Identifying Drug-Drug Interactions in Diabetic Patients with Chronic Kidney Disease: Pharmacist’s Interventions

Abstract

Drug-drug interactions (DDIs) can negatively affect patients ‘therapeutic outcomes. Therefore, our aim was to evaluate DDIs among diabetic patients with chronic kidney disease (CKD). To achieve this aim, our objectives were to identify DDIs in diabetic patients with CKD admitted to the Medicine Department of the tertiary care hospital and to evaluate pharmacist’s interventions in managing DDIs among these patients. A prospective observational study was conducted over 6 months. The pharmacist performed a medication chart review, and DDIs were identified by using Lexicomp® drug interaction. The pharmacist informed prescribers regarding the occurrence of DDIs, and all pharmacist`s interventions were classified according to Pharmaceutical Care Network Europe. Overall 307 DDIs were identified among a total of 119 study patients with an average of 2.6 DDIs per patient. The most of identified DDIs (205, 66.7%) belonged to the interaction risk-rating category of C, which indicates that DDIs required close monitoring of patients’ therapy to avoid any potential adverse outcome. DDIs that needed to be managed by considering therapy modification (risk-rating category of D) and avoiding drug combination (risk-rating category of X) were accounted for 19.2% and 14.0% of all detected interactions, respectively. Interactions between Furosemide–Insulin (43, 14.0%), Amlodipine–Calcium carbonate/vitamin D3 (35, 11.4%) were found to be among most commonly identified DDIs. The pharmacist delivered different types of interventions to prescribers, which ranged from monitoring of therapy outcome to stopping DDIs. A great proportion of delivered pharmacist’s interventions (87%) were accepted by prescribers. Clinically significant DDIs occurred commonly in hospitalized diabetic patients with CKD. The pharmacist delivered important interventions in timely identifying DDIs.