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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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2
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Turossi-Amorim ED, Camargo B, do Nascimento DZ, Schuelter-Trevisol F. Potential Drug Interactions Between Psychotropics and Intravenous Chemotherapeutics Used by Patients With Cancer. J Pharm Technol 2022; 38:159-168. [PMID: 35600279 PMCID: PMC9116124 DOI: 10.1177/87551225211073942] [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: 11/15/2022] Open
Abstract
Introduction: Patients undergoing cancer treatment usually have comorbidities, and psychiatric disorders are commonly seen in these patients. For the treatment of these psychiatric disorders, the use of psychotropic drugs is common, turning these patients susceptible to untoward drug interactions. Therefore, the aim of this study was to estimate the prevalence of clinically relevant drug-drug interactions (DDI) between chemotherapeutic and psychotropic agents in patients with cancer treated at an oncology service in southern Brazil. Methods: An observational epidemiological study with a cross-sectional census-type design was carried out between October and December 2020. The drug-drug interactions were identified through consultation and analysis of the Medscape Drug Interaction Check and Micromedex databases. The interactions were classified as major, when the interaction can be fatal and/or require medical intervention to avoid or minimize serious adverse effects and moderate, when the interaction can exacerbate the patient's condition and/or requires changes in therapy. Results: A total of 74 patients was included in the study among the 194 patients seen in the oncology service during the period studied. A total of 24 (32.4%) DDIs were found, 21 (87.5%) of which were classified as being of major risk and 3 (12.5%) as moderate risk. According to the mechanism of action, 19 (79.1%) were classified as pharmacodynamic interactions and 5 (20.9%) as pharmacokinetic interactions. Conclusion: It was shown that a considerable percentage of patients undergoing intravenous chemotherapy are at risk of pharmacological interaction with psychotropic drugs. Thus, it is essential that the oncologist considers all psychotropic drugs and other drugs used by patients in order to avoid drug-drug interactions.
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Affiliation(s)
- Eric Diego Turossi-Amorim
- State University of Londrina, Tubarao,
Brazil,Eric Diego Turossi Amorim, PhD in
Physiological Sciences, University of Southern Santa Catarina, Avenida José
Acácio Moreira, 787, Tubarao 121 88704-900, Brazil.
| | - Bruna Camargo
- University of Southern Santa Catarina,
Tubarao, Brazil
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3
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Olateju OA, Babalola CP, Olubiyi OO, Kotila OA, Kwasi DA, Oaikhena AO, Okeke IN. Quinoline Antimalarials Increase the Antibacterial Activity of Ampicillin. Front Microbiol 2021; 12:556550. [PMID: 34149629 PMCID: PMC8206527 DOI: 10.3389/fmicb.2021.556550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/26/2021] [Indexed: 01/20/2023] Open
Abstract
Bacterial and malaria co-infections are common in malaria endemic countries and thus necessitate co-administration of antibiotics and antimalarials. There have long been anecdotal clinical reports of interactions between penicillins and antimalarial agents, but the nature and mechanisms of these interactions remain to be investigated. In this study, we employed antimicrobial interaction testing methods to study the effect of two antimalarials on the antibacterial activity of ampicillin in vitro. Paper strip diffusion, a modified disc diffusion and checkerboard methods were used to determine the nature of interactions between ampicillin and quinoline antimalarials, chloroquine and quinine, against Gram-positive and Gram-negative bacteria. The impact of antimalarials and ampicillin-antimalarial drug combinations on cell integrity of test bacteria were determined by measuring potassium release. The tested antimalarials did not show substantial antibacterial activity but quinine was bactericidal at high concentrations. Chloroquine and quinine increased ampicillin activity, with increasing concentrations extending the antibacterial’s inhibition zones by 2.7-4.4 mm and from 1.1 to over 60 mm, respectively. Observed interactions were largely additive with Fractional Inhibitory Concentration Indices of >0.5-1 for all ampicillin-antimalarial combinations. Quinine and, to a lesser extent, chloroquine increase the activity of ampicillin and potentially other β-lactams, which has implications for combined clinical use.
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Affiliation(s)
- Olajumoke A Olateju
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Chinedum P Babalola
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.,Centre for Drug Discovery Development and Production (CDDDP), Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Olujide O Olubiyi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olayinka A Kotila
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.,Centre for Drug Discovery Development and Production (CDDDP), Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - David A Kwasi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.,Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Anderson O Oaikhena
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Lima EDC, Camarinha BD, Ferreira Bezerra NC, Panisset AG, Belmino de Souza R, Silva MT, Lopes LC. Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit. Front Pharmacol 2020; 11:555407. [PMID: 33343344 PMCID: PMC7744879 DOI: 10.3389/fphar.2020.555407] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Children are exposed to drug-drug interactions (DDI) risks due to their organism’s complexity and the need for several medicines prescriptions in pediatric intensive care units (PICU). This study aimed to assess the prevalence of potential DDIs in a Brazilian PICU. We carried out a cross-sectional study at a pediatric teaching hospital from Rio de Janeiro (Brazil) over one year. Potential DDIs (pDDIs) between prescribed medicines for hospitalized children in PICU (n = 143) were analyzed according to severity using Micromedex®. Sex, age group, number of drugs prescribed, vasoactive amines use (a proxy of clinical complexity), and the PICU length of stay were summarized using descriptive statistics. Association between the PICU length stay, and variables sex, age, clinical condition complexity, number of drugs prescribed, and severity of pDDI were examined by univariate and multiple linear regression. Seventy percent of patients aged three days to 14 years old were exposed at least one potential DDIs during PICU stay. Two hundred eighty-four different types of pDDIs were identified, occurring 1,123 times. Nervous system drugs were implicated in 55% of the interactions, and fentanyl (10%) was most involving in pDDIs. Most pDDIs were classified as higher severity (56.2%), with reasonable documentation (64.6%) and unspecified onset time (63.8%). Worse clinical condition, ten or more drugs prescribed, and most severe pDDIs were associated with a longer PICU length of stay. Multiple linear regression analysis showed an increase of 9.83 days (95% confidence interval: 3.61–16.05; p = 0.002) in the PICU length of stay in children with major or contraindicated pDDIs. The results of this research may support the monitoring and prevention of pDDIs related to adverse events in children in intensive care and the design and conduction of new studies.
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Affiliation(s)
| | - Barbara Dias Camarinha
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Anderson Gonçalves Panisset
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Raquel Belmino de Souza
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Course of Pharmaceutical Science, Universidade de Sorocaba, Sorocaba, Brazil
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Evaluation of potential drug-drug interactions in a pediatric population. Turk Arch Pediatr 2020; 55:30-38. [PMID: 32231447 PMCID: PMC7096558 DOI: 10.14744/turkpediatriars.2019.60938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 10/14/2019] [Indexed: 11/20/2022]
Abstract
Aim: A large number of medications are prescribed in pediatric clinics and this leads to the development of drug–drug interactions (DDI) that may complicate the course of the disease. The aim of the study was to identify the prevalence of potential drug–drug interactions, to categorize main drug classes involved in severe drug–drug interactions and to highlight clinically relevant DDIs in a pediatric population. Material and Methods: A total of 1500 prescriptions during the 12-month study period were retrospectively reviewed; 510 prescriptions that comprised two or more drugs were included in study. The presence of potential drug–drug interactions was identified by using the Lexi-Interact database and categorized according to severity A (unknown), B (minor), C (moderate), D (major), and X (contraindicated). Results: There were 1498 drugs in 510 prescriptions; 253 of these (49.6%) included 2 drugs, 228 (44.7%) included 3–4 drugs, and 29 (5.6%) included ≥5 drugs. A total of 634 (42%) potential drug–drug interactions were idenfied. Among those, 271 (42.7%) were categorized as A, 284 (44.8%) as B, 53 (8.4%) as C, and 26 (4.1%) as D. There was no potential risk for X interaction. Anti-infectives (36%) were the most commonly prescribed drug classes involved in C and/or D categories. Clarithromycin was the most commonly interacting agent that interfered with budesonide. Conclusion: It is noteworthy that a significant number of drugs causing potential drug–drug interactions are prescribed together in pediatric clinics. Increasing the awareness of physicians on this issue will prevent potential complications and ensure patient safety.
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Kulkarni AP. Are We fulfilling the Hippocratic Oath? Indian J Crit Care Med 2019; 23:163. [PMID: 31130784 PMCID: PMC6521819 DOI: 10.5005/jp-journals-10071-23144] [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] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Kulkarni AP. Are We fulfilling the Hippocratic Oath? Indian J Crit Care Med 2019;23(4):163.
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Affiliation(s)
- Atul P Kulkarni
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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7
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Baker C, Feinstein JA, Ma X, Bolen S, Dawson NV, Golchin N, Horace A, Kleinman LC, Meropol SB, Pestana Knight EM, Winterstein AG, Bakaki PM. Variation of the prevalence of pediatric polypharmacy: A scoping review. Pharmacoepidemiol Drug Saf 2019; 28:275-287. [PMID: 30724414 PMCID: PMC6461742 DOI: 10.1002/pds.4719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. METHODS We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. RESULTS Two hundred eighty-four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross-sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%-54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%-61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%-50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. CONCLUSIONS The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.
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Affiliation(s)
- Courtney Baker
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - James A. Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Xuan Ma
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Shari Bolen
- Center for Health Care Research and Policy, MetroHealth, Cleveland, OH
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH
| | - Neal V. Dawson
- Center for Health Care Research and Policy, MetroHealth, Cleveland, OH
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, WA
| | - Alexis Horace
- Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, LA
| | - Lawrence C. Kleinman
- UH Rainbow The Center for Child Health and Policy, University Hospitals, Cleveland, OH and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sharon B. Meropol
- UH Rainbow The Center for Child Health and Policy, University Hospitals, Cleveland, OH and School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine
| | | | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy and Department of Epidemiology, University of Florida, Gainesville, FL
| | - Paul M. Bakaki
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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Falade OB, Falusi AG, Olaniyi AA, Ezeasor C, Kwasi DA, Babalola CP. Significant Pharmacokinetic Interactions Between Quinine and Ampicillin-Cloxacillin Combination. Drugs R D 2017; 16:193-203. [PMID: 27020278 PMCID: PMC4875923 DOI: 10.1007/s40268-016-0128-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The co-existence of malaria with bacterial infections is common in the tropics, hence the concurrent use of antimalarials and antibiotics. Objective This study aimed to investigate the effect on pharmacokinetics and antimicrobial activity of co-administration of quinine and combined ampicillin–cloxacillin. Methods In total, 14 healthy adults received single oral doses of ampicillin–cloxacillin combination alone and with quinine in a randomized crossover manner. Urine samples collected at predetermined intervals over 48 h were analysed. The effect of quinine on minimum inhibitory concentrations (MICs) of ampicillin and cloxacillin were determined against Staphylococcus aureus by agar diffusion, agar dilution, and broth dilution. Results Quinine significantly reduced the rate and extent of excretion of ampicillin and cloxacillin (p < 0.0002). The total amounts of ampicillin and cloxacillin excreted unchanged (Du∞) alone were 217.10 ± 53.82 and 199.0 ± 64.29 mg versus 126.40 ± 50.63 and 135.20 ± 52.24 mg, respectively, with quinine. Respective maximum excretion rates (dDu/dtmax) for ampicillin and cloxacillin were 43.55 ± 19.41 and 77.64 ± 29.65 mg/h alone versus 18.01 ± 8.52 and 53.16 ± 20.72 mg/h with quinine. This indicates a significant reduction in Du∞and dDu/dtmax by 41.78 and 58.65 % for ampicillin and 32.06 and 31.53 % for cloxacillin. Conversely, the disposition of quinine was unaffected by ampicillin–cloxacillin (p > 0.1). The MIC of antibiotics alone versus with quinine, respectively, were 0.11 ± 0.04 and 0.78 ± 0.1 µg/ml for ampicillin, and 0.18 ± 0.1 and 0.92 ± 0.4 µg/ml for cloxacillin, with a five- to sevenfold increase (p > 0.01); indicating a decrease in antimicrobial activity by quinine. Conclusions Quinine therefore, reduced the bioavailability and the antimicrobial activity of ampicillin–cloxacillin upon co-administration, which may have therapeutic implications. Caution is required with the co-administration of these medicines.
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Affiliation(s)
- Olubunmi B Falade
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adeyinka G Falusi
- Genetic and Bioethics Unit, Institute of Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ajibola A Olaniyi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Chizoba Ezeasor
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - David A Kwasi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Chinedum P Babalola
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria. .,Genetic and Bioethics Unit, Institute of Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria.
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9
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Getachew H, Assen M, Dula F, Bhagavathula AS. Potential drug–drug interactions in pediatric wards of Gondar University Hospital, Ethiopia: A cross sectional study. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Baniasadi S, Farzanegan B, Alehashem M. Important drug classes associated with potential drug-drug interactions in critically ill patients: highlights for cardiothoracic intensivists. Ann Intensive Care 2015; 5:44. [PMID: 26603290 PMCID: PMC4658340 DOI: 10.1186/s13613-015-0086-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients in the intensive care unit (ICU) are more prone to drug-drug interactions (DDIs). The software and charts that indicate all interactions may not be proper for clinical usage. This study aimed to identify the main drug classes associated with clinically significant DDIs in cardiothoracic ICU and categorize DDIs to make cardiothoracic intensivists aware of safe medication usage. METHODS This prospective study was conducted over 6 months in a cardiothoracic ICU of a university-affiliated teaching hospital. The presence of potential drug-drug interactions (pDDIs) was assessed by a clinical pharmacologist using Lexi-Interact database. Clinically significant pDDIs were defined according to severity and reliability rating. Interacting drug classes, mechanisms, and recommendations were identified for each interaction. RESULTS From 1780 administered drugs, 496 lead to major (D) and contraindicated (X) interactions. Nine drug classes were responsible for D and/or X interactions with excellent (E) and/or good (G) reliability. Anti-infective agents (45.87 %) were the main drug classes that caused clinically significant pDDIs followed by central nervous system drugs (14.67 %). Azole antifungals as the most interacting antimicrobial agents precipitated metabolism inhibition of CYP3A substrates. CONCLUSIONS Clinically significant pDDIs as potential patient safety risks were prevalent in critically ill patients. The findings from current study help to improve knowledge and awareness of clinicians in this area and minimize adverse events due to pDDIs.
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Affiliation(s)
- Shadi Baniasadi
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behrooz Farzanegan
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Alehashem
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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11
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Pharmacoepidemiological study of drug-drug interactions in onco-hematological pediatric patients. Int J Clin Pharm 2014; 36:1160-9. [PMID: 25204258 DOI: 10.1007/s11096-014-0011-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Onco-hematological patients are particularly susceptible to drug-drug interactions (DDIs) because they often undergo multiple combined treatments. Some studies have analyzed the frequency of DDIs in adult patients with cancer; however, the prevalence of DDIs in children, and especially among pediatric cancer patients, remains unknown. OBJECTIVE To determine the prevalence of DDIs in treatment sheets comparing two commonly used drug interaction databases, to describe the most common clinically relevant DDIs (CR-DDIs) and to investigate the risk factors associated with them. SETTING An onco-hematological pediatric unit from a tertiary hospital in Spain. METHOD A prospective, observational and descriptive study was carried out from November 2012 to February 2013. Twice a week, every patient's treatment sheet was collected. Each medication list was screened through two databases: Thomson Micromedex™ and Drug Interaction Facts™. All identified DDIs were graded by their level of severity. Summary statistics were used to describe patient and disease characteristics, most often prescribed drugs, and frequency, types and classification of CR-DDIs. Multivariate analysis was used to identify risk factors associated with CRDDIs. MAIN OUTCOME MEASURE Prevalence of CR-DDIs was measured as percentage. RESULTS A total of 506 potential DDIs were detected in 150 treatment sheets. The prevalence of CR-DDIs by Micromedex database and Drug Interaction Facts database were 44.7 and 51.3% respectively. Amikacin, azole antifungals, antiemetics and cyclosporine were the most frequent drugs involved in CR-DDIs. In multivariate analysis, the main risk factor associated with increased odds for CR-DDIs was a higher number of drugs. CONCLUSION The frequency of potential DDIs was related to a higher number of drugs, being immunosuppressant and azole antifungal agents the most commonly involved drugs. The lack of agreement between different databases enhances the complexity to detect drug interactions in clinical practice.
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Espinosa-Bosch M, Santos-Ramos B, Gil-Navarro MV, Santos-Rubio MD, Marín-Gil R, Villacorta-Linaza P. Prevalence of drug interactions in hospital healthcare. Int J Clin Pharm 2012; 34:807-17. [PMID: 22965222 DOI: 10.1007/s11096-012-9697-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 08/22/2012] [Indexed: 12/29/2022]
Abstract
AIM OF THE REVIEW To study the prevalence of drug interactions in hospital healthcare by reviewing literature. METHOD A review was carried out of studies written in Spanish and English on the prevalence of drug interactions in hospital care published in Pubmed between January 1990 and September 2008. The search strategy combined free text and MeSH terms, using the following keywords: "Drug interaction", "prevalence" and "hospital". For each article, we classified independent variables (pathology, age of population, whether patients were hospitalized or not, geographical location, etc.) and dependent variables (number of interactions per 100 patients studied, prevalence of patients with interactions, most common drug interactions, and others). RESULTS The search generated 436 articles. Finally, 47 articles were selected for the study, 3 provided results about drug interactions with real clinical consequences, 42 about potential interactions, and 2 described both. The prevalence of patients with interactions was between 15 and 45 % and the number of interactions per 100 patients was between 37 and 106, depending on the group of studies analyzed. There was a considerable increase in these rates in patients with heart diseases and elderly persons. CONCLUSION There is a large number of studies on the prevalence of drug interactions in hospitals but they report widely varying results. The prevalence is higher in patients with heart diseases and elderly people.
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Affiliation(s)
- María Espinosa-Bosch
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n., 41013, Seville, Spain
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Okasha D, Kassis I, Haddad S, Krivoy N. General medications utilization and cost patterns in hospitalized children. Pharm Pract (Granada) 2009; 7:54-8. [PMID: 25147593 PMCID: PMC4139757 DOI: 10.4321/s1886-36552009000100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 02/16/2009] [Indexed: 11/30/2022] Open
Abstract
Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults.
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Affiliation(s)
- Doaa Okasha
- Clinical Pharmacology Institute, Rambam Health Care Campus. Haifa ( Israel )
| | - Imad Kassis
- Senior Physician in Pediatric and Infectious Diseases, Pediatric Infectious Diseases Unit, Meyer Pediatric Hospital, Rambam Health Care Campus. B. Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa ( Israel )
| | - Salim Haddad
- Chief Pharmacist and Director of the Central Pharmacy, Pharmacy Services, Rambam Health Care Campus. Haifa ( Israel )
| | - Norberto Krivoy
- Senior Physician in Medicine and Director of the Clinical Pharmacology Institute, Rambam Health Care Campus. B. Rappaport Faculty of Medicine, Technion -Israel Institute of Technology, Haifa ( Israel )
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