How do we prevent the burden of extremely harmful and clinically nonbeneficial drug–drug interactions among chronic kidney disease patients?

Abstract

The chronic intake of different medications by chronic kidney disease (CKD) patients predisposes them to extremely harmful and clinically nonbeneficial drug–drug interactions (DDIs) which can ultimately lead to increase in morbidity, mortality, healthcare cost, and frequency and length of hospitalization. This produces a negative deteriorating and counter-efficient outcome on the health, quality of life and treatment response of these patients. This was an 18-month prospective descriptive study that reviewed the medical case records of consented adult CKD patients attending the Nephrology medical outpatient clinic of a Nigerian Tertiary Healthcare Centre from January 2015 to June 2016. The Medscape drug reference database was used to evaluate patients’ medications for extremely harmful, clinically nonbeneficial DDIs. This study involved 123 consented adult CKD patients comprising of 82 (66.67%) males and 41 (33.33%) females with a mean age of 53.81 ± 16.03 years. In this study, the prevalence of extremely harmful, clinically nonbeneficial DDIs (type D or type X interaction categories only) was 24.4%, while the overall prevalence for all the observed DDIs was 95.9%. The most frequent extremely harmful, clinically nonbeneficial DDIs in this study was between α-methyldopa and metoclopramide: 16 (0.9%) interactions in eight (6.5%) patients. Furthermore, α-methyldopa decreases the antiemetic effects of metoclopramide by pharmacodynamics antagonism at the chemoreceptor trigger zone site D2-receptors (type X; pharmacodynamics). In addition, metoclopramide decreases the level of α-methyldopa by inhibition of gastrointestinal tract (GIT) absorption, as this applies to only oral formulations of both agents (type D; pharmacokinetic). The occurrence and burden of extremely harmful, clinically nonbeneficial DDIs is significantly high among these CKD patients. There is also a critical need to minimize the number of prescribed medications for these patients in order to optimize their care.