Abstract
This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients. PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: "drug interactions," "clinically relevant," and "hospital." In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish. From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0-19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose. This systematic review showed that, despite the significant prevalence of potential DDIs reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction. The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, consequently, contribute to patient safety.
Highlights
Medicines play an important role in the prevention of diseases and the promotion, maintenance, and recovery of a patient’s health, thereby contributing to improvements in the quality of life and life expectancy of the population [1,2,3]
This systematic review showed that, despite the significant prevalence of potential drug-drug interactions (DDIs) reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction
The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, contribute to patient safety
Summary
Medicines play an important role in the prevention of diseases and the promotion, maintenance, and recovery of a patient’s health, thereby contributing to improvements in the quality of life and life expectancy of the population [1,2,3]. Despite these benefits, problems with pharmacotherapy are becoming more frequent and occur in 42–81% of hospitalized patients [4,5,6,7]. After ferrous sulfate was discontinued, a reduction was noted in the BP levels of patients [14]
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