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Ketenci S, Akpınar G. Potential drug-drug interactions in adults receiving oral anticoagulant and antiaggregant therapy. Expert Opin Drug Saf 2023; 22:733-739. [PMID: 36860167 DOI: 10.1080/14740338.2023.2186397] [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: 11/22/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Anticoagulant and antiaggregant drugs are drug groups with high mortality and the most common cause of malpractice. RESEARCH DESIGN AND METHODS 18 and 65 years were scheduled for pharmacotherapy in the Family Health Center. 122 patients during their anticoagulant and/or antiaggregant treatment were evaluated in terms of drug-drug interactions. RESULTS Drug-drug interactions were detected in 89.7% of the patients included in the study. A total of 212 drug-drug interactions were found in 122 patients. Of these, 12 (5.6%) were identified as A, 16 (7.5%) B, 146 (68.6%) C, 32 (15.2%) D and 6 (2.8%) X risk category. The number of DDI was found to be significantly higher in patients aged between 56 and 65 years. The most drug interactions are significantly higher in the C and D categories, respectively. The most predicted clinical outcomes of DDI's were increased in the therapeutic effect and adverse/toxic reactions. CONCLUSIONS Contrary to expectations, it is seen that although polypharmacy is relatively less in patients aged 18-65 years compared to patients over 65 years of age, it is very important to detect drug interactions in this age group in terms of safety, efficacy and treatment benefit in terms of drug-drug interaction.
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Affiliation(s)
- Sema Ketenci
- Faculty of Medicine, Department of Medical Phamacology, Atlas University, Kagıthane, Turkiye
| | - Gökçe Akpınar
- Turkish Ministry of Health, Gebze Family Health Center, Istanbul, Turkiye
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Turossi-Amorim ED, Camargo B, Schuelter-Trevisol F. Prevalence of Potential Pharmacological Interactions in Patients Undergoing Systemic Chemotherapy in a Tertiary Hospital. Hosp Pharm 2022; 57:646-653. [PMID: 36081531 PMCID: PMC9445545 DOI: 10.1177/00185787211073464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Introduction: Pharmacological interactions are frequently observed in patients with chronic diseases, and their occurrence is proportional to the amount of medication used daily. Patients undergoing chemotherapy treatment commonly have comorbidities, which favor a greater prevalence of polypharmacy, increasing the risk of drug interactions. Therefore, the aim of this study was to estimate the prevalence of drug interactions in patients undergoing intravenous chemotherapy treated at a hospital oncology service in southern Brazil. Methods: This was an observational study with a cross-sectional design that was carried out with the analysis of secondary data obtained through the review of medical records. The population assessed consisted of all cancer patients who received intravenous chemotherapy from October to December 2020. Results: Out of the 297 patients included in the study, 231 (77.8%) had at least 1 potential pharmacological interaction. In total, 1044 drug interactions were found that were classified according to severity, resulting in 18 (1.7%) contraindicated drug-drug interactions (DDI), 699 (67%) severe, 281 (26.9%) moderate, and 46 (4.4%) minor interactions. There was an association between polypharmacy and the prevalence of drug interactions. Conclusion: The results demonstrate that a large percentage of patients undergoing chemotherapy are susceptible to drug interactions. Thus, it is necessary that prescribers consider all drugs used by patients and, when possible, prescribe alternative drugs that have less potential for interaction in order to prevent drug interactions adverse effects and provide a better prognosis for patients.
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Affiliation(s)
| | - Bruna Camargo
- University of Southern Santa Catarina, Tubarao, Brazil
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Ambulatory Medication Safety in Primary Care: A Systematic Review. J Am Board Fam Med 2022; 35:610-628. [PMID: 35641040 PMCID: PMC9730343 DOI: 10.3122/jabfm.2022.03.210334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To review the literature on medication safety in primary care in the electronic health record era. METHODS Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias. RESULTS Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm. CONCLUSIONS This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.
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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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Rogero-Blanco E, Del-Cura-González I, Aza-Pascual-Salcedo M, García de Blas González F, Terrón-Rodas C, Chimeno-Sánchez S, García-Domingo E, López-Rodríguez JA. Drug interactions detected by a computer-assisted prescription system in primary care patients in Spain: MULTIPAP study. Eur J Gen Pract 2021; 27:90-96. [PMID: 33982632 PMCID: PMC8128212 DOI: 10.1080/13814788.2021.1917543] [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] [Indexed: 11/09/2022] Open
Abstract
Background Drug interactions increase the risk of treatment failure, intoxication, hospital admissions, consultations and mortality. Computer-assisted prescription systems can help to detect interactions. Objectives To describe the drug–drug interaction (DDI) and drug–disease interaction (DdI) prevalence identified by a computer-assisted prescription system in patients with multimorbidity and polypharmacy. Factors associated with clinically relevant interactions were analysed. Methods Observational, descriptive, cross-sectional study in primary health care centres was undertaken in Spain. The sample included 593 patients aged 65–74 years with multimorbidity and polypharmacy participating in the MULTIPAP Study, recruited from November 2016 to January 2017. Drug interactions were identified by a computer-assisted prescription system. Descriptive, bivariate, and multivariate analyses with logistic regression models and robust estimators were performed. Results Half (50.1% (95% CI 46.1–54.1)) of the patients had at least one relevant DDI and 23.9% (95% CI 18.9–25.6) presented with a DdI. Non-opioid–central nervous system depressant drug combinations and benzodiazepine–opioid drug combinations were the two most common clinically relevant interactions (10.8% and 5.9%, respectively). Factors associated with DDI were the use of more than 10 drugs (OR 11.86; 95% CI 6.92–20.33) and having anxiety/depressive disorder (OR 1.98; 95% CI 1.31–2.98). Protective factors against DDI were hypertension (OR 0.62; 95% CI 0.41–0.94), diabetes (OR 0.57; 95% CI 0.40–0.82), and ischaemic heart disease (OR 0.43; 95% CI 0.25–0.74). Conclusion Drug interactions are prevalent in patients aged 65–74 years with multimorbidity and polypharmacy. The clinically relevant DDI frequency is low. The number of prescriptions taken is the most relevant factor associated with presenting a clinically relevant DDI.
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Affiliation(s)
- Eloísa Rogero-Blanco
- Primary Health Care Center General Ricardos, Madrid, Spain.,URJC International Doctoral School, Interuniversity Program of Epidemiology and Public Health, Madrid, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Isabel Del-Cura-González
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Research Support Unit, Primary Care Management, Madrid, Spain.,Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
| | | | - Francisca García de Blas González
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Primary Care Management, Mendiguchia Carriche Health Center (Leganés, Madrid, Spain), Madrid, Spain
| | | | | | - Eva García-Domingo
- Multiprofessional Teaching Unit of Family and Community Medicine of the Málaga/Guadalhorce Healthcare District, Malaga, Spain
| | - Juan A López-Rodríguez
- Primary Health Care Center General Ricardos, Madrid, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Research Support Unit, Primary Care Management, Madrid, Spain.,Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
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Kardas P, Urbański F, Lichwierowicz A, Chudzyńska E, Czech M, Makowska K, Kardas G. The Prevalence of Selected Potential Drug-Drug Interactions of Analgesic Drugs and Possible Methods of Preventing Them: Lessons Learned From the Analysis of the Real-World National Database of 38 Million Citizens of Poland. Front Pharmacol 2021; 11:607852. [PMID: 33536918 PMCID: PMC7849760 DOI: 10.3389/fphar.2020.607852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Drug-drug interactions may lead to poor health outcomes, as well as increased costs and utilization of healthcare services. Unfortunately, real-world data continuously prove high prevalence of potential drug-drug interactions (pDDIs) worldwide. Among identified drivers, ageing, multimorbidity and polypharmacy play a very important role. With these factors being widespread, the need for implementation of strategies minimizing the burden of pDDIs becomes an urgency. This, however, requires a better understanding of the prevalence of pDDIs and the underlying causative factors. Aim of study: To assess the real-world prevalence of pDDIs and its characteristics in the general population of Poland, using analgesic drugs as a model, and to find out whether pDDIs are caused by prescribing coming from the very same prescribers (co-prescribing). Methods: A retrospective analysis of the 2018 dispensation data of the National Health Fund (NHF) - the only Polish public healthcare payer organization with nationwide coverage. We searched for selected pDDIs of non-steroidal anti-inflammatory drugs (NSAIDs) with antihypertensives, other NSAIDs (double use), oral glucocorticoids, oral anticoagulants, selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and antiplatelet drugs; as well as opioides with SSRIs, SNRIs, gabapentinoids, and benzodiazepines. A pDDI was deemed present if two drugs standing in a possible conflict were dispensed within the same calendar month. Results: Out of 38.4 million citizens of Poland, 23.3 million were dispensed prescribed drugs reimbursed by NHF in 2018. In this cohort, we have identified 2,485,787 cases of analgesic drug pDDIs, corresponding with 6.47% of the Polish population. Out of these, the most prevalent pDDI was caused by “NSAIDs + antihypertensives” (1,583,575 cases, i.e., 4.12% of the Polish population), followed by “NSAIDs + NSAIDs” (538,640, 1.40%) and “NSAIDs + glucocorticoids” (213,504, 0.56%). The most persistent pDDIs among those studied were caused by “Opioids + Gabapentinoids” (2.19, 95%CI: 2.16–2.22 months). On average, 76.63% of all cases of pDDIs were caused by drugs prescribed by the very same prescribers. Conclusion: Based on high-quality, nationwide data, we have found a high prevalence of analgesic drugs-related pDDIs in Poland. Over ¾ of the identified pDDIs were caused by co-prescribing, i.e., prescriptions issued by the same prescribers. The significance of the problem, illustrated with our findings on analgesic drugs-related pDDIs in Poland, deserves much more scientific and policymaker attention.
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Affiliation(s)
- Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | | | | | | | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
| | | | - Grzegorz Kardas
- Department of Internal Diseases, Asthma and Allergy, Medical University of Lodz, Łódź, Poland
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Rahman MM, Howard G, Qian J, Garza K, Abebe A, Hansen R. Disparities in all-cause mortality with potentially inappropriate medication use: Analysis of the Reasons for Geographic and Racial Differences in Stroke study. J Am Pharm Assoc (2003) 2021; 61:44-52. [PMID: 32988759 PMCID: PMC7796934 DOI: 10.1016/j.japh.2020.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/03/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Health disparities across different socioeconomic subgroups have been reported in previous studies. Mortality with potentially inappropriate medication (PIM) use may be subject to similar disparities. We aimed to assess the association between PIM use and all-cause mortality and the effect of disparity parameters (sex, race, income, education, and location of residence) on this relationship. METHODS This longitudinal cohort study included 26,399 U.S. adults aged 45 years and older from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, of which 13,475 participants were aged 65 years and older (recruited 2003-2007). PIM use and drug-drug interactions (DDIs) were identified through the 2015 Beers Criteria and a clinically significant DDIs list by the American Family Physicians, respectively. Cox regression was used to assess disparities in mortality with PIM use, iteratively adjusting for disparity parameters and other covariates. The full models included interaction terms between PIM use and other covariates. A similar method was used for the analyses of disparities in mortality with DDIs. RESULTS Approximately 87% of older adults used at least 1 drug listed in the Beers Criteria, and 3.8% of all participants used 2 or more drugs with DDIs. In the adjusted analysis, an increased risk of mortality was observed among whites with PIM use (hazard ratio [HR] = 1.27 [95% CI 1.10-1.47]). The higher mortality rate was observed among blacks without PIM use (1.34 [1.09-1.65]). Lower income and education were independent predictors for higher mortality. CONCLUSION Racial differences in all-cause mortality with PIM use were observed. Further research is needed to better understand the contributing factors of such disparities to develop appropriate interventions.
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Affiliation(s)
- Md Motiur Rahman
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA
| | - George Howard
- University of Alabama at Birmingham, Ryals School of Public Health, Department of Biostatistics, Birmingham, AL, USA
| | - Jingjing Qian
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA
| | - Kimberly Garza
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA
| | - Ash Abebe
- Auburn University, Department of Mathematics and Statistics, Auburn, AL, USA
| | - Richard Hansen
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA
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Fatemeh A, Fatemeh R, Kazem H, Mona K, Reza JM, Kheirollah G. Drug-drug interactions and potentially inappropriate medications among elderly outpatients. BRAZ J PHARM SCI 2021. [DOI: 10.1590/s2175-97902020000418728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kurt M, Akdeniz M, Kavukcu E. Assessment of Comorbidity and Use of Prescription and Nonprescription Drugs in Patients Above 65 Years Attending Family Medicine Outpatient Clinics. Gerontol Geriatr Med 2019; 5:2333721419874274. [PMID: 31523700 PMCID: PMC6732845 DOI: 10.1177/2333721419874274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 11/25/2022] Open
Abstract
Background and aim: Aging is often accompanied by chronic diseases,
comorbidity, and polypharmacy. Use of prescription/nonprescription drugs, and
over-the-counter (OTC) drugs seen frequently in the elderly. The aim of this
study was to assess the comorbidity and multimorbidity status and to evaluate
the use of prescription and nonprescription drugs in patients aged 65 years.
Materials and Methods: In this cross-sectional and descriptive
study, statistical analyses were performed using SPSS Version 22.0.
Kolmogorov–Smirnov tests were applied based on meeting the assumption of a
normal distribution of the data. Other statistical tests used were one-way
analysis of variance tests, t tests, Pearson correlation
analysis, Chi-square tests, Mann–Whitney U tests, and Spearman
correlation analysis. Results: A total of 244 people participated
in the study. The multimorbidity rate was 85%. Participants used an average of
4.26 drugs daily. The polypharmacy ratio was 42%. The nonprescription drug usage
rate was 20%. Participants used nonprescription drugs most often with the
pharmacist’s advice. Conclusion: Multimorbidity, comorbidity,
prescription, and nonprescription drug use were very high among elderly
patients. Because older people are more susceptible to adverse drug reactions
and drug interactions, physicians who provide care to older people should take a
comprehensive drug history.
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