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Kalash A, Abdelrahman A, Al-Zakwani I, Al Suleimani Y. Potentially Harmful Drug-Drug Interactions and Their Associated Factors Among Hospitalized Cardiac Patients: A Cross-Sectional Study. Drugs Real World Outcomes 2023; 10:371-381. [PMID: 37178272 PMCID: PMC10491557 DOI: 10.1007/s40801-023-00373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are responsible for a significant proportion of mortalities worldwide. Elderly patients are the most affected by cardiovascular diseases, and because of factors such as polypharmacy, multimorbidity, and age-related changes in drug availability and metabolism, they are highly susceptible to the occurrence of drug-drug interactions. Drug-drug interactions are among the many drug-related problems leading to negative outcomes among inpatients and outpatients. Thus, it is important to investigate the prevalence, involved drugs, and factors related to potential drug-drug interactions (pDDIs) to properly optimize pharmacotherapy regimens for these patients. OBJECTIVE We aimed to determine the prevalence of pDDIs, drugs most frequently implicated, and significant predictors associated with these interactions among hospitalized patients in the Cardiology Unit at Sultan Qaboos University Hospital in Muscat, Oman. METHODS This retrospective cross-sectional study included 215 patients. Micromedex Drug-Reax® was used to identify pDDIs. Data extracted from patients' medical records were collected and analyzed. Univariable and multivariable linear regression was applied to determine the predictors associated with the observed pDDIs. RESULTS A total of 2057 pDDIs were identified, with a median of nine (5-12) pDDIs per patient. Patients with at least one pDDI accounted for 97.2% of all the included patients. The majority of pDDIs were of major severity (52.6%), fair level of documentation (45.5%), and pharmacodynamic basis (55.9%). Potential drug-drug interactions between atorvastatin and clopidogrel were the most frequently observed (9%). Of all the detected pDDIs, around 79.6% of them included at least one antiplatelet drug. Having diabetes mellitus as a comorbidity (B = 2.564, p < 0.001) and the number of drugs taken during the hospitalization period (B = 0.562, p < 0.001) were factors positively associated with the frequency of pDDIs. CONCLUSIONS Potential drug-drug interactions were highly prevalent among hospitalized cardiac patients at Sultan Qaboos University Hospital, Muscat, Oman. Patients having diabetes as a comorbidity and with a high number of administered drugs were at a higher risk of an increased number of pDDIs.
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Affiliation(s)
- Abdulrahman Kalash
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. BOX 35, PC 123 Al Khoudh, Muscat, Oman
| | - Aly Abdelrahman
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. BOX 35, PC 123 Al Khoudh, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. BOX 35, PC 123 Al Khoudh, Muscat, Oman
| | - Yousuf Al Suleimani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. BOX 35, PC 123 Al Khoudh, Muscat, Oman.
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Spanakis M, Ioannou P, Tzalis S, Chouzouri F, Patelarou E, Kofteridis DP, Antoniou KM, Schiza SE, Patelarou A, Tzanakis N. Evaluation of Drug Interactions in Hospitalized Patients with Respiratory Disorders in Greece. Adv Respir Med 2023; 91:74-92. [PMID: 36825942 PMCID: PMC9952796 DOI: 10.3390/arm91010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
Background: Patients with respiratory disorders often have additional diseases and are usually treated with more than one medication to manage their respiratory conditions as well as additional comorbidities. Thus, they are frequently exposed to polypharmacy (≥5 drugs), which raises the risk for drug-drug interactions (DDIs) and adverse drug reactions (ADRs). In this work, we present the results regarding the prevalence of DDIs in hospitalized patients with respiratory disorders in Greece. Methods: A 6-month descriptive single-center retrospective observational study enrolled 102 patients with acute or chronic respiratory disorders. Clinical characteristics and medication regimens were recorded upon admission, hospitalization, and discharge. The prevalence of DDIs and their clinical significance was recorded and analyzed. Results: Unspecified acute lower respiratory tract infection (25%), exacerbations of chronic obstructive pulmonary disease (12%) and pneumonia (8%) were the most frequent reasons for admission. Cardiovascular disorders (46%), co-existing respiratory disorders (32%), and diabetes (25%) were the most prevalent comorbidities. Polypharmacy was noted in 61% of patients upon admission, 98% during hospitalization, and 63% upon discharge. Associated DDIs were estimated to be 55% upon admission, 96% throughout hospitalization, and 63% on discharge. Pharmacodynamic (PD) DDIs were the most prevalent cases (81%) and referred mostly to potential risk for QT-prolongation (31.4% of PD-DDIs) or modulation of coagulation process as expressed through the international normalized ratio (INR) (29.0% of DDIs). Pharmacokinetic (PK) DDIs (19% of DDIs) were due to inhibition of Cytochrome P450 mediated metabolism that could lead to elevated systemic drug concentrations. Clinically significant DDIs characterized as "serious-use alternative" related to 7% of cases while 59% of DDIs referred to combinations that could be characterized as "use with caution-monitor". Clinically significant DDIs mostly referred to medication regimens upon admission and discharge and were associated with outpatient prescriptions. Conclusions: Hospitalized patients with respiratory disorders often experience multimorbidity and polypharmacy that raise the risk of DDIs. Clinicians should be conscious especially if any occurring arrhythmias, INR modulations, and prolonged or increased drug action is associated with DDIs.
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Affiliation(s)
- Marios Spanakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research & Technology-Hellas (FORTH), GR-70013 Heraklion, Crete, Greece
- Correspondence:
| | - Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Sotiris Tzalis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Flora Chouzouri
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Evridiki Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Katerina M. Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Sophia E. Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Nikos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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Spanakis M, Ioannou P, Tzalis S, Papakosta V, Patelarou E, Tzanakis N, Patelarou A, Kofteridis DP. Drug-Drug Interactions among Patients Hospitalized with COVID-19 in Greece. J Clin Med 2022; 11:jcm11237172. [PMID: 36498745 PMCID: PMC9740400 DOI: 10.3390/jcm11237172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
The modulation of the pharmacological action of drugs due to drug-drug interactions (DDIs) is a critical issue in healthcare. The aim of this study was to evaluate the prevalence and the clinical significance of potential DDIs in patients admitted to the University Hospital of Heraklion in Greece with coronavirus disease 2019 (COVID-19). Cardiovascular disorders (58.4%) and diabetes (types I and II) (29.6%) were the most common comorbidities. A high occurrence of DDIs was observed, and clinically significant DDIs that may hamper response to treatment represented 40.3% of cases on admission, 21% during hospitalization, and 40.7% upon discharge. Polypharmacy and comorbidities were associated with a higher prevalence of DDIs in a statistically significant way (p < 0.05, 95% CI). Clinically significant DDIs and increased C-reactive protein values upon admission were associated with prolonged hospitalization. The results reveal that patients admitted due to COVID-19 in Greece often have an additional burden of DDIs that healthcare teams should approach and resolve.
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Affiliation(s)
- Marios Spanakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
- Correspondence:
| | - Petros Ioannou
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Sotiris Tzalis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Vasiliki Papakosta
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Evridiki Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece
| | - Nikos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
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Perić A, Udilović A, Dobrić S, Vezmar Kovačević S. The impact of treatment choices on potential drug-drug interactions in hypertensive patients. Br J Clin Pharmacol 2021; 88:2340-2348. [PMID: 34862631 DOI: 10.1111/bcp.15168] [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: 07/20/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim of this study was to analyse potential drug-drug interactions (pDDIs) and their potential adverse drug reactions (ADRs) among hypertensive patients. Moreover, we investigated the possibility of reducing pDDIs with different treatment choices. METHODS This was a cross-sectional study including all outpatients with hypertension and two or more medications, treated in a university hospital in Serbia. Lexicomp Interact (Lexi-Comp, Inc., Hudson, OH) was used for identification of pDDIs and potential ADRs. Treatment choices were explored according to patient characteristics, treatment guidelines and the interacting potential of drugs. Data were analysed using descriptive analysis and multiple logistic regression. RESULTS A total of 350 patients were included in this study, with average age (77 [36-98] years and 6.1 [2.5]) medications. The majority of patients (86.0%) had at least one clinically significant pDDI, and the average was 3.78 (3.90) (range 1-25). Suggestions for treatment change aimed mainly at eliminating drug duplications, reducing the use of thiazide diuretics, sulfonylureas, alpha-lipoic acid and pentoxifylline and increasing the use of calcium-channel blockers, when appropriate. pDDIs would have decreased to 2.10 (2.52), P <.001, yet male gender, ≥6 medications, cardiovascular diseases, diabetes, benign prostatic hyperplasia, would be predictive of two or more pDDIs. The main potential adverse outcomes of pDDIs were hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis. CONCLUSION Careful choice of drugs can reduce but not eliminate pDDIs and their potential ADRs in hypertensive patients. Close monitoring for hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis is necessary.
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Affiliation(s)
- Aneta Perić
- Sector for Pharmacy, Military Medical Academy, Belgrade, Serbia.,Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Ana Udilović
- Deutsche Rentenversicherung Bayern Süd Rehafachzentrum Bad Füssing-Passau Standort Passau, Pasau, Germany
| | - Silva Dobrić
- Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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Lopes M, Coimbra MA, Costa MDC, Ramos F. Food supplement vitamins, minerals, amino-acids, fatty acids, phenolic and alkaloid-based substances: An overview of their interaction with drugs. Crit Rev Food Sci Nutr 2021:1-35. [PMID: 34792411 DOI: 10.1080/10408398.2021.1997909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Food supplements are a widespread group of products ingested as a diet complement, whose consumption has recently skyrocketed due to the consumers' concern with their well-being. Among food supplements, vitamin- and mineral-based ones are the top sellers, and the demand of others, such as those containing polyphenols, is increasing. Owing to their alleged natural characteristics, consumers take the safety of food supplements for granted, and use them even when taking medicines. Thus, their potential interactions with drugs have been sparsely evaluated. This manuscript aims to bring forth an up-to-date overview of the most important knowledge involving the interactions between food supplements and drugs, relevant to be aware by nutritionists and other healthcare professionals. To this end, an extensive bibliographic review was conducted focusing on peer reviewed data from experimental in vivo evidence and clinical studies whenever major clinical interactions have been reported. Elder people and polymedicated or chronic patients are especially vulnerable to the therapeutic ineffectiveness and toxicity caused by these types of interactions. Drugs used to treat cardiovascular, autoimmune, nervous, and oncological diseases are commonly involved in important clinical interactions with food supplements, many with a narrow therapeutic margin.
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Affiliation(s)
- Maria Lopes
- Faculty of Pharmacy, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal.,REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, Oporto, Portugal
| | - Manuel A Coimbra
- LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal.,Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal
| | - Maria do Céu Costa
- Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal.,CBIOS-Universidade Lusófona's Research Centre for Biosciences & Health Technologies, Lisboa, Portugal.,NICiTeS, Polytechnic Institute of Lusophony, ERISA-Escola Superior de Saúde Ribeiro Sanches, Lisboa, Portugal
| | - Fernando Ramos
- Faculty of Pharmacy, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal.,REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, Oporto, Portugal.,Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal
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Spanakis M, Patelarou A, Patelarou E, Tzanakis N. Drug Interactions for Patients with Respiratory Diseases Receiving COVID-19 Emerged Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11711. [PMID: 34770225 PMCID: PMC8583457 DOI: 10.3390/ijerph182111711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 12/28/2022]
Abstract
Pandemic of coronavirus disease (COVID-19) is still pressing the healthcare systems worldwide. Thus far, the lack of available COVID-19-targeted treatments has led scientists to look through drug repositioning practices and exploitation of available scientific evidence for potential efficient drugs that may block biological pathways of SARS-CoV-2. Till today, several molecules have emerged as promising pharmacological agents, and more than a few medication protocols are applied during hospitalization. On the other hand, given the criticality of the disease, it is important for healthcare providers, especially those in COVID-19 clinics (i.e., nursing personnel and treating physicians), to recognize potential drug interactions that may lead to adverse drug reactions that may negatively impact the therapeutic outcome. In this review, focusing on patients with respiratory diseases (i.e., asthma or chronic obstructive pulmonary disease) that are treated also for COVID-19, we discuss possible drug interactions, their underlying pharmacological mechanisms, and possible clinical signs that healthcare providers in COVID-19 clinics may need to acknowledge as adverse drug reactions due to drug-drug interactions.
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Affiliation(s)
- Marios Spanakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, GR-71004 Heraklion, Crete, Greece; (A.P.); (E.P.)
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research & Technology-Hellas (FORTH), GR-70013 Heraklion, Crete, Greece
| | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, GR-71004 Heraklion, Crete, Greece; (A.P.); (E.P.)
| | - Evridiki Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, GR-71004 Heraklion, Crete, Greece; (A.P.); (E.P.)
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, GR-71303 Heraklion, Crete, Greece;
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Choi MK, Song IS. Pharmacokinetic Drug-Drug Interactions and Herb-Drug Interactions. Pharmaceutics 2021; 13:pharmaceutics13050610. [PMID: 33922481 PMCID: PMC8146483 DOI: 10.3390/pharmaceutics13050610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Min-Koo Choi
- College of Pharmacy, Dankook University, Cheon-an 31116, Korea;
| | - Im-Sook Song
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, Vessel-Organ Interaction Research Center (VOICE), Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu 41566, Korea
- Correspondence: ; Tel.: +82-53-950-8575; Fax: +82-53-950-8557
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