Abstract
Background: Drug-drug interactions (DDIs) are one of the significant drug related problems encountered in clinical settings. Better understanding of the mechanisms, severity, and likely consequences of clinically significant DDIs are essential for proper medication therapy management (MTM). This study is conducted with the aim to aware clinical practitioners about clinically significant DDIs that occur in clinical settings and to help them manage such events with the accurate knowledge and technique.
 Methods: A descriptive cross-sectional study was conducted in Shree Birendra Hospital, Kathmandu on the prescription of medical out-patient department from June to November 2020. Total 483 prescriptions were selected randomly. A panel of physicians, pharmacologists and clinical pharmacists under the supervision of a consultant physician using MICROMEDEX DRUG-REAX, Evaluation of Drug Interactions, Drug Interaction Facts, Drug Interactions: Analysis and Management was conducted. Main outcome measure was obtained by the supervisor’s endorsement on panelists' opinion about clinical importance of DDIs.
 Results: A total of 2006 medicines were prescribed in 483 prescription samples. The number of drugs per prescription was in a range from 2 to 11 with 4.15 on average. DDIs were found in 21.53% prescriptions (n=104). 168 DDIs were identified with major, moderate, and minor types in 32 (19%), 85 (51%), and 51 (30%) respectively. As per occurrence, the panel determined that 13 interactions were clinically important.
 Conclusion: The drug interactions identified by a panel of expert using standard evaluation tool are considered to be clinically important and likely to occur in the clinical settings. Clinically significant DDIs can be preventable and can also be used for the beneficial effects in MTM. Adequate knowledge regarding nature of DDIs, inclusion of automated system in prescribing and dispensing area, and inter-professional collaboration of a clinical team is liable to prevent and manage such events and help in rational drug therapy.
Highlights
In the last few decades, medicine has become a leading reason for reduced mortality and disease burden.[1]
As Drug-drug interactions (DDIs) compendia seem to be dependent on a few authors or a small number of editors to evaluate drug interactions, consistent results related to DDIs demands great effort.[16]
The drug interactions are identified by a panel of experts using a standard evaluation tool
Summary
In the last few decades, medicine has become a leading reason for reduced mortality and disease burden.[1]. Adverse drug reaction (ADR) is one of the major causes of hospital admission of which drug interactions are more common.[4] Though the study of the potential of DDIs is an important part of drug development and market approval; comprehensive knowledge on DDIs and method of identifying potential interactions is a must for the health professionals in order to reduce the medical and economic losses.[2] Drug interaction may lead to an altered response in terms of both safety and efficacy, where concomitant administration of the drugs may alter the absorption, distribution, metabolism, or excretion of the object drug. This study is conducted with the aim to aware clinical practitioners about clinically significant DDIs that occur in clinical settings and help them manage such events with appropriate knowledge and technique. The main outcome measure was obtained by the supervisor’s endorsement of panelists’ opinions about the clinical importance of DDIs
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