Gebrezgabiher HA. Potential drug-drug interactions and associated factors among hospitalized pediatric patients in Adigrat general hospital, Tigrai, north Ethiopia: a retrospective cross-sectional study. BMC Pediatr 2024; 24:652. [PMID: 39394093 PMCID: PMC11468254 DOI: 10.1186/s12887-024-05128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 10/03/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Drug-drug interactions (DDIs) are associated with increased or decreased adverse effects and decreased or decreased therapeutic effects. Hospitalized pediatric patients are exposed to a number of potential DDIs (pDDIs). There are limited studies on pDDIs among pediatric patients in Ethiopia. This study was aimed to evaluate the pDDIs and associated factors among hospitalized pediatric patients in Adigrat general hospital, Tigrai, northern Ethiopia. METHODS A retrospective cross-sectional study was carried out among hospitalized pediatric patients in Adigrat general hospital from 01 July 2020 to 31 August 2020. A simple random sampling technique was used to select medical charts. Micromedex 2.0 database was used to screen pDDIs. Data was analyzed using statistical package for social science version 21 and a P-value of ≤ 0.05 was considered statistically significant. RESULTS Of the total 146 patients studied, 100 (68.5%) were exposed for at least one pDDI. A total of 158 pDDIs consisting of 33 distinct interacting drug pairs were identified. About 19.3% of the patients had at least one major pDDI, 6.7% at least one moderate and 68.9% at least one minor pDDIs. On the other hand, 63.3% of the total pDDIs were minor and 25.9% major while 3. 8% were contraindicated pDDIs with 15.2% fair and 81.6% good level of documentation. The overall mean duration of pDDIs exposure was about 4.9 (1-23) days. The frequently occurring potential clinical consequences of pDDIs comprised increased risk of QT-interval prolongation (10.1%), theophylline toxicity (5.1%), antiepileptic toxicity (5.1%) and formation of ceftriaxone calcium precipitates (3.8%). Infant/toddler age group (adjusted odds ratio [AOR] = 31.961, 95% CI: 1.117-914.528), number of diseases (AOR = 0.255, 95% CI: 0.069-0.939) and polypharmacy (AOR = 0.276, 95% CI: 0.091-0.838) were associated with pDDIs exposures. CONCLUSIONS A large number of pediatric patients were exposed to a various pDDIs. Age, number of diseases and polypharmacy predicted for the occurrence of pDDIs. Besides, the major severity pDDIs encounted frequently in the current study can potentially lead to a life threatening cardio-vascular toxicicty from QT-interval prolongation. Clinicians should be vigilant to pDDIs to prevent potential clinical consequences of pDDIs. Moreover, computerized drug interaction screening and clincal pharmacy services should be practiced to improve patients' safety.
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Affiliation(s)
| | - Abrahaley Mulu Kidane
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O. Box 50, Adigrat, Tigrai, Ethiopia
| | - Haylay Araya Gebrezgabiher
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O. Box 50, Adigrat, Tigrai, Ethiopia
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Guzmán Cordero C, Sáez-Torres de Vicente M, Jiménez Espinosa Á, Gago Sánchez AI. Pharmacist's role in the management of drug-drug interactions caused by nirmatrelvir/ritonavir in COVID-19 oncohematology patients. J Oncol Pharm Pract 2024:10781552241237750. [PMID: 38454628 DOI: 10.1177/10781552241237750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE New drugs developed for SARS-CoV-2 infection, such as nirmatrelvir/ritonavir (NMV/r), represent a potential for oncohematology patients, but also pose a challenge in managing the potential clinically relevant drug-drug interactions (pDDIs) that may arise. The aim of this study is to assess the frequency, severity, and pharmacist detection of pDDIs. METHODS This prospective, observational, study spanned 8 months, involving 42 oncohematology patients prescribed NMV/r in a tertiary-level hospital. A Board Certified oncology pharmacist assessed pDDIs using three databases and made recommendations to prescribing physicians. Linear and logistic regression analyses were employed to explore the relationship between prescribed drugs and pDDIs. RESULTS Clinically relevant pDDIs were detected in 76.2% of patients, with 18.1% of all medications involved in drug-drug interactions (DDIs). The most common drugs implicated were atorvastatin and imatinib. Micromedex® identified 63.3% of interactions as major severity, while Lexicomp® and University of Liverpool classifications were less restrictive. Pharmacists prevented most DDIs from reaching patients through different interventions, including treatment monitoring (44.2%), discontinuation (36.5%), and dose reduction (17.3%). CONCLUSION This study highlights the high prevalence of clinically significant pDDIs in oncohematology patients receiving NMV/r for COVID-19. Pharmacists, as integral members of the healthcare team, played a crucial role in detecting, categorizing, and mitigating these interactions. The results underscore the need for comprehensive studies to evaluate the impact of pharmacist-led interventions in optimizing drug therapy and enhancing patient safety in this vulnerable population.
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Affiliation(s)
- Carlos Guzmán Cordero
- Pharmacy Department, Reina Sofía University Hospital / Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) / University of Córdoba, Córdoba, Spain
| | - María Sáez-Torres de Vicente
- Pharmacy Department, Reina Sofía University Hospital / Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) / University of Córdoba, Córdoba, Spain
| | | | - Ana Isabel Gago Sánchez
- Pharmacy Department, Reina Sofía University Hospital / Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) / University of Córdoba, Córdoba, Spain
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Ramasubbu SK, Mishra A, Mandal S. Prevalence of QT-Prolonging Drug-Drug Interactions in Psychiatry: A Systematic Review and Meta Analysis. J Pharm Pract 2024; 37:162-168. [PMID: 35968552 DOI: 10.1177/08971900221121371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background: Drug-drug interactions (DDIs) are considered an emerging threat to the patients if undetected. DDIs can prolong QT interval, leading to fatal ventricular arrhythmia. Antipsychotics and antidepressants prescribed commonly to psychiatric patients have the propensity to prolong QT interval and can precipitate Torsades de pointes (TdP). This review aimed to summarize the prevalence of QT interval prolonging DDIs in psychiatric patients. Methods: This meta-analysis was carried out following the MOOSE (Meta-analysis of Observational Studies in Epidemiology) statement. Databases like Pubmed/MEDLINE, Google Scholar and Research gate were scanned for English language papers. Indexed terms from Medical Subject (MeSH) and other search terms for "QT prolongation", "Drug interactions", and "Psychiatry" were used to identify the articles. All published articles available until the day of the collection were considered. Outcome measures were analyzed with meta package in R language. Results: A total of 5 studies were eligible for inclusion. From the included studies, QT-prolonging DDIs were found in 14806 patients out of 30122 patients. The prevalence of QT-prolonging DDIs in psychiatric patients was found to be 42% (95% confidence interval: 21%, 66%). The factors associated with potential drug-drug interactions were related to patient characteristics such as polypharmacy, age and comorbid disease. Conclusion: This review concluded that psychiatric patients were prescribed the drugs/drug combinations which can prolong QT interval and can cause adverse effects on the cardiovascular system. Hence, it is important to implement precautionary safety interventions, be vigilant and prevent QT prolongation and adverse cardiac effects in clinical practice.
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Affiliation(s)
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumitra Mandal
- Department of Pharmacology, All India Institute of Medical Sciences, Kalyani, India
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Yan Y, Gong Y, Jiang M, Gao Y, Guo S, Huo J, Zhao Z, Li C. Utilization of glucagon-like peptide-1 receptor agonists in children and adolescents in China: a real-world study. Front Endocrinol (Lausanne) 2023; 14:1170127. [PMID: 37383395 PMCID: PMC10293789 DOI: 10.3389/fendo.2023.1170127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023] Open
Abstract
Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been widely used in treating type 2 diabetes mellitus (T2DM) and obesity in adults, but scientific research about the indication in children and adolescents is scarce. The current study aims to explore the prescriptions of GLP-1RAs in children and adolescents in China and to evaluate its rationality. Methods GLP-1RA prescriptions of children and adolescents were retrospectively obtained from the Hospital Prescription Analysis Cooperative Project. The study extracted information on patient's demographic characteristics, monotherapy and combination therapy of GLP-1RAs, and trends in GLP-1RA usage from 2016 to 2021. The rationality of GLP-1RA prescriptions was comprehensively assessed based on the indications approved by China National Medical Products Administration (NMPA), the U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA), Pharmaceuticals and Medical Devices Agency (PMDA), and published randomized controlled trials (RCTs). Results A total of 234 prescriptions from 46 hospitals were included, with a median age of 17 years old. The majority of patients were diagnosed with overweight/obesity or prediabetes/diabetes, accounting for 43.59% and 46.15%, respectively. There were 88 patients on GLP-1RA monotherapy. GLP-1RAs plus metformin was the most common combination therapy (38.89%). 12.39% of patients were found a co-administration with orlistat. The share of overweight/obesity prescriptions increased from 27% in 2016 to 54% in 2021, whereas prediabetes/diabetes prescriptions declined from 55% to 42%. The prescriptions were divided into appropriate and questionable groups according to the diagnosis, and the potentially questionable prescription was related to age (p = 0.017), department visited (p = 0.002), and any hospitalization (p < 0.001). Conclusions This study described the prescribing of GLP-1RAs in children and adolescents. Our findings indicated that the utilization of GLP-1RAs has increased from 2016 to 2021. There was a strong basis for administering GLP-1RAs in overweight/obesity and prediabetes/diabetes, whereas the evidence was insufficient in other conditions. It is crucial to demand robust and sustained efforts to enhance the awareness of the safety of utilization of GLP-1RAs in children and adolescents.
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Affiliation(s)
- Yilong Yan
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Ying Gong
- Department of Pharmacy, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Meizhu Jiang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Yiming Gao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Shanshan Guo
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiping Huo
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cao Li
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Chen Y, Ding L. Potential drug-drug interactions in outpatients with depression of a psychiatry department. Saudi Pharm J 2023; 31:207-213. [PMID: 36942274 PMCID: PMC10023543 DOI: 10.1016/j.jsps.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022] Open
Abstract
Objective This study aims to explore the prevalence and associated risk factors for potential drug-drug interactions (pDDIs) in prescriptions among outpatients with depression, and report the widespread relevant drug interactions. Methods The cross-sectional retrospective study was conducted on outpatients in a psychiatric hospital. We included prescriptions of outpatients with a principal diagnosis of depression from April 1st to June 30th in 2021. The patients were ≥ 18 years old and treated with two or more drugs including at least one psychotropic drug. pDDIs were detected and identified mainly using Medscape's drug interactions checker. Gender, the number of concomitant drugs, age and diagnosis were analysed as potential risk factors for the occurrence of pDDIs by logistic regression. Results A total of 13,617 prescriptions were included in the present analysis, and 4222 prescriptions (31.0%) were at risk of 8557 pDDIs. The risk of pDDIs in patients who were prescribed 4-6 drugs (OR: 3.49, 95% CI: 3.11-3.91, p < 0.001) or 7 or more drugs simultaneously (OR: 7.86, 95% CI: 1.58-39.04, p < 0.05) increased compared with patients prescribed 2-3 drugs. Patients with recurrent depressive disorders (OR: 1.18, 95% CI: 1.02-1.36, p < 0.05) had an increased risk of pDDIs compared with patients with depressive episodes. In terms of severity of pDDIs identified by Medscape's drug interactions checker, 0.7%, 16.4%, 77.5% and 5.4% of pDDIs were classified as contraindicated, serious, monitor closely and minor, respectively. The most common pDDI was escitalopram + quetiapine (374 prescriptions), which was classified as serious and monitor closely due to different mechanisms of interaction. Increased central nervous system (CNS)-depressant effect was the most frequent potential clinical adverse outcome of the identified pDDIs. Conclusions pDDIs in outpatients with depression were prevalent in this retrospective study. The number of concomitant drugs and severity of the disease were important risk factors for pDDIs. The pDDIs of the category monitor closely were the most common, and the CNS-depressant effect was the most frequent potential clinical adverse outcome.
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Gago‐Sánchez AI, Font P, Cárdenas M, Aumente MD, Del Prado JR, Calleja MÁ. Real clinical impact of drug-drug interactions of immunosuppressants in transplant patients. Pharmacol Res Perspect 2021; 9:e00892. [PMID: 34755493 PMCID: PMC8578873 DOI: 10.1002/prp2.892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022] Open
Abstract
The main objective was to determine the prevalence of real drug-drug interactions (DDIs) of immunosuppressants in transplant patients. We conducted a prospective, observational 1-year study at a tertiary hospital, including all transplanted patients. We evaluated data from monitoring blood concentrations of immunosuppressive drugs and adverse drug events (ADEs) caused by DDIs. The DDIs were classified as C, D, or X according to their Lexi-Interact rating (C = monitor therapy, D = consider therapy modification, X = avoid combination). The clinical importance of real DDIs was expressed in terms of patient outcomes. The causality of DDIs was determined using Drug Interaction Probability Scale. The data were analyzed using Statistical Package for Social Sciences v. 25.0. A total of 309 transplant patients were included. Their mean age was 52.0 ± 14.7 years (18-79) and 69.9% were male. The prevalence of real DDIs was 21.7%. Immunosuppressive drugs administered with antifungal azoles and tacrolimus (TAC) with nifedipine have a great clinical impact. Real DDIs caused ADEs in 22 patients. The most common clinical outcome was nephrotoxicity (1.6%; n = 5), followed by hypertension (1.3%; n = 4). Suggestions for avoiding category D and X DDIs included: changing the immunosuppressant dosage, using paracetamol instead of non-steroidal anti-inflammatory drugs, and interrupting atorvastatin. The number of drugs prescribed and having been prescribed TAC was associated with an increased risk of real DDIs. There are many potential DDIs described in the literature but only a small percentage proved to be real DDIs, based on the patients´ outcomes.
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Affiliation(s)
- Ana Isabel Gago‐Sánchez
- Pharmacy DepartmentHospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of CórdobaCórdobaSpain
| | - Pilar Font
- Rheumatology DepartmentHospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of CórdobaCórdobaSpain
| | - Manuel Cárdenas
- Pharmacy DepartmentHospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of CórdobaCórdobaSpain
| | - María Dolores Aumente
- Pharmacy DepartmentHospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of CórdobaCórdobaSpain
| | - José Ramón Del Prado
- Pharmacy DepartmentHospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of CórdobaCórdobaSpain
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Biase TMMA, Silva MT, Galvao TF. Potential drug interactions in adults living in the Brazilian Amazon: A population-based case-control study, 2019. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100056. [PMID: 35480614 PMCID: PMC9030716 DOI: 10.1016/j.rcsop.2021.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Marcus Tolentino Silva
- Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao Paulo, Brazil
| | - Tais Freire Galvao
- School of Pharmaceutical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
- Corresponding author at: School of Pharmaceutical Sciences, State University of Campinas, R. Candido Portinari, 200 - Cidade Universitária Zeferino Vaz, CEP: 13083-871 Campinas, Sao Paulo, Brazil.
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ÖZDAMAR EN, ÖZDAMAR İ. Evaluation of the potential drug-drug interactions at orthopedics and traumatology outpatient clinics of a tertiary care hospital. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.865824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Assessing Drug-Drug Interaction Potential among Patients Admitted to Surgery Departments in Three Palestinian Hospitals. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9634934. [PMID: 33029535 PMCID: PMC7532408 DOI: 10.1155/2020/9634934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Abstract
Background Drug-drug interactions (DDIs) are a common issue that leads to adverse drug reactions in hospitals. Patients in the surgical department are expected to have potential DDIs that may lead to morbidity and mortality. Objectives To study potential DDI prevalence in the surgery departments in 3 hospitals in Palestine. Moreover, to identify pertinent factors that are associated with drug-drug interactions. Method A cross-sectional study in 3 governmental Palestinian hospitals: Palestine Medical Complex, Rafidia Hospital, and Beit Jala Hospital. Patients who are 20 years old or above and admitted to the surgical wards between September 2017 and February 2018 were included in the study. Patient demographics, all medications given in the hospital, and hospitalization period were obtained from medical files. The digital clinical decision support system Micromedex® was used for analysis and classification of possible drug interactions. Bivariate analysis and logistic regression were used to study the risk factors for developing DDIs. Results 502 patients were included in this report. The prevalence of potential DDIs among patients admitted to surgery wards in three Palestinian hospitals was 56%. The number of detected potential DDIs per patient was 2.22 ± 3.76. The number of prescribed medications (P < 0.001) was found to increase the possibility of having drug interactions. Conclusions DDIs in Palestinian hospitals are a prevalent problem, and caution should be taken when ordering medications to hospitalized patients in surgery departments.
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Eneh PC, Hullsiek KH, Kiiza D, Rhein J, Meya DB, Boulware DR, Nicol MR. Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda. BMC Infect Dis 2020; 20:572. [PMID: 32758158 PMCID: PMC7405463 DOI: 10.1186/s12879-020-05296-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of potential DDIs (pDDIs) in hospitalized HIV patients presenting with suspected cryptococcal or tuberculous meningitis. Methods In a retrospective review of three cryptococcal meningitis trials between 2010 and 2017 in Kampala, Uganda, medications received over hospitalization were documented and pDDI events were assessed. IBM Micromedex DRUGDEX® online drug reference system was used to identify and describe potential interactions as either contraindicated, major, moderate or minor. For antiretroviral DDIs, the Liverpool Drug Interactions Checker from the University of Liverpool was also used to further describe interactions observed. Results In 1074 patients with suspected meningitis, pDDIs were present in 959 (overall prevalence = 89.3%) during the analyzed 30 day window. In total, 278 unique interacting drug pairs were identified resulting in 4582 pDDI events. Of all patients included in this study there was a mean frequency of 4.27 pDDIs per patient. Of the 4582 pDDI events, 11.3% contraindicated, 66.4% major, 17.4% moderate and 5% minor pDDIs were observed. Among all pDDIs identified, the most prevalent drugs implicated were fluconazole (58.4%), co-trimoxazole (25.7%), efavirenz (15.6%) and rifampin (10.2%). Twenty-one percent of the contraindicated pDDIs and 27% of the major ones involved an antiretroviral drug. Increased likelihood of QT interval prolongation was the most frequent potential clinical outcome. Dissonance in drug interaction checkers was noted requiring clinicians to consult more than one database in making clinical decisions about drug combinations. Conclusions The overall prevalence of pDDIs in this population is high. An understanding of drug combinations likely to result in undesired clinical outcomes, such as QT interval prolongation, is paramount. This is especially important in resource limited settings where availability of therapeutic drug monitoring and laboratory follow-up are inconsistent. Adequate quantification of the increased likelihood of adverse clinical outcomes from multiple drug-drug interactions of the same kind in a single patient is needed to aid clinical decisions in this setting.
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Affiliation(s)
- Prosperity C Eneh
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | | | - Daniel Kiiza
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Joshua Rhein
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - David B Meya
- Infectious Disease Institute, Makerere University, Kampala, Uganda.,Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - David R Boulware
- Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Melanie R Nicol
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA.
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Medina-Barajas F, Vázquez-Méndez E, Pérez-Guerrero EE, Sánchez-López VA, Hernández-Cañaveral II, Gabriel A RO, Huerta-Olvera SG. Pilot study: Evaluation of potential drug-drug interactions in hospitalized pediatric patients. Pediatr Neonatol 2020; 61:279-289. [PMID: 31866496 DOI: 10.1016/j.pedneo.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/05/2019] [Accepted: 11/15/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Evaluate the type and severity of potential drug-drug interactions and identify risk factors involved, in pediatric patients admitted in a hospital setting. METHODS Transversal retrospective analytical study was carried out with hospitalized pediatric patients from a Hospital in the West of Mexico, second and third level. The patients included were ≤18 years old hospitalized in the children wards; those admitted at the emergency room, neonatal intermediate and intensive therapy units were not included. Medical prescriptions were reviewed taking into consideration anthropometric characteristics, diagnosis and number of drugs prescribed to identify potential drug-drug interactions using Micromedex 2.0 database. RESULTS 88 patients were included, an average of 4.6 ± 2.8 of drugs were prescribed per patient. 37 subjects (42%) presented some degree of potential drug-drug interactions of which 25.5% were major and 27.7% moderate according to the software. Identified risk factors were: age ≥ 4 years (OR 1.917; 95% CI 1.081-3.399), BSA ≥ 0.8m2(OR 1.825; 95% CI 1.021-3.263), height ≥ 1 m (OR 2.556;95% CI 1.322 - 4.941), and number of prescribed medications ≥ 4 (OR 2.106;95% CI 1.248 - 3.556). CONCLUSION Some of the interactions found were for the benefit of the patient, but others were considered undesirable because they altered the pharmacokinetics of some of the medications administered. Detecting in time the harmful interactions for a patient may favor the patient's safety.
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Affiliation(s)
- Fabiola Medina-Barajas
- Pharmacy Service, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", 750 Salvador Quevedo y Zubieta St., 44340, Guadalajara, Mexico.
| | - Estefanía Vázquez-Méndez
- Medical and Pharmaceutical Biotechnology Department, Centro de Asistencia en Tecnología y Diseño del Estado de Jalisco, 800 Normalistas Av., 44270, Guadalajara, Mexico.
| | - Edsaúl Emilio Pérez-Guerrero
- Molecular Biology and Genomics Department, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., 44340, Guadalajara, Mexico.
| | | | - Iván I Hernández-Cañaveral
- Microbiology Department, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., 44340, Guadalajara, Mexico.
| | - Real-Ornelas Gabriel A
- Centro integral de Medicina Ambiental y Toxicología CIMATOX S.A.S, de C.V. María Reyes 2, Guadalajara, Mexico.
| | - Selene G Huerta-Olvera
- Medical and Life Sciences Department, Centro Universitario de la Ciénega, Universidad de Guadalajara, 1115 Universidad Av., 47820, Ocotlán, Mexico.
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Evaluation of potential drug-drug interactions in a pediatric population. Turk Arch Pediatr 2020; 55:30-38. [PMID: 32231447 PMCID: PMC7096558 DOI: 10.14744/turkpediatriars.2019.60938] [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: 03/28/2019] [Accepted: 10/14/2019] [Indexed: 11/20/2022]
Abstract
Aim: A large number of medications are prescribed in pediatric clinics and this leads to the development of drug–drug interactions (DDI) that may complicate the course of the disease. The aim of the study was to identify the prevalence of potential drug–drug interactions, to categorize main drug classes involved in severe drug–drug interactions and to highlight clinically relevant DDIs in a pediatric population. Material and Methods: A total of 1500 prescriptions during the 12-month study period were retrospectively reviewed; 510 prescriptions that comprised two or more drugs were included in study. The presence of potential drug–drug interactions was identified by using the Lexi-Interact database and categorized according to severity A (unknown), B (minor), C (moderate), D (major), and X (contraindicated). Results: There were 1498 drugs in 510 prescriptions; 253 of these (49.6%) included 2 drugs, 228 (44.7%) included 3–4 drugs, and 29 (5.6%) included ≥5 drugs. A total of 634 (42%) potential drug–drug interactions were idenfied. Among those, 271 (42.7%) were categorized as A, 284 (44.8%) as B, 53 (8.4%) as C, and 26 (4.1%) as D. There was no potential risk for X interaction. Anti-infectives (36%) were the most commonly prescribed drug classes involved in C and/or D categories. Clarithromycin was the most commonly interacting agent that interfered with budesonide. Conclusion: It is noteworthy that a significant number of drugs causing potential drug–drug interactions are prescribed together in pediatric clinics. Increasing the awareness of physicians on this issue will prevent potential complications and ensure patient safety.
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Holm J, Eiermann B, Kimland E, Mannheimer B. Prevalence of potential drug-drug interactions in Swedish pediatric outpatients. PLoS One 2019; 14:e0220685. [PMID: 31381591 PMCID: PMC6681954 DOI: 10.1371/journal.pone.0220685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/22/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To describe the occurrence of potential drug-drug interactions (DDIs) in prescribed drugs, dispensed to pediatric outpatients in Sweden. METHODS A cross sectional study was conducted based on data from a national register of prescribed drugs, dispensed at pharmacies, to children 0-17 years old. The study period was January 1 to April 30, 2010. Drug dispensing data was linked to the DDI database SFINX. Prevalence and frequencies of potential interactions were investigated, and drugs commonly involved in interactions were identified. The study focused on clinically relevant potential interactions, class D (should be avoided), and class C (can be handled, e.g. by dose adjustment). RESULTS In the Swedish pediatric population, 0 to 17 years of age, 12% (n = 231 078) of children had at least two dispensed drugs. In this group of patients, 0.14% had potential D-interactions and 1,3% had potential C-interactions. The number of D- and C-interactions that may lead to reduced effects were 181 (52%), and 1224 (32%) respectively. The ten most frequent drugs were involved in 78% and 65% of all potential D-, and C-interactions respectively. Furthermore, 80%, and 58% of the D-, and C-interactions respectively occurred in patients aged 12 to 17. CONCLUSIONS We identified a limited number of drugs that were represented in the majority of potential interactions. Interactions that can lead to a reduced treatment effect constituted approximately half of D-interactions, and a third of C-interactions. The frequency of potential interactions was higher in older children. The results may contribute to increased prescriber awareness of important potential drug interactions among pediatric outpatients.
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Affiliation(s)
- Johan Holm
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- * E-mail:
| | - Birgit Eiermann
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Inera AB, Swedish Association of Local Authorities and Regions, Stockholm, Sweden
| | - Elin Kimland
- Swedish Medical Products Agency, Uppsala, Sweden
| | - Buster Mannheimer
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Udaykumar P, Rao C, Shenoy V. Potential drug–drug interactions in the pediatric intensive care unit of a tertiary care hospital. J Pharmacol Pharmacother 2019. [DOI: 10.4103/jpp.jpp_27_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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