1
|
Valladales-Restrepo LF, Ospina-Cano JA, Aristizábal-Carmona BS, Machado-Alba JE. Prescription Patterns of Inducers and Inhibitors of Cytochrome P450 and Their Potential Drug Interactions in the Real World: A Cross-Sectional Study. Drugs Real World Outcomes 2024:10.1007/s40801-024-00450-1. [PMID: 39243339 DOI: 10.1007/s40801-024-00450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/09/2024] Open
Abstract
INTRODUCTION Both the induction and inhibition of cytochrome P450 are associated with multiple pharmacological interactions, which can lead to loss of efficacy or increase the risk of adverse drug reactions. OBJECTIVE The aim was to determine the prescription patterns of cytochrome P450-inducing and -inhibiting drugs and their contraindicated and major pharmacological interactions in a group of patients from Colombia. METHODS This cross-sectional observational study included patients who received drugs that induce or inhibit metabolism and examined their contraindicated and major pharmacological interactions. The patients were identified from a population-based database of drug dispensing. Patients were included between December 1 and December 31, 2021. Inhibitors and inducers of cytochrome P450 were classified based on FDA (Food and Drug Administration) guidelines. Drug interactions were identified using the Micromedex® database. Descriptive, bivariate and multivariable analysis was performed. RESULTS A total of 63,433 patients were analyzed. Antiseizure medications (35.9%) and antifungals (27.6%) were the most used inducers and inhibitors. A total of 30.1% of patients had potential contraindicated or greater interactions. The following factors were associated with a higher probability of presenting a potential pharmacological interaction: being male (OR 1.14; 95% CI 1.10-1.19), aged 18-39 years (OR 1.77; 95% CI 1.67-1.89) or 40-64 years (OR 1.64; 95% CI 1.56-1.72), having neurological diseases (OR 1.28; 95% CI 1.21-1.35), having psychiatric diseases (OR 3.84; 95% CI 3.58-4.13), having rheumatologic diseases (OR 1.32; 95% CI 1.23-1.41), receiving comedications with statins (OR 1.14; 95% CI 1.08-1.19), receiving comedications with analgesics (OR 1.33; 95% CI 1.27-1.38), receiving comedications with antiparasitics (OR 2.88; 95% CI 2.66-3.11) and an increase in the number of medications (OR 1.24; 95% CI 1.23-1.25). CONCLUSION Among the users of cytochrome P450 inhibitors and inducers, potential contraindications and greater interactions are very common, especially in men under 65 years of age with comorbidities and polypharmacy.
Collapse
Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Juan Alberto Ospina-Cano
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia
| | - Brayan Stiven Aristizábal-Carmona
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia.
| |
Collapse
|
2
|
Zarrabi S, Hosseini E, Sadeghi K, Vaezi M, Shahrami B. Assessment of drug-drug interactions among patients with hematologic malignancy: A clinical pharmacist-led study. J Oncol Pharm Pract 2024:10781552241281664. [PMID: 39223926 DOI: 10.1177/10781552241281664] [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: 09/04/2024]
Abstract
INTRODUCTION Patients with hematologic malignancies often receive multiple medications, leading to potential drug-drug interactions (DDIs). Identifying and managing these DDIs is crucial for ensuring patient safety and effective care. This study aimed to identify and describe DDIs and associated factors in hematologic malignancy patients. METHODS This prospective interventional study was conducted at a referral center and included hospitalized patients with hematologic malignancies who were receiving at least four concurrent medications. A pharmacist initially compiled a comprehensive list of all medications through patient interviews and medication reviews, and subsequently, identified and categorized potential DDIs using the Lexi-interact® and Micromedex® databases. The clinical pharmacist then evaluated the clinical impact of the identified DDIs in every individual patient and provided appropriate interventions to resolve them. RESULTS A total of 200 patients met the inclusion criteria for the study, with 1281 DDIs identified across 337 distinct types. The majority of identified DDIs exhibited major severity (52.1%) and pharmacokinetic mechanisms (50.3%), with an unspecified onset (79.4%) and fair evidence (67%). Of the identified DDIs, 81.1% were considered clinically significant, prompting 1059 pharmacotherapy interventions by the clinical pharmacist. Additionally, a significant relationship was observed between the number of drugs used during hospitalization and the occurrence of DDIs (P < 0.001, r = 0.633). CONCLUSION DDIs are highly prevalent among hospitalized patients with hematologic malignancies, with their occurrence increasing alongside the number of medications administrated. The intervention of a clinical pharmacist is crucial to evaluate the clinical impact of these DDIs and implement effective interventions for their management.
Collapse
Affiliation(s)
- Sogol Zarrabi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Hosseini
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Sadeghi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vaezi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Simal I, Somers A, Amrouch C, Capiau A, Cherubini A, Cruz-Jentoft AJ, Gudmundsson A, Soiza RL, O 'Mahony D, Petrovic M. A descriptive analysis of drug-drug interactions and corresponding adverse drug reactions in multimorbid older inpatients: findings from the SENATOR trial. Eur Geriatr Med 2024:10.1007/s41999-024-01025-7. [PMID: 39095682 DOI: 10.1007/s41999-024-01025-7] [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: 03/25/2024] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Drug-drug interactions (DDIs) are prevalent among multimorbid and polymedicated older adults and can increase the risk of adverse drug reactions (ADRs), hospital admissions, and mortality. This study describes the incidence and prevalence of 66 clinically relevant DDIs and analyses the occurrence of 12 corresponding predefined ADRs in older inpatients enrolled in the SENATOR trial. METHODS The sub-study of the SENATOR trial that involved 1537 multimorbid older inpatients, recruited from 2016 to 2018 in six academic teaching hospitals in Belgium, Iceland, Ireland, Italy, Scotland, and Spain respectively, and analysed 66 potentially clinically significant DDIs. Descriptive analysis determined DDI and corresponding ADR prevalence/incidence. RESULTS At baseline (median age: 78 [72, 84], 52.8% male), the prevalence of patients with DDIs was high (50.9%), increased during hospitalisation (55.2%) and reduced to 49.7% after 12 weeks. The most common DDIs were: ≥ 2 potassium reducing drugs (17.1%), ≥ 3 centrally acting drugs (9.0%), and SSRI + loop/thiazide diuretic (7.2%). Of all participants, one-third experienced a prevalent (36.6%)/incident (35.8%) ADR. Major serum electrolyte disturbance had the highest incidence (10.7%)/prevalence (11.5%). Incident ADRs were more common in patients with DDIs (p = 0.013). A higher prevalence of new onset falls (p = 0.013), major constipation (p = 0.004), and major serum electrolyte disturbances (p = 0.006) was observed in patients with related and thus potentially causal DDIs. CONCLUSIONS Clinicians should, be aware of DDIs and the involved drug classes that can lead to an increased rate of ADRs in older multimorbid inpatients. Regularly reevaluating the appropriateness of the frequently prescribed drug classes and initiating judicious deprescribing is recommended.
Collapse
Affiliation(s)
- Ine Simal
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Cheima Amrouch
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Andreas Capiau
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | | | - Adalsteinn Gudmundsson
- Department of Geriatric Medicine, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Roy L Soiza
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Denis O 'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
- Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
4
|
Stojadinovic M, Lausevic M, Milosevic IA, Zaric RZ, Jemcov TK, Komadina L, Petrovic DS, Djuric P, Bulatovic A, Jakovljevic S, Jankovic S. Risk Factors for Potential Drug-Drug Interactions in Patients on Chronic Peritoneal Dialysis. Pharmacology 2024; 109:147-155. [PMID: 38432197 DOI: 10.1159/000537968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The prevalence of potential drug-drug interactions (pDDIs) is becoming a major safety concern, as it has been previously linked to a significant number of adverse drug events and could have serious consequences for patients, including death. This is especially relevant for patients with chronic renal failure, as they are particularly vulnerable to drug-drug interactions. The aim of this study was to evaluate the prevalence and associated factors of pDDIs in patients receiving chronic peritoneal dialysis. METHODS An observational, cross-sectional study was conducted on consecutive peritoneal dialysis patients attending four tertiary care hospitals for regular monthly examination. The primary outcome was the number of pDDIs identified using Lexicomp. Potential predictors were determined using multiple linear regression. RESULTS Total number of patients included in the study was 140. The results showed that pDDIs were highly prevalent, especially in patients who use antiarrhythmics (p = 0.001), have diabetes mellitus (p = 0.001), recently started peritoneal dialysis (p = 0.003), or have higher number of prescribed drugs (p < 0.001). Number of prescribed drugs (p < 0.001) remained a significant predictor of high-risk pDDIs in addition to the female gender (p = 0.043). CONCLUSION Clinicians should be particularly cautious when prescribing multiple medications to high-risk patients, such as peritoneal dialysis patients, to mitigate the risk of drug-drug interactions and associated adverse health outcomes.
Collapse
Affiliation(s)
- Milorad Stojadinovic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mirjana Lausevic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Iman Assi Milosevic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Tamara Kosta Jemcov
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Ljiljana Komadina
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Dejan Slavko Petrovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Nephrology, University Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Petar Djuric
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Ana Bulatovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Stefan Jakovljevic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Surgery, University Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Clinical Pharmacology, University Clinical Center of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
5
|
Poloyac SM, Daugherty KK, DeVilliers MM, Farrell DF, Malhotra A, Nolin TD, Panyam J, Perumal O, Sheaffer EA, Swaan PW. Report of the 2023 AACP Council of Deans Taskforce on Pharmacy Research and Scholarship. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100641. [PMID: 38185465 DOI: 10.1016/j.ajpe.2024.100641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The objective of this review is to provide the conclusions from the American Association of Colleges of Pharmacy (AACP) Council of Deans (COD) Taskforce on Research and Scholarship. FINDINGS The charges and the findings of the committee are: (1) Define the scholarship needs/opportunities to strengthen the outputs. The committee recommends that AACP update its definitions of research/scholarship to include discovery, integration, application/practice, and teaching/learning. A deployed survey demonstrated a high Special Interest Groups research/scholarship interest. (2) Assemble a toolkit of grant and scholarship resources to assist colleges/schools. The AACP should update the existing funding opportunity listing and combine it with additional resources. (3) Create a framework for effective research collaboration and mentorship. The AACP should identify key areas of pharmacy research and experts to serve as mentors and to meet with external stakeholders. (4) and (5) Consider the need for and purpose of a COD standing committee for research and scholarship. Explore the value of a formal research dean's subcommittee. It was recommended that AACP form a research/scholarship committee or Special Interest Groups and create the Pharmacy Scholarship, Research, and Graduate Education pre-meeting to the Interim Meeting. (6) Identify key statements/outputs of the COD that need to be prepared for publication/sharing. We recommended the key statement/outputs in the areas of discovery, integration, application/practice, and teaching and learning. SUMMARY The taskforce reviewed the state of research and scholarship across the Academy and provided recommendations with the goal of advancing research across all areas of the pharmacy profession.
Collapse
Affiliation(s)
- Samuel M Poloyac
- University of Texas at Austin College of Pharmacy, Austin, TX, USA.
| | | | | | | | - Ashim Malhotra
- California Northstate University College of Pharmacy, Elk Grove, CA, USA
| | - Thomas D Nolin
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Jayanth Panyam
- Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Om Perumal
- South Dakota State University College of Pharmacy & Allied Health Professions, Brookings, SD, USA
| | | | - Peter W Swaan
- University of Florida College of Pharmacy, Gainesville, FL, USA
| |
Collapse
|
6
|
Klopotowska JE, Leopold JH, Bakker T, Yasrebi-de Kom I, Engelaer FM, de Jonge E, Haspels-Hogervorst EK, van den Bergh WM, Renes MH, Jong BTD, Kieft H, Wieringa A, Hendriks S, Lau C, van Bree SHW, Lammers HJW, Wierenga PC, Bosman RJ, de Jong VM, Slijkhuis M, Franssen EJF, Vermeijden WJ, Masselink J, Purmer IM, Bosma LE, Hoeksema M, Wesselink E, de Lange DW, de Keizer NF, Dongelmans DA, Abu-Hanna A. Adverse drug events caused by three high-risk drug-drug interactions in patients admitted to intensive care units: A multicentre retrospective observational study. Br J Clin Pharmacol 2024; 90:164-175. [PMID: 37567767 DOI: 10.1111/bcp.15882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
AIMS Knowledge about adverse drug events caused by drug-drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+ ) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. METHODS We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. RESULTS In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). CONCLUSION The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.
Collapse
Affiliation(s)
- Joanna E Klopotowska
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jan-Hendrik Leopold
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Tinka Bakker
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Izak Yasrebi-de Kom
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Frouke M Engelaer
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther K Haspels-Hogervorst
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maurits H Renes
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bas T de Jong
- Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands
| | - Hans Kieft
- Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands
| | - Andre Wieringa
- Department of Clinical Pharmacy, Isala Hospital, Zwolle, The Netherlands
| | - Stefaan Hendriks
- Department of Intensive Care, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Cedric Lau
- Department of Hospital Pharmacy, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Sjoerd H W van Bree
- Department of Intensive Care, Hospital Gelderse Vallei, Ede, The Netherlands
| | | | - Peter C Wierenga
- Department of Hospital Pharmacy, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Rob J Bosman
- Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands
| | - Vincent M de Jong
- Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands
| | - Mirjam Slijkhuis
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Eric J F Franssen
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Wytze J Vermeijden
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Joost Masselink
- Department of Hospital Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ilse M Purmer
- Department of Intensive Care, Haga Hospital, The Hague, The Netherlands
| | - Liesbeth E Bosma
- Department of Hospital Pharmacy, Haga Hospital, The Hague, The Netherlands
| | - Martin Hoeksema
- Department of Intensive Care, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Elsbeth Wesselink
- Department of Hospital Pharmacy, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Dylan W de Lange
- Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Aksoy N, Ozturk N. A meta-analysis assessing the prevalence of drug-drug interactions among hospitalized patients. Pharmacoepidemiol Drug Saf 2023; 32:1319-1330. [PMID: 37705139 DOI: 10.1002/pds.5691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Drug-drug interactions (DDIs), particularly in hospitalized patients can result in adverse drug events and unfavorable health consequences. The aim of this meta-analysis is to provide up-to-date evidence on the prevalence of clinically evident adverse drug events due to DDIs in hospitalized patients. METHODS Data from Scopus, PubMed, Cochrane and Web of Science were extracted using these keywords (Drug interaction/drug-drug interactions, Hospital/ hospitals, Adverse drug event, Hospitalized patients, inpatient, Department, Hospital stay, Harm, Mortality, death). The studies that include Observational studies on hospitalized patients, reporting potential DDIs using an electronic database, and reporting the clinically observed adverse drug interactions (ADI) through symptoms, signs or Laboratory tests are included. Using Open meta-Software (version 12.11.14), the incidence of clinically evident DDIs among hospitalized patients was determined and shown in a forest plot. RESULTS Only 15 of the 8261 articles found through a literature search met the inclusion criteria and reported the desired outcome. The pooled prevalence of potential drug-drug interactions is 64.9% (CI 95% 0.618-0.736). While clinically evident DDIs have a pooled frequency of 17.17% (CI 95% 0.133-0.256). CONCLUSION The issue of DDIs remains a significant concern in hospitalized patients, with a notable rise in their prevalence. This meta-analysis encompassed a greater quantity of studies and demonstrated a heightened proportion of drug-drug interaction prevalence in comparison to the percentages reported in the previously published meta-analysis.
Collapse
Affiliation(s)
- Nilay Aksoy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Altınbaş University, İstanbul, Turkey
| | - Nur Ozturk
- Department of Clinical Pharmacy, Faculty of Pharmacy, Altınbaş University, İstanbul, Turkey
- Department of Clinical Pharmacy, Graduate School of Health Sciences, İstanbul Medipol University, İstanbul, Turkey
| |
Collapse
|
8
|
Karajizadeh M, Zand F, Vazin A, Saeidnia HR, Lund BD, Tummuru SP, Sharifian R. Design, development, implementation, and evaluation of a severe drug-drug interaction alert system in the ICU: An analysis of acceptance and override rates. Int J Med Inform 2023; 177:105135. [PMID: 37406570 DOI: 10.1016/j.ijmedinf.2023.105135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The override rate of Drug-Drug Interaction Alerts (DDIA) in Intensive Care Units (ICUs) is very high. Therefore, this study aimed to design, develop, implement, and evaluate a severe Drug-Drug Alert System (DDIAS) in a system of ICUs and measure the override rate of this system. METHODS This is a cross-sectional study that details the design, development, implementation, and evaluation of a DDIAS for severe interactions into a Computerized Provider Order Entry (CPOE) system in the ICUs of Nemazee general teaching hospitals in 2021. The patients exposed to the volume of DDIAS, acceptance and overridden of DDIAS, and usability of DDIAS have been collected. The study was approved by the local Institutional Review Board (IRB) and; the ethics committee of Shiraz University of Medical Science on date: 2019-11-23 (Approval ID: IR.SUMS.REC.1398.1046). RESULTS The knowledge base of the DDIAS contains 9,809 severe potential drug-drug interactions (pDDIs). A total of 2672 medications were prescribed in the population study. The volume and acceptance rate for the DDIAS were 81 % and 97.5 %, respectively. The override rate was 2.5 %. The mean System Usability Scale (SUS) score of the DDIAS was 75. CONCLUSION This study demonstrates that implementing high-risk DDIAS at the point of prescribing in ICUs improves adherence to alerts. In addition, the usability of the DDIAS was reasonable. Further studies are needed to investigate the establishment of severe DDIAS and measure the prescribers' response to DDIAS on a larger scale.
Collapse
Affiliation(s)
- Mehrdad Karajizadeh
- Shiraz University of Medical, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz, Iran.
| | - Farid Zand
- Shiraz University of Medical Sciences, Anesthesiology and Critical Care Research Center, Shiraz, Iran
| | - Afsaneh Vazin
- Shiraz University of Medical Sciences, Shiraz, Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz, Iran
| | | | - Brady D Lund
- University of North Texas, Department of Information Science, Denton, TX, US
| | - Sai Priya Tummuru
- University of North Texas, Department of Information Science, Denton, TX, US
| | - Roxana Sharifian
- Shiraz University of Medical Sciences, Department of Health Information Management, Health Human Resources Research Center, School of Management & Medical Information Sciences, Shiraz, Iran.
| |
Collapse
|
9
|
Sulaiman DM, Shaba SS, Almufty HB, Sulaiman AM, Merza MA. Screening the Drug-Drug Interactions Between Antimicrobials and Other Prescribed Medications Using Google Bard and Lexicomp® Online™ Database. Cureus 2023; 15:e44961. [PMID: 37692178 PMCID: PMC10492649 DOI: 10.7759/cureus.44961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/12/2023] Open
Abstract
Aim This study aimed to critically appraise the drug-drug interaction (DDI) screening performance of Google Bard (Google AI, Mountain View, California, United States) by comparing it with the authorized Lexicomp® Online™ database (Wolters Kluwer Health, Philadelphia, Pennsylvania, United States). Methods This cross-sectional study was conducted between April 2023 and August 2023, and enrolled 414 prescriptions that had been collected randomly between April 2023 and June 2023. These prescriptions were processed individually by Lexicomp online and Google Bard to screen for DDIs between antimicrobials and other prescribed medications. Results The total number of DDIs based on Lexicomp and Google Bard were 90 and 68, respectively. Cohen's Kappa (κ) values showed that there was a nil to slight agreement between Lexicomp and Google Bard regarding the DDI risk rating (κ=0.01). Regarding the severity rate, there was a slight agreement between them (κ=0.02), but in terms of reliability rate, there was no agreement (κ =-0.02). Conclusion This study unveiled differences between Lexicomp and Google Bard regarding their DDI identification, severity rating, and reliability rates. It is fundamental to consider that both tools have their strengths and weaknesses and, therefore, should not be individually depended on for final clinical decisions. However, Lexicomp can be considered authoritative in screening DDIs, but Google Bard currently lacks the necessary precision and reliability for conducting such screenings.
Collapse
Affiliation(s)
- Dilveen M Sulaiman
- Department of Pharmacology, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Suhail S Shaba
- Department of Pharmaceutics, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Hind B Almufty
- Department of Clinical Pharmacy, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Asmaa M Sulaiman
- Department of Clinical Pharmacy, Azadi Teaching Hospital, Duhok, IRQ
| | - Muayad A Merza
- Department of Internal Medicine, Azadi Teaching Hospital, Duhok, IRQ
| |
Collapse
|
10
|
Pinkoh R, Rodsiri R, Wainipitapong S. Retrospective cohort observation on psychotropic drug-drug interaction and identification utility from 3 databases: Drugs.com®, Lexicomp®, and Epocrates®. PLoS One 2023; 18:e0287575. [PMID: 37347788 PMCID: PMC10287001 DOI: 10.1371/journal.pone.0287575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Pharmacotherapy is necessary for many people with psychiatric disorders and polypharmacy is common. The psychotropic drug-drug interaction (DDI) should be concerned and efficiently monitored by a proper instrument. OBJECTIVES This study aimed to investigate the prevalence and associated factors of psychotropic DDI and to compare the identification utility from three databases: Drugs.com®, Lexicomp®, and Epocrates®. METHODS This was a retrospective cohort design. We collected demographic and clinical data of all patients hospitalised in the psychiatric inpatient unit in 2020. Psychotropic DDI profiles were examined through three databases. Descriptive statistics were used to report comprehensiveness of each database and prevalence of psychotropic DDI. The Fleiss' kappa index would be analysed to indicate agreement strength of DDI severity classification among three databases. RESULTS From 149 total admissions, the psychotropic DDIs were found in 148 admissions (99.3%). Thorough the study, there were 182 of both psychotropic and other agents prescribed under 1,357 prescriptions. In total, 2,825 psychotropic DDIs were identified by using Drugs.com® 2,500 times, Epocrates® 2,269 times, and Lexicomp® 2,265 times. Interactions with clonazepam was the three most frequent agents when co-administrated with quetiapine (n = 56), risperidone (n = 36), and valproic acid and derivatives (n = 36). Serious DDIs were comparatively lower in incidence and there was no evidence of its association with reported clinical adverse consequences. The study revealed slight and fair agreement regarding severity classification among the three databases was found. DDI events detected by Drugs.com® were greatest in number, but Lexicomp® provided the broadest list of medications prescribed in our study. CONCLUSION Among three databases, interactions detected by Drugs.com® were greatest in number, whereas Lexicomp® provided the broadest list of medications. Development of such databases, based on both theoretical and clinical conceptions, should be focused to balance safety of patients and weariness of healthcare providers.
Collapse
Affiliation(s)
- Ravi Pinkoh
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ratchanee Rodsiri
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry and Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| |
Collapse
|
11
|
Verbič MD, Brvar M, Kos MK. Adverse drug reactions in the ambulatory internal patients at the emergency department: Focus on causality assessment and drug-drug interactions. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:195-210. [PMID: 37307369 DOI: 10.2478/acph-2023-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/14/2023]
Abstract
A non-interventional retrospective study in ambulatory patients was conducted at the emergency department of the Division of internal medicine. In 2 months, 266 suspected adverse drug reactions (ADRs) were identified in 224/3453 patients (6.5 %). In 158/3453 patients (4.6 %), an ADR was the reason for emergency department visit and in 49 patients (1.4 %), ADRs led to hospitalisation. A causality assessment algorithm was developed, which included Naranjo algorithm and levels of ADR recognition by the treating physician and the investigators. Using this algorithm, 63/266 ADRs (23.7 %) were classified as "certain", whereas using solely the Naranjo score calculation, only 19/266 ADRs (7.1 %) were assessed as "probable" or "certain", and the rest of ADRs (namely, 247/266 = 92.9 %) were assessed as "possible". There were 116/266 (43.6 %) ADRs related to potential drug-drug interactions (DDIs), stated in at least one of the literature sources used. Based on the causality relationship, the rate of the clinically expressed DDIs was 19.0 %, or 12/63 "certain" ADR cases. Of these, 10 cases presented serious DDI-related ADRs. In summary, ADR causality assessment based exclusively on Naranjo algorithm demonstrated low sensitivity at an ambulatory emergency setting. Additional clinical judgment, including the opinion of the treating physician, proved necessary to avoid under-rating of the causality relationship, and enabled the determination of clinically expressed DDIs.
Collapse
Affiliation(s)
- Matej Dobravc Verbič
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
| | - Miran Brvar
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 2University of Ljubljana, Faculty of Medicine, Centre for Clinical Physiology Ljubljana, Slovenia
| | - Mojca Kerec Kos
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
| |
Collapse
|
12
|
Luzze B, Atwiine B, Lugobe HM, Yadesa TM. Frequency, severity, and factors associated with clinically significant drug-drug interactions among patients with cancer attending Mbarara Regional Referral Hospital Cancer Unit, Uganda. BMC Cancer 2022; 22:1266. [PMID: 36471270 PMCID: PMC9721055 DOI: 10.1186/s12885-022-10396-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/02/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cancer is a major public health problem with pharmacotherapy being the cornerstone of its management. Cancer patients receive multiple drugs concurrently risking Drug-Drug Interactions (DDIs). DDIs, though avoidable, can significantly contribute to morbidity, mortality, and increased healthcare costs in this population of patients. Currently, there is no published study from Uganda on clinically significant DDIs (cs-DDIs) among cancer patients. This study identifies frequency, severity, and factors associated with cs-DDIs at Mbarara Regional Referral Hospital Cancer Unit (MRRHCU). METHOD A cross-sectional study was conducted among 300 cancer patients receiving chemotherapy from a tertiary care hospital in western Uganda from January-February 2022. A questionnaire and data collection form were used to collect patient data. Lexicomp® Drug interaction software was used to screen the patient drug information for DDIs and assess their severity. Predictors of DDIs were identified using logistic regression using SPSS (Statistical Package for Social Sciences). RESULT Three hundred participants were enrolled with a mean age of 48 ± 23.3 years. One hundred eighty-one patients experienced 495 cs-DDIs; with a mean of 1.7 ± 2.2. The prevalence of cs-DDI was 60.3% (55.0-66.0% at 95% CI). Digestive organ neoplasms were the most commonly (80, 26.7%) diagnosed category, and 'plant alkaloids and other natural products were the most frequently (143, 47.7%) used chemotherapeutic drug classes. About three-quarters of cs-DDIs were rated as category C risk (367, 74.1%) whereas over two-thirds (355, 71.7%) were moderate in severity.. Being female (aOR = 2.43 [1.23-4.48 at 95% CI]; P-value = 0.011) and use of ≥ 6 drugs concurrently (aOR = 18.82 [9.58-36.95 at 95% CI]; P-value < 0.001)) were significantly associated with cs-DDIs. CONCLUSION More than half of the participants experienced at-least one cs-DDI which is generally higher than what was reported in high-income settings. About three-quarters were category C and moderate in severity, and require enhanced monitoring for safety and treatment outcome. Being female and using ≥ 6 drugs were significantly associated with cs-DDIs.
Collapse
Affiliation(s)
- Bonny Luzze
- grid.33440.300000 0001 0232 6272Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Barnabas Atwiine
- grid.33440.300000 0001 0232 6272Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.459749.20000 0000 9352 6415Cancer Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Henry Mark Lugobe
- grid.33440.300000 0001 0232 6272Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- grid.33440.300000 0001 0232 6272Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Pharm-Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.427581.d0000 0004 0439 588XDepartment of Pharmacy, Ambo University, Ambo, Ethiopia
| |
Collapse
|
13
|
Dagnew EM, Ergena AE, Wondm SA, Sendekie AK. Potential drug-drug interactions and associated factors among admitted patients with psychiatric disorders at selected hospitals in Northwest Ethiopia. BMC Pharmacol Toxicol 2022; 23:88. [PMID: 36447276 PMCID: PMC9710177 DOI: 10.1186/s40360-022-00630-1] [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] [Received: 07/27/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prescribing medications without potential drug-drug interactions (pDDIs) is one of the components of the rational use of medications. However, taking combined medications has resulted in life-threatening pDDIs, which are causing severe clinical outcomes for patients. This study was aimed at assessing the prevalence of pDDIs and associated factors in admitted patients with psychiatric disorders. METHODS An institution-based multicenter cross-sectional study was conducted among patients with psychiatric disorders admitted to a selected hospital in Northwest Ethiopia. Samples were approached through a systematic sampling method. The Statistical Package for the Social Sciences (SPSS) version 26 was used to analyze the data. Logistic regression was applied to determine the association of variables with pDDIs. A p-value of < 0.05 was statistically significant. RESULTS Out of 325 study participants, more than half (52.9%) were females, with a median age of 61 years. Overall, more than two-thirds (68.9%) were exposed to at least one clinically significant, either significant or serious level of pDDIs. Nearly one-fourth (23.2%) of participants had at least one serious level of pDDIs. Older patients were found more likely to have pDDIs compared to younger patients (p = 0.043). Similarly, patients with a higher number of prescribed medications (p = 0.035) and patients with longer hospital admissions (p = 0.004) were found more likely to be exposed to pDDIs than their counterparts. CONCLUSION In this study, a significant number of admitted patients with psychiatric problems encountered clinically significant pDDIs. As a result, healthcare providers could assess and follow patients with a combination of medications that potentially have a drug-drug interaction outcome.
Collapse
Affiliation(s)
- Ephrem Mebratu Dagnew
- grid.449044.90000 0004 0480 6730Depatment of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Asrat Elias Ergena
- grid.59547.3a0000 0000 8539 4635Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samuel Agegnew Wondm
- grid.449044.90000 0004 0480 6730Depatment of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ashenafi Kibret Sendekie
- grid.59547.3a0000 0000 8539 4635Depatment of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
14
|
Quantitative Prediction of Adverse Event Probability Due to Pharmacokinetic Interactions. Drug Saf 2022; 45:755-764. [PMID: 35737292 DOI: 10.1007/s40264-022-01190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Iatrogeny due to drug-drug interactions is insufficiently documented, due to the high number of possible combinations. OBJECTIVE This study aimed to design a simple but general method to predict the variation of adverse events (AE) frequency due to a pharmacokinetic or pharmacodynamic interaction. METHODS Three prediction models were designed using a logistic probability density function. Each prediction model was based on three components: the AE odds ratio of each drug in the combination, and the area under the curve ratio (Rauc) of the pharmacokinetic interaction, if any. Pharmacodynamic interaction was assumed to be additive on logit scale. Rauc was predicted using a well-validated mechanistic static model, freely available online. No combination study is required. The method was evaluated against a wide range of AEs (28 High Level Terms) and 211 drug combinations (involving 43 victim drugs and 55 perpetrators), by comparing the observed and predicted frequencies. The observed odds ratios were estimated with a disproportionality analysis from the FDA Adverse Event Reporting System, using an approach that minimizes biases. RESULTS With the best model, the rate of prediction considered as correct (within 50-200% of the observed value) was 72%, and the bias was negligible (-5%). The AE odds ratio due to pharmacokinetic and pharmacodynamic interactions was equally well predicted. CONCLUSIONS A simple workflow to implement the method in practice is proposed. This method may help to foresee and to anticipate the harmful consequences associated with drug-drug interactions, at virtually no experimental cost, when the odds ratio of an AE is known for each drug alone and the AUC ratio is known or predicted by a suitable model.
Collapse
|
15
|
Perveen S, Gauhar S, Yousuf RI, Ali H, Zafar F, Sheikh AF. Evaluation of pharmacokinetic interactions of amoxicillin with ranitidine in healthy human volunteers of Karachi, Pakistan. PLoS One 2022; 17:e0267791. [PMID: 35609024 PMCID: PMC9128966 DOI: 10.1371/journal.pone.0267791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Polypharmacy may be considered as the customary practice to provide optimum care services to patients but inter resulted in augmented probability of multiple drug interaction. Keeping in view the importance of drug interaction possibility, this study was designed to evaluate the effect of ranitidine on pharmacokinetics of amoxicillin in the local population of Karachi, Pakistan. Amoxicillin and ranitidine are the most commonly prescribed drugs to treat duodenal ulcer caused by Helicobacter pylori. The current investigation was carried out as a single center, open label, two phase, single dose, randomized way in cross over manner to evaluate the potential of pharmacokinetic interaction among amoxicillin formulation and ranitidine in adult healthy male volunteers. Post dosing blood samples were collected at multiple time points that are 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 10 hours after administering amoxicillin 250mg capsule with and without ranitidine. For estimation of amoxicillin concentration in plasma, an HPLC method was developed and validated. The solvent system consisted of 0.025M phosphate buffer: acetonitrile (94:6 v/v). C18 column was employed with a flow rate of 1.0 ml/minute and at 230nm. A linear pattern with a correlation coefficient of 0.999 in the concentration ranges of 25μg/mL to 0.097μg/mL for amoxicillin and 25μg/mL to 0.048μg/mL for ranitidine was observed. Amoxicillin retention time was about 8 minutes and ranitidine retention time was around 12 minutes. Amoxicillin levels were computed and the concentrations were applied to calculate the pharmacokinetic parameters. Pharmacokinetic parameters were estimated by Kinetica TM 4.4.1 (Thermo Electron Corp. USA). The analysis of variance (two way) and t test (two one sided) were applied on log transformed pharmacokinetic parameters of amoxicillin. The Tmax was determined between amoxicillin alone and amoxicillin with ranitidine by Friedman test. The 90% confidence interval values for Cmax(calc) (0.687–0.743) and Tmax(calc) (1.148–1.742) for amoxicillin with or without ranitidine were not found within the FDA acceptable limits of 0.8–1.25. Study demonstrated the significant reduction in peak plasma levels of amoxicillin in presence of ranitidine. It is advisable to administer both drugs with time interval to avoid such interactions and increases in the bactericidal efficacy of amoxicillin.
Collapse
Affiliation(s)
- Shaheen Perveen
- Faculty of Pharmacy, Department of Pharmaceutics, University of Karachi, Karachi, Pakistan
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
- * E-mail:
| | - Shahnaz Gauhar
- RAK College of Pharmaceutical Sciences, RAK MHSU, Ras Al Khaimah, UAE
| | - Rabia Ismail Yousuf
- Faculty of Pharmacy, Department of Pharmaceutics, University of Karachi, Karachi, Pakistan
| | - Huma Ali
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Farya Zafar
- Faculty of Pharmacy, Department of Pharmaceutics, University of Karachi, Karachi, Pakistan
| | - Anab Fatima Sheikh
- College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
16
|
Tukukino C, Parodi López N, Svensson SA, Wallerstedt SM. Drug interaction alerts in older primary care patients, and related medically justified actions. Eur J Clin Pharmacol 2022; 78:1115-1126. [PMID: 35355082 PMCID: PMC9184366 DOI: 10.1007/s00228-022-03292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe presented interaction alerts in older patients, and the extent to which these require further medical action for the specific patient or are already being addressed. METHODS Interaction alerts presented at a physician consultation, for 274 consecutive primary care patients treated with two or more drugs (median age: 75 years; 59% female), were extracted. These alerts are based on Janusmed, a decision support integrated in the medical records that provides recommendations for managing the interactions. One general practitioner (GP) and one GP/clinical pharmacologist determined in retrospect, first independently and then in consensus, whether the alerts justified further medical action, considering each patient's health condition. RESULTS In all, 405 drug interaction alerts in 151 (55%) patients were triggered. Medical action in response was deemed medically justified for 35 (9%) alerts in 26 (17%) patients. These actions most often involved a switch to a less interacting drug from the same drug class (n = 10), a separate intake (n = 9), or the ordering of a laboratory test (n = 8). Out of 531 actions suggested by the alert system, only 38 (7%) were applicable to the specific patient, as, for instance, laboratory parameters were already being satisfactorily monitored or a separate intake implemented. CONCLUSIONS More than every other older patient receives drug treatment that triggers drug interaction alerts. Nine in ten alerts were already being addressed or were not relevant in the clinical setting, whereas, for the remaining tenth, some medical action, that for unknown reasons had not been taken, was reasonable. These findings show that interaction alerts are questionable as indicators of problematic prescribing.
Collapse
Affiliation(s)
- Carina Tukukino
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden
| | - Staffan A Svensson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Närhälsan Hjällbo Health Centre, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden. .,HTA-Centrum, Sahlgrenska University Hospital, Gothenburg, Sweden.
| |
Collapse
|
17
|
Rodríguez CL, Kaas‐Hansen BS, Eriksson R, Biel JH, Belling KG, Andersen SE, Brunak S. Drug interactions in hospital prescriptions in Denmark: Prevalence and associations with adverse outcomes. Pharmacoepidemiol Drug Saf 2022; 31:632-642. [PMID: 35124852 PMCID: PMC9303679 DOI: 10.1002/pds.5415] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/08/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022]
Abstract
Purpose While the beneficial effects of medications are numerous, drug–drug interactions may lead to adverse drug reactions that are preventable causes of morbidity and mortality. Our goal was to quantify the prevalence of potential drug–drug interactions in drug prescriptions at Danish hospitals, estimate the risk of adverse outcomes associated with discouraged drug combinations, and highlight the patient types (defined by the primary diagnosis of the admission) that appear to be more affected. Methods This cross‐sectional (descriptive part) and cohort study (adverse outcomes part) used hospital electronic health records from two Danish regions (~2.5 million people) from January 2008 through June 2016. We included all inpatients receiving two or more medications during their admission and considered concomitant prescriptions of potentially interacting drugs as per the Danish Drug Interaction Database. We measured the prevalence of potential drug–drug interactions in general and discouraged drug pairs in particular during admissions and associations with adverse outcomes: post‐discharge all‐cause mortality rate, readmission rate and length‐of‐stay. Results Among 2 886 227 hospital admissions (945 475 patients; median age 62 years [IQR: 41–74]; 54% female; median number of drugs 7 [IQR: 4–11]), patients in 1 836 170 admissions were exposed to at least one potential drug–drug interaction (659 525 patients; median age 65 years [IQR: 49–77]; 54% female; median number of drugs 9 [IQR: 6–13]) and in 27 605 admissions to a discouraged drug pair (18 192 patients; median age 68 years [IQR: 58–77]; female 46%; median number of drugs 16 [IQR: 11–22]). Meropenem‐valproic acid (HR: 1.5, 95% CI: 1.1–1.9), domperidone‐fluconazole (HR: 2.5, 95% CI: 2.1–3.1), imipramine‐terbinafine (HR: 3.8, 95% CI: 1.2–12), agomelatine‐ciprofloxacin (HR: 2.6, 95% CI: 1.3–5.5), clarithromycin‐quetiapine (HR: 1.7, 95% CI: 1.1–2.7) and piroxicam‐warfarin (HR: 3.4, 95% CI: 1–11.4) were associated with elevated mortality. Confidence interval bounds of pairs associated with readmission were close to 1; length‐of‐stay results were inconclusive. Conclusions Well‐described potential drug–drug interactions are still missed and alerts at point of prescription may reduce the risk of harming patients; prescribing clinicians should be alert when using strong inhibitor/inducer drugs (i.e. clarithromycin, valproic acid, terbinafine) and prevalent anticoagulants (i.e. warfarin and non‐steroidal anti‐inflammatory drugs ‐ NSAIDs) due to their great potential for dangerous interactions. The most prominent CYP isoenzyme involved in mortality and readmission rates was 3A4.
Collapse
Affiliation(s)
- Cristina Leal Rodríguez
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen Denmark
| | - Benjamin Skov Kaas‐Hansen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen Denmark
- Clinical Pharmacology Unit, Zealand University Hospital Roskilde Denmark
| | - Robert Eriksson
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen Denmark
- Department of Pulmonary and Infectious Diseases Nordsjællands Hospital Hillerød Denmark
| | - Jorge Hernansanz Biel
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen Denmark
| | - Kirstine G. Belling
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen Denmark
| | | | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen Denmark
| |
Collapse
|
18
|
Vicente-Valor J, Escudero-Vilaplana V, Collado-Borrell R, Pérez-Ramírez S, Villanueva-Bueno C, Narrillos-Moraza Á, García-Sánchez S, Beamud-Cortés M, Herranz A, Sanjurjo M. Potential and real drug interactions in patients treated with abiraterone or enzalutamide in clinical practice. Expert Opin Drug Metab Toxicol 2022; 17:1467-1473. [PMID: 35001772 DOI: 10.1080/17425255.2021.2027908] [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: 10/19/2022]
Abstract
BACKGROUND Abiraterone and enzalutamide, androgen receptor pathway inhibitors (ARPI) for the treatment of metastatic castration-resistant prostate cancer (mCRPC), are at high risk of potential drug interactions (PDIs). We aimed to describe PDIs and their management, and triggered adverse events (AEs) in clinical practice. METHODS We conducted a cross-sectional study in mCRPC patients who started treatment with abiraterone or enzalutamide in a university hospital between August 1st, 2016 and July 31st, 2020. Lexicomp® was used to identify and analyze PDIs, and the clinical records to assess their management and the occurrence of AEs. RESULTS We included 173 patients: 36.8% and 93.0% of patients treated with abiraterone and enzalutamide, respectively, had at least 1 PDI. Globally, 6.3% of PDIs had X-risk (contraindication due to high probability of AE). Treatment was modified in 9.2% of patients and 9.8% suffered AEs due to PDIs. Factors associated with a higher risk of PDIs were polypharmacy (OR=41.0, p=0.003) and treatment with enzalutamide (OR=128.26, p< 0.001). CONCLUSIONS At least two-thirds of patients treated with ARPI suffered a PDI. Overall, abiraterone would have a more favorable PDI profile. Knowing these interaction profiles may be helpful to develop a more efficient therapeutic follow-up and to select the safest treatment.
Collapse
Affiliation(s)
- Juan Vicente-Valor
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Roberto Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Sara Pérez-Ramírez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Cristina Villanueva-Bueno
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Álvaro Narrillos-Moraza
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Sebastián García-Sánchez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Manel Beamud-Cortés
- Urology Department, Hospital General Universitario Doctor Peset. Avenida de Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Ana Herranz
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - María Sanjurjo
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Doctor Esquerdo, 46, 28007 Madrid, Spain
| |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
Roca B, Roca M. Assessment of Drug Interactions with Online Electronic Checkers in Multi-Pathological Patients. Pharmacology 2021; 107:111-115. [PMID: 34818251 DOI: 10.1159/000518439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Multi-pathological patients are at high risk of drug interactions and side effects. We aimed to assess the usefulness of 3 online drug interaction checkers. METHODS In a cross-sectional study, carried out in the Medicine Department of Hospital General of Castellon, Spain, in February 2020, we assessed drug interaction detection with 3 online electronic checkers, Drugs.com, Lexicomp®, and Medscape, and compared results obtained with the 3 tools. From every hospitalized patient, we obtained the list of drugs he or she had been taking until admission. Bivariable tests were used for analysis. p values <0.05 were considered significant. RESULTS We included data from 134 patients; 68 (51%) were male; median (and interquartile range) of their age was 82 (76-88) years. A total of 1,082 substance drugs were entered in the checkers. The number of highest grade interactions found with every program was Drugs.com 85, Lexicomp® 33, and Medscape 67. Positive correlations were found between age and number of drug substances prescribed (p = 0.009) and between number of drug substances prescribed and interactions found with any of the 3 checkers (p < 0.001 in all 3 cases). Regarding highest grade interactions, agreement among all 3 checkers was poor. CONCLUSIONS The 3 online checkers we assessed found a large number of interactions. The 3 programs gave very discrepant results. Impact on Practice Statements: The analyzed programs, Drugs.com, Lexicomp®, and Medscape Interactions, found a large number of drug interactions in the studied patients. The 3 programs gave very discrepant results among them.
Collapse
Affiliation(s)
- Bernardino Roca
- Hospital General Universitario of Castellon, Universitat Jaume I, Castelló, Spain
| | - Manuel Roca
- Hospital of Vinaros, Universitat Jaume I, Castellon, Spain
| |
Collapse
|
21
|
Oka N, Kondo M, Matsubara H, Izushi K, Tasaka Y. [Potential Drug-Drug Interactions among Three or More Drugs: A Retrospective Multi-center Study in Pharmacies in the Kojima Region, Okayama]. YAKUGAKU ZASSHI 2021; 141:979-984. [PMID: 34193658 DOI: 10.1248/yakushi.20-00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Drug-drug interactions (DDIs) are responsible for an increase in the incidence of adverse drug reactions. Although CYP is known to be involved in metabolic processes, the DDIs among three or more drugs that involve the same CYP molecular species have not been fully investigated. In this study, we retrospectively examined the relationship between the number of drugs and potential DDIs in metabolic processes involving CYPs in patients who picked up their prescribed drugs at 11 pharmacies in the Kojima Branch of the Okayama Pharmaceutical Association. We found that 66.5% of the 924 patients had potential DDIs; more than half of the patients who took six or more drugs had potential DDIs among three or more drugs. The mean number of CYP3A4-related drugs involved in potential DDIs was 3.52±1.56 in patients who took seven drugs, suggesting the need for careful monitoring of specific symptoms and blood test results for the early detection of adverse drug reactions caused by DDIs among three or more drugs.
Collapse
Affiliation(s)
- Natsumi Oka
- Laboratory of Clinical Pharmacy, School of Pharmacy, Shujitsu University
| | | | | | | | - Yuichi Tasaka
- Laboratory of Clinical Pharmacy, School of Pharmacy, Shujitsu University
| |
Collapse
|
22
|
Hammar T, Hamqvist S, Zetterholm M, Jokela P, Ferati M. Current Knowledge about Providing Drug-Drug Interaction Services for Patients-A Scoping Review. PHARMACY 2021; 9:69. [PMID: 33805205 PMCID: PMC8103271 DOI: 10.3390/pharmacy9020069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
Drug-drug interactions (DDIs) pose a major problem to patient safety. eHealth solutions have the potential to address this problem and generally improve medication management by providing digital services for health care professionals and patients. Clinical decision support systems (CDSS) to alert physicians or pharmacists about DDIs are common, and there is an extensive body of research about CDSS for professionals. Information about DDIs is commonly requested by patients, but little is known about providing similar support to patients. The aim of this scoping review was to explore and describe current knowledge about providing digital DDI services for patients. Using a broad search strategy and an established framework for scoping reviews, 19 papers were included. The results show that although some patients want to check for DDIs themselves, there are differences between patients, in terms of demands and ability. There are numerous DDI services available, but the existence of large variations regarding service quality implies potential safety issues. The review includes suggestions about design features but also indicates a substantial knowledge gap highlighting the need for further research about how to best design and provide digital DDI to patients without risking patient safety or having other unintended consequences.
Collapse
Affiliation(s)
- Tora Hammar
- Department of Medicine and Optometry, The eHealth Institute, Linnaeus University, 391 82 Kalmar, Sweden;
| | - Sara Hamqvist
- Department of Media and Journalism, Linnaeus University, 391 82 Kalmar, Sweden;
| | - My Zetterholm
- Department of Medicine and Optometry, The eHealth Institute, Linnaeus University, 391 82 Kalmar, Sweden;
- Department of Informatics, Linnaeus University, 391 82 Kalmar, Sweden; (P.J.); (M.F.)
| | - Päivi Jokela
- Department of Informatics, Linnaeus University, 391 82 Kalmar, Sweden; (P.J.); (M.F.)
| | - Mexhid Ferati
- Department of Informatics, Linnaeus University, 391 82 Kalmar, Sweden; (P.J.); (M.F.)
| |
Collapse
|