Abstract
Introduction: Patients with Parkinson's disease are exposed to higher number of drugs on average than other elderly persons. Levodopa, of the mainstay of Parkinson's disease therapy, is frequently interacting with numerous drugs. Aim: The aim of this study was to identify predictors of potential drug-drug interactions (pDDIs) in hospitalized patients suffering from Parkinson's disease (PD). Material and Methods: This was a academic retrospective cross-sectional study in PD patients hospitalized at the Clinic of Neurology, Clinical Center Kragujevac. Medical records of hospitalized patients during the period 1.1.2017 - 31.12.2019 were analysed. The pDDIs were identified by means of Micromedex andLexi-Interact online softwares, and multivariate regression methods were used to reveal potential predictors of number of pDDIs per patient. Results: Micromedex detected 160 different pDDIs in 77.8% of 72 patients with PD. The most frequent pDDIs were those that involved aspirin (with bisoprolol, sertraline and perindopril). Predictors of pDDIs in general was total number of drugs, while use of antidepressants presented a significant risk factor for major pDDIs. Lexi-Interact revealed 310 pDDIs in 98.6% of patients. The three most common pDDIs were with levodopa (bisoprolol, clonazepam, perindopril). Total number of drugs, number of co-morbidities, hospitalization at the neurodegenerative ward, and use of antipsychotics were identified as the relevant predictors of pDDIs. Lexi-interact software detected significantly more pDDIs than Micromedex (p<0.001). Conclusion: Neurologists should pay special attention when deciding whether to administer new drug to a PD patient with multiple comorbidities, hospitalized in a neurodegenerative ward and/or taking antidepressant or antipsychotic drugs.
Highlights
Patients with Parkinson’s disease (PD) are exposed to higher number of drugs on average than other elderly persons because apart from chronic non-communicable diseases that usually go with advanced age they need several drugs for controlling symptoms of the disease itself [1,2]
The conventional pharmacotherapy of Parkinson’s disease includes a variety of drugs that act by different mechanisms with the common outcome – increase in the level and activity of dopamine in central nervous system (CNS) (levodopa combined with DOPA decarboxylase inhibitors, dopamine agonists, catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, etc.)
A total of 72 patients were included in this study and they were admitted to the hospital for the following reasons: (1) to clearly confirm a diagnosis of PD, (2) to treat the exacerbation of PD or (3) to treat comorbidities, such as acute ischemic stroke (AIS) (14 patients - 19.44%), cerebral small blood vessels disease (3 - 4.17%), brain tumors (1 - 1.39%) and spinal cord with peripheral nervous system disorders (8 - 11.11%)
Summary
Patients with Parkinson’s disease (PD) are exposed to higher number of drugs on average than other elderly persons because apart from chronic non-communicable diseases that usually go with advanced age they need several drugs for controlling symptoms of the disease itself [1,2]. Since PD is usually associated with a number of physical and mental disorders, especially in the elderly, favoring the simultaneous use of many other drugs, such as cardiovascular drugs, antidiabetic drugs, psychotropic drugs (i.e. antipsychotics, antidepressants, sedatives, anti-dementia drugs), analgesics, antibiotics, etc., drug-drug interactions are likely to occur [4]. Numerous potential drug-drug interactions (pDDIs) interactions of antiparkinsonian medications are well-known. Serious are potential interactions of levodopa with MAO inhibitors, whose simultaneous use should be avoided due to the high risk of hypertensive crisis [11]. Due to pDDIs, concomitant use of antiparkinsonian drugs with diuretics and calcium channel blockers in patients with PD and associated hypertension is certainly not desirable [12]. Possible occurrence of serotonin syndrome is the reason why selegiline should not be used concomitantly with fluoxetine and tricyclic antidepressants [13,14]
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