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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.
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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
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Hughes JE, Waldron C, Bennett KE, Cahir C. Prevalence of Drug-Drug Interactions in Older Community-Dwelling Individuals: A Systematic Review and Meta-analysis. Drugs Aging 2023; 40:117-134. [PMID: 36692678 PMCID: PMC9925489 DOI: 10.1007/s40266-022-01001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Drug-drug interactions (DDIs) can lead to medication-related harm, and the older population is at greatest risk. We conducted a systematic review and meta-analysis to estimate DDI prevalence and identify common DDIs in older community-dwelling adults. METHODS PubMed and EMBASE were searched for observational studies published between 01/01/2010 and 10/05/2021 reporting DDI prevalence in community-dwelling individuals aged ≥ 65 years. Nursing home and inpatient hospital studies were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Meta-analysis was performed using a random-effects model with logit transformation. Heterogeneity was evaluated using Cochran's Q and I2. DDI prevalence and 95% confidence intervals (CIs) are presented. All analyses were performed in R (version 4.1.2). RESULTS There were 5144 unique articles identified. Thirty-three studies involving 17,011,291 community-dwelling individuals aged ≥ 65 years met inclusion criteria. Thirty-one studies reported DDI prevalence at the study-participant level, estimates ranged from 0.8% to 90.6%. The pooled DDI prevalence was 28.8% (95% CI 19.3-40.7), with significant heterogeneity (p < 0.10; I2 = 100%; tau2 = 2.13) largely explained by the different DDI identification methods. Therefore, 26 studies were qualitatively synthesised and seven studies were eligible for separate meta-analyses. In a meta-analysis of three studies (N = 1122) using Micromedex®, pooled DDI prevalence was 57.8% (95% CI 52.2-63.2; I2 = 69.6%, p < 0.01). In a meta-analysis of two studies (N = 809,113) using Lexi-Interact®, pooled DDI prevalence was 30.3% (95% CI 30.2-30.4; I2 = 6.8%). In a meta-analysis of two studies (N = 947) using the 2015 American Geriatrics Society Beers criteria®, pooled DDI prevalence was 16.6% (95% CI 5.6-40.2; I2 = 97.5%, p < 0.01). Common DDIs frequently involved cardiovascular drugs, including ACE inhibitor-potassium-sparing diuretic; amiodarone-digoxin; and amiodarone-warfarin. CONCLUSIONS DDIs are prevalent among older community-dwelling individuals; however, the methodology used to estimate these events varies considerably. A standardised methodology is needed to allow meaningful measurement and comparison of DDI prevalence.
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Affiliation(s)
- John E Hughes
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
| | - Catherine Waldron
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Kathleen E Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Caitriona Cahir
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Maideen NMP, Balasubramanian R, Muthusamy S, Nallasamy V. An Overview of Clinically Imperative and Pharmacodynamically Significant Drug Interactions of Renin-Angiotensin-Aldosterone System (RAAS) Blockers. Curr Cardiol Rev 2022; 18:e110522204611. [PMID: 35546745 PMCID: PMC9893153 DOI: 10.2174/1573403x18666220511152330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hypertension is a leading cause of cardiovascular disease and chronic kidney disease, resulting in premature death and disability. The Renin-Angiotensin-Aldosterone System (RAAS) blockers, including Angiotensin-Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs), are used as first-line antihypertensive therapy to treat hypertensive patients with comorbidities, including diabetes, ischemic heart disease, heart failure, and chronic kidney disease. The use of RAS blockers is associated with the risks, such as hyperkalemia, angioedema, etc. The drugs potentiating them interact pharmacodynamically, resulting in adverse consequences. This review article focuses on the clinically important drug interactions of RAAS blockers. MATERIALS AND METHODS The electronic databases, such as Medline/PubMed Central/PubMed, Google Scholar, ScienceDirect, Cochrane Library, Directory of Open Access Journals (DOAJ), Embase, and reference lists were searched to identify relevant articles. RESULTS The risk of hyperkalemia may be enhanced potentially in patients receiving a RAS blocker and potassium-sparing diuretics, potassium supplements, trimethoprim, adrenergic betablockers, antifungal agents, calcineurin inhibitors, pentamidine, heparins or an NSAID, concomitantly. The patients taking ACE inhibitors and mTOR inhibitors, DPP4 inhibitors, alteplase, or sacubitril/valsartan concurrently may be at increased risk of developing angioedema. CONCLUSION Clinicians, pharmacists, and other healthcare practitioners should be accountable for medication safety. To avoid adverse implications, prescribers and pharmacists must be aware of the drugs that interact with RAAS blockers.
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Affiliation(s)
| | | | - Sudha Muthusamy
- Department of Pharmacology, J.K.K. Nattraja College of Pharmacy, Komarapalayam- 638 183, India
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Hughes JE, Russo V, Walsh C, Menditto E, Bennett K, Cahir C. Prevalence and Factors Associated with Potential Drug-Drug Interactions in Older Community-Dwelling Adults: A Prospective Cohort Study. Drugs Aging 2021; 38:1025-1037. [PMID: 34632551 PMCID: PMC8594274 DOI: 10.1007/s40266-021-00898-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Older patients are at increased risk of drug-drug interactions (DDIs) due to polypharmacy. Cardiovascular and central nervous system (CNS) drugs are commonly implicated in serious DDIs. OBJECTIVES This study aimed to determine the prevalence and factors associated with potential 'severe' cardiovascular and CNS DDIs among older (≥ 70 years) community-dwellers. METHODS This was a prospective cohort study using linked data from a national pharmacy claims database and waves 1 and 2 of The Irish LongituDinal study on Ageing (TILDA). 'Severe' cardiovascular and CNS DDIs were identified using the British National Formulary 77 and Stockley's Drug Interactions. The prevalence of 'severe' DDIs (any DDI vs. none) was calculated. Logistic regression was used to examine the association between sociodemographic, functional ability, and medication-related factors and the risk of DDI exposure between waves 1 and 2. RESULTS A total of 1466 patients were included [mean age (standard deviation) = 78 (5.5) years; female n = 795, 54.2%]. In total, 332 community-dwellers aged ≥ 70 years [22.65%, 95% confidence interval (CI) 20.58-24.86] were potentially exposed to at least one 'severe' cardiovascular or CNS DDI, with more than half (54.82%) of this cohort dispensed the same DDI for a prolonged time (≥ 3 consecutive claims). Aspirin-warfarin was the most frequently dispensed (co-prescribed) DDI (n = 34, 10.24%, 95% CI 7.39-14.00), followed by atorvastatin-clarithromycin (n = 19, 5.72%, 95% CI 3.64-8.81). Polypharmacy [≥ 10 vs. < 5 drugs, odds ratio (OR) 13.40, 95% CI 8.22-21.85] and depression (depressed vs. not, OR 2.12, 95% CI 1.34-3.34) were significantly associated with these DDIs, after multivariable adjustment. CONCLUSION 'Severe' cardiovascular and CNS DDIs are prevalent in older community-dwellers in Ireland, and those with polypharmacy and depression are at a significantly increased risk.
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Affiliation(s)
- John E Hughes
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Veronica Russo
- Department of Pharmacy, CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Local Health Units (LHU) ROME 1, Rome, Italy
| | - Caroline Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Enrica Menditto
- Department of Pharmacy, CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Saldarreaga Marin A, Cendros M, Ciudad CJ, Sabater A. Case Report: Fatigue and Bleeding in a Polymedicated Patient Using Several Herbal Supplementations, Detected with g-Nomic® Software. Pharmgenomics Pers Med 2021; 14:963-970. [PMID: 34408471 PMCID: PMC8367204 DOI: 10.2147/pgpm.s323463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
This was a case report of severe fatigue and bleeding in a 65-year-old man with ischemic heart disease who was wearing a stent and taking multiple medications for hypertension and diabetes. The use of a drug interaction and personalized prescription software (g-Nomic®) revealed potential interactions, involving acetylsalicylic acid and several non-pharmaceutical products including ginger, blueberry extracts, pineapple juice, docosahexaenoic acid and liquorice. Correction of these interactions resulted in complete remission of the reported side effects. This supports the idea that non-pharmaceuticals potentiated the effects of acetylsalicylic acid on haemostasis, producing the bleeding that would have caused fatigue. It is important to use appropriate tools to detect drug interactions that also take into account commonly used non-pharmaceutical products. Drug interactions can be considered illnesses by themselves.
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Affiliation(s)
- Abel Saldarreaga Marin
- Bahía de Cádiz-La Janda Health District, Mobile Emergency Unit of the Andalusian Health Care, Service of Cádiz, Cádiz, Spain
| | | | - Carlos J Ciudad
- Biochemistry and Molecular Biology Unit, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Ana Sabater
- Eugenomic, Barcelona, Spain
- Correspondence: Ana Sabater Eugenomic, c/ Londres 6, Barcelona, 08029, SpainTel +34-93-292-2963 Email
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Szilvay A, Somogyi O, Dobszay A, Meskó A, Zelkó R, Hankó B. Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them-A multicenter descriptive study according to medication reviews in Hungarian community pharmacies. PLoS One 2021; 16:e0253645. [PMID: 34157039 PMCID: PMC8219127 DOI: 10.1371/journal.pone.0253645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The study examined the Drug-Related Problems (DRPs) of patients with polypharmacy in 78 Hungarian community pharmacies, especially the interaction risks in terms of their clinical severity. Also, the objective was to analyze pharmacists’ interventions to solve the identified interaction risks. Methodology The research was carried out in the framework of the training of specialist pharmacists at Semmelweis University, with the participation of 78 graduated pharmacists with the collaboration of 98 GPs. A total of 755 patients participated in pharmaceutical counseling which meant a medication review process. DRPs were uniformly categorized and the interventions were recorded by pharmacists, while a detailed analysis of interaction risks was performed by authors. Results A total of 984 DRPs were registered. The most common category of DRPs was the "non-quantitative safety problems" (62.6%). Interaction risk was the most common cause of DRPs (54.0%). The highest proportion of interaction risks were between two prescription drugs (66.7%). In 30.7% of interaction risks’ cases, there was not known negative outcome. In contrast, it was recommended to modify the therapy in 14.9% of interaction risks. Acetylsalicylic acid (22.8%), acenocoumarol (17.7%), and diclofenac (13.9%) were the most common active substances which caused serious interaction risks. A total of 599 pharmacist interventions were used to solve the 531 interaction risks. Pharmacists notified the GPs about the problem in 28.4% of cases and they intervened without the GP in 63.1% of cases, most often with patient education (27.4%). Conclusion Medication review by community pharmacists is required for the safe medicine using of patients with polypharmacy, as a significant number of DRPs have been recorded. The incidence of interaction risks stood out. It is essential to develop a pharmaceutical guideline to properly classify the clinical relevance of interaction risks (e.g. according to high-risk active substances) and to increase the collaboration with GPs.
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Affiliation(s)
- András Szilvay
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Orsolya Somogyi
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Annamária Dobszay
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Attiláné Meskó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Romána Zelkó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Balázs Hankó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
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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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Pattern and Appropriateness of Medicines Prescribed to Outpatients at a University Hospital in Northwestern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3729401. [PMID: 29404369 PMCID: PMC5748306 DOI: 10.1155/2017/3729401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/26/2017] [Indexed: 12/28/2022]
Abstract
The study assessed the pattern and appropriateness of medicines prescribed to outpatients at Gondar University Referral Hospital in northwestern Ethiopia. An institution-based cross-sectional study was employed, through interviews and prescription reviews, among 346 patients at the outpatient pharmacy, from 2nd to 20th of May 2016. Data on sociodemographic profile of patients and medicines prescribed to them were collected. A mean of 1.72 medicines per encounter was prescribed, over a third of the total being anti-infectives. Patients were able to get about 85% of these medicines. An unskilled government employee would be required to work more than one and a half day to be able to afford the average priced medicine. Among prescriptions with two or more medicines, more than a third had at least one potential drug-drug interaction (PDDI), the commonest pair containing amoxicillin and doxycycline. Being male, being older (50–59 years), and increased number of medicines were associated with higher likelihood of PDDIs. In conclusion, the number of medicines prescribed per encounter was up to accepted standard. However, their availability fell short, together with considerable cost. Regarding appropriateness, a significant proportion of potential drug-drug interactions is identified and associated with patient's sex, age, and number of medicines prescribed.
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