Drug Interaction Checker Research Articles

Investigating Potential Drug-Drug Interactions from Greek e-Prescription Data.

The prevalence of potential drug-drug interactions (pDDIs) is indicative of the prevalence of actual drug-drug interactions and prescription quality. However, they are significantly understudied in Greece. The objective of the study was to determine the prevalence of pDDIs among outpatients and identify factors associated with their occurrence. Anonymous e-prescription data between 2012 and 2017 were obtained from community pharmacies in Thessaloniki, Greece. Patients taking more than one medication for at least three months were included. pDDIs were identified and categorized depending on their clinical significance using Drug Interactions Checker. Crude and adjusted odds ratios (ORs) with accompanying 95% confidence intervals (CIs) of risk factors of pDDIs occurrence were identified using multivariable logistic regression. During the study period, 6,000 anonymous e-prescriptions (1,000 per year) satisfying the inclusion criteria were collected. The overall prevalence of major pDDIs was 17.4% (63.0% for moderate pDDIs). The most common major pDDIs were between amlodipine and simvastatin (22.8% of major interactions), followed by clopidogrel and omeprazole (6.4% of major interactions). Polypharmacy (≥5 concomitantly received medications) was associated with an increased risk of major pDDIs (adjusted OR, 5.72; 95% CI, 4.87-6.72); no associations were observed regarding age, sex, and number of prescribing physicians. The prevalence of pDDIs in this study was higher than previously reported in other European countries, with polypharmacy being a potential risk factor. Those results argue for a need for improvement in the area of prescribing in Greece.

Potential Drug–Drug Interactions in Ambulatory Patients with Hypertension: a Retrospective Study

Background: Patients with cardiovascular diseases (CVD) are vulnerable to experiencing drug-drug interactions (DDIs). DDIs are a concern among patients receiving multiple drug regimens but they are also an avoidable cause of adverse drug reactions. The study of potential DDIs (pDDIs) would make it easier for the healthcare provider to deliver better patient care and mitigate pDDIs incidence. Objective: This study aimed to assess the frequency, severity level and risk factors associated with pDDIs among medications used to treat hypertensive ambulatory patients in Universitas Airlangga hospital. Methods: A retrospective observational study was carried out from electronic prescriptions received by hypertensive patients in March 2021. Data collection includes demographic data, the profile of antihypertensive drug use, and pDDIs. pDDIs were identified by severity using Lexicomp Drug Interaction Checker (Application). Univariate logistic regression analysis was used to find associated factors of major pDDIs. A p-value less than 0.05 (≤ 0.05) was considered statistically significant. Results: From 704 patients, 53.98% women and 46.02% men, 89.06% (n = 627) patients had minor to major pDDIs; 1354 pDDIs were identified, 89.4% (n = 1,210) were moderate and 9.8% (n = 133) were major class. Multiple antihypertensive drug regimens had significance associated with the major pDDIs occurrence. Conclusion: We found a high prevalence of pDDIs among hypertensive patients. The majority of pDDIs were of moderate severity. Multiple antihypertensive drug regimens were associated factors in the presence of major pDDIs.

Identification of Drug Interaction Adverse Events in Patients With COVID-19

During the COVID-19 pandemic, urgent clinical management of patients has mainly included drugs currently administered for other diseases, referred to as repositioned drugs. As a result, some of these drugs have proved to be not only ineffective but also harmful because of adverse events associated with drug-drug interactions (DDIs). To identify DDIs that led to adverse clinical outcomes and/or adverse drug reactions in patients with COVID-19 by systematically reviewing the literature and assessing the value of drug interaction checkers in identifying such events. After identification of the drugs used during the COVID-19 pandemic, the drug interaction checkers Drugs.com, COVID-19 Drug Interactions, LexiComp, Medscape, and WebMD were consulted to analyze theoretical DDI-associated adverse events in patients with COVID-19 from March 1, 2020, through February 28, 2022. A systematic literature review was performed by searching the databases PubMed, Scopus, and Cochrane for articles published from March 1, 2020, through February 28, 2022, to retrieve articles describing actual adverse events associated with DDIs. The drug interaction checkers were consulted again to evaluate their potential to assess such events. The DDIs identified in the reviewed articles involved 46 different drugs. In total, 575 DDIs for 58 drug pairs (305 associated with at least 1 adverse drug reaction) were reported. The drugs most involved in DDIs were lopinavir and ritonavir. Of the 6917 identified studies, 20 met the inclusion criteria. These studies, which enrolled 1297 patients overall, reported 115 DDI-related adverse events: 15 (26%) were identifiable by all tools analyzed, 29 (50%) were identifiable by at least 1 of them, and 14 (24%) remained nonidentifiable. The main finding of this systematic review is that the use of drug interaction checkers could have identified several DDI-associated adverse drug reactions, including severe and life-threatening events. Both the interactions between the drugs used to treat COVID-19 and between the COVID-19 drugs and those already used by the patients should be evaluated.

An investigation of the use of app technology to support clinical management of patients with chronic myeloid leukaemia (CML).

The availability of healthcare apps to support patient self-management of various medical conditions, including cancer, has increased considerably in the past decade. However, there are limited published data on the role of apps in the management of chronic myeloid leukaemia (CML). The primary aim of this study was to investigate the current and future role of apps as a means of supporting patients with CML. A 31-item questionnaire was developed and distributed to patients via three on-line CML support groups. Responses were received from 286 patients. There was an approximate 2:1 female: male split and the majority (54%, n = 155) resided in the United Kingdom. 91% (n = 260) of respondents were currently receiving drug treatment for their CML. 23.4% (n = 67) of respondents were aware that apps were available to support their CML management and 11.5% (n = 33) had experience of using such an app. 94.1% (n = 238) of those who had not used a patient support app in the past stated that they would consider using an app in the future to help manage their disease. App awareness was significantly higher amongst male patients (30.3% vs. 19.9%). Likelihood of being a current or previous app user was higher amongst younger patients (16.3% for <55 years old vs. 5.6% for ≥55 years old) whilst younger patients and those with a more recent diagnosis of CML were both more likely to be interested in using an app in the future. When asked about potential app functionality, a drug interaction checker was the feature of greatest interest to respondents. We have identified both a lack of awareness of and a low uptake of patient support apps amongst CML patients. Importantly, we have demonstrated a clear interest in CML-specific apps amongst this population. Based on the functionality that study participants were most interested in, we will work with health care professionals, app developers and patients to develop a new app to deliver holistic support to CML patients.

Evaluation of Drug-Related Problems in Chronic Kidney Disease Patients.

BackgroundChronic kidney disease (CKD) is a challenging global health problem with increasing prevalence worldwide. Concurrence of CKD and comorbidities results in the use of multiple medications and exposing patients to polypharmacy. Polypharmacy in CKD is common across all the stages of the disease and leads to poor medication adherence, higher healthcare costs, and drug-related problems, such as drug-drug interactions (DDIs) and adverse drug reactions (ADRs). DDIs and ADRs in CKD patients may lower the quality of life, increase the length of hospital stay, and augment the risks of morbidity and mortality.MethodologyThis was a hospital-based, prospective, cross-sectional study conducted in a secondary care hospital. The study population comprised 130 adult CKD patients admitted to the nephrology department including those on maintenance hemodialysis. Study-related data were obtained from the electronic patient case records. Medications prescribed to the patients were analyzed for potential DDIs (pDDIs) using Portable Emergency and Primary Care Information Database (PEPID 12.1) drug interaction checker. All observed and reported suspected ADRs related to the prescribed drugs were evaluated for causality, severity, preventability, and predictability.ResultsOut of the 130 patients, majority were males (n = 71, 54.6%), in the age group of 61-70 years (n = 45, 34.6%), and belonged to CKD stage 5 (n = 105, 80.8%). The mean number of drugs prescribed was 11.1 ± 3.8 per patient. The prevalence of pDDIs was found to be 89.2%. Upon analysis by the PEPID database, 708 pDDIs with 215 different pairs of interacting drugs were identified. Polypharmacy (odds ratio (OR): 62.34, 95% confidence interval (CI): 7.97-487.64, p < 0.001) was identified as an independent predictor of the occurrence of pDDIs. Negative binomial regression analysis revealed that dyslipidemia (incidence rate ratio (IRR): 2.7, 95% CI 2.09-3.48, p < 0.001) and diabetes (IRR: 1.2, 95% CI 1.01-1.54, p = 0.040) increased the probability of occurrence of pDDI by 2.7 and 1.2 folds, respectively. Furthermore, the likelihood of pDDI increased with every one-day increase in the length of hospital stay (IRR: 1.02, 95% CI 1.00-1.03, p = 0.015) by 1.02 times and polypharmacy (IRR: 6.30, 95% CI 3.04-13.02, p < 0.001) by 6.3 times. The incidence of ADRs was found to be 10.7%. Majority of suspected ADRs were possible (n = 7, 50.0%), of mild and moderate severity (n = 7, 50.0%), and non-preventable (n = 8, 57.1%) type.ConclusionsThis study investigated two important drug-related problems, pDDIs, and ADRs, in the CKD population. High proportion of CKD patients in the study had pDDIs. Comorbid conditions such as dyslipidemia and diabetes mellitus, length of hospital stay, and polypharmacy were significantly associated with increased likelihood of pDDIs. Furthermore, there was a burden of ADRs in the study population, of which most ADRs were possible and of mild to moderate severity. Prevention, identification, and resolution of these problems in CKD patients is important and can be achieved through medication optimization, which requires a proactive interdisciplinary collaboration between clinicians, clinical pharmacists, and other healthcare professionals.

EVALUASI INTERAKSI OBAT JANTUNG KORONER PADA PASIEN RAWAT INAP DI RUMAH SAKIT UMUM IMELDA PEKERJA INDONESIA MEDAN

Coronary heart disease is the most common cause of death globally. Deaths in patients with coronary heart disease are 7.8 million out of 11.11 million people in developing countries in 2020. One of the factors that can worsen heart disease is drug interactions caused by patients with heart disease not only having one disease but followed by other diseases. so that they use more than one kind of drug. The purpose of this study was to describe the treatment profile of CHD patients and drug interactions in coronary heart inpatients at Imelda General Hospital, Indonesian Workers. This research is an observational study designed with retrospective descriptive design. Data analysis was carried out by screening drug interactions using the Drug Interaction Checker. The results showed that the criteria for CHD patients mostly occurred in women (56.3%) at the age of 56-60 years (23.9%). The distribution of diagnoses in CHD patients had the most three diagnoses of disease and with the most comorbidities, namely dyspepsia (20.6%) and diabetes mellitus (19.0%). The most widely used coronary heart therapy in inpatients at Imelda Workers' Hospital in Indonesia was SDN (12.7%) while the combination therapy was Clopidogrel and Concor (4.2%). Drug interactions in CHD patients were mostly nifedipine and atorvastatin with moderate levels.

Potensi Interaksi Obat di Ruang Rawat Intensif: Sebuah Studi Observasional di Salah Satu Rumah Sakit Kota Bandung

The hospital’s Intensive Care Unit (ICU) is at the forefront of treating emergency patients requiring intensive care. The comprehensive, fast, and accurate medication in the unit causes the incidence of drug-drug interactions (DDI’s) and can lead to therapeutic failures in patients. Therefore, this study aimed to describe potential (DDIs) in the ICU of a hospital in Bandung. A descriptive observational study was performed in a hospital in Bandung from 1st to 31st March 2021. The drug use report observed the use of medics in the ICU. Furthermore, the potential DDI’s were identified using a drug interaction checker. It was validated using the textbook and another reputable checker. There are twenty-one types of drugs commonly used in the study setting, and the analysis showed twenty-two potential DDI’s. The interaction consists of three significant DDI’s, including dexamethasone-levofloxacin, phenytoin-nicardipine, and phenytoin-nimodipine, while the others are moderate. The majority of them generally affect the blood pressure and nervous system. Health care providers should observe the high incidence of DDI’s when selecting and monitoring drugs in the ICU. Further study is needed to explore the potential of other drugs that can minimize the interaction effect. Therefore, it is expected to improve ICU patients’ safety in adverse drug reaction situations.

Evolving patterns of antiretroviral drug interactions in people with HIV in British Columbia, Canada.

To characterize the annual prevalence of antiretroviral/nonantiretroviral drug interactions in relation to antiretroviral therapy (ART)-prescribing patterns, and to describe drug interaction-related ART changes. This cohort study included ART-treated adults in British Columbia, Canada between 01 January 2010 and 31 December 2016. Medication dispensing records were abstracted from a population-based, linked administrative-health dataset and used to identify antiretroviral-comedication drug interactions ('caution'/'avoid' drug interactions in HIV-focused drug interaction checkers). We identified temporal trends in annual drug interaction prevalence and quantified the association between taking higher drug interaction-risk ART and receiving nonrecommended antiretroviral-comedication combinations using Poisson regression models, modified for binary outcomes and correlated data. Clinician-reported, drug interaction-related ART changes and associated adverse events were abstracted from an HIV drug treatment registry and summarized descriptively. Among 8571 ART-treated adults who received nonantiretroviral comedications, prevalence of having any drug interaction or receiving nonrecommended drug combination(s) significantly declined from 85 to 71% and 5.6 to 3.2%, respectively, between 2010 and 2016 ( P < 0.001). This paralleled a shift from higher drug interaction-risk ART (e.g. ritonavir/cobicistat-boosted protease inhibitors) to lower drug interaction-risk ART (e.g. unboosted integrase inhibitors). Risk of receiving a nonrecommended antiretroviral-comedication combination was greater for persons taking higher vs. lower drug interaction-risk ART [adjusted risk ratio (aRR) 3.12, 95% confidence interval (CI) 2.24-4.35]. Boosted antiretroviral-inhaled corticosteroid drug interactions accounted for the most commonly dispensed, nonrecommended drug combinations, and the most commonly reported drug interaction-related adverse events (adrenal insufficiency). The prevalence of antiretroviral-comedication drug interactions is declining as ART shifts towards antiretrovirals with lower drug interaction potential but nonrecommended drug combinations remain a concern. Healthcare providers should screen for drug interactions whenever drugs are prescribed or dispensed.

The Practice of the Community Pharmacists in Managing Potential Drug-Drug Interactions: A Simulated Patient Visits.

BackgroundDrug-drug interactions (DDIs) can cause treatment failure and serious adverse drug reactions, leading to morbidity and mortality. Due to their significant effects on the patient’s health, community pharmacists (CPs) competence in detecting and preventing these interactions is essential to provide optimal health services. Thus, this study aimed to explore the performance of the CPs in situations involving the presence of potential DDIs.MethodsA cross-sectional, simulated patient study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used to evaluate the performance of the CPs. Ten final year B. Pharm. students were selected to act as simulated patients (SPs); they were trained for two weeks to familiarize their roles. All encounters were documented immediately after leaving the pharmacy by the SPs in the data collection form.ResultsAll planned SPs visits were completed, resulting in 470 visits. None of the CPs asked about the patients’ medication history in both scenarios. After the SPs provided information about the drug used currently by the patient, 13.6% and 23.4% of the CPs had identified the potential DDIs in scenario 1 and scenario 2, respectively. In scenario 1, 59.4% distinguished the interaction of simvastatin with both drugs, while, in scenario 2, 74.5% recognized the interaction of warfarin with both drugs. In identifying DDIs, around half of the CPs were dependent on their knowledge or using drug interaction checker programs. The most common intervention made by the CPs was referring the patient to the prescriber (56.3% CPs in scenario 1 and 60% CPs in scenario 2).ConclusionCPs practice in identifying and managing potential DDIs was poor. The current CPs practices need substantial improvement. Therefore, professional education and the use of software programs in community pharmacies should be encouraged.

Toxicity profile, adverse drug reactions and drug-drug interactions among geriatric cancer patients under metronomic chemotherapy in a South Indian tertiary care hospital.

The study aims to examine the toxicity profile, pattern of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in geriatric cancer patients receiving metronomic chemotherapy. Patients were followed after each cycle till 12 weeks. Haematological parameters such as complete blood count, liver function test and renal function test were recorded from the baseline to the final visit. The Common Terminology Criteria for Adverse Events (CTCAE) scale was used to characterise the toxicity profile. ADRs that the patients had were documented and assessed for its causality, severity and preventability. The Lexicomp drug interaction checker was used to grade DDIs. Of 129 patients, according to CTCAE grading, haemoglobin indicated grade 1 toxicity, while other haematological parameters revealed no toxicity. Although there was a statistically significant difference in ALT, alkaline phosphate, serum creatinine and potassium (p < 0.05), it was not clinically significant. A total of 226 ADRs were documented. Anaemia was the most frequently occurred ADR (14%) and Capecitabine caused the highest number of ADRs. Assessments of causality showed that the majority of cases are "possible" (63%). In evaluating the severity of ADRs, 99% ADRs were "mild" and 61% of ADRs were "probably" preventable. Upon assessing the DDIs, 82% of the prescriptions had "no known interaction". Metronomic chemotherapy in geriatric cancer patients exhibited grade 1 toxicity for haemoglobin. Anemia was the most common ADRs. The majority of cases were "possible" in causality, "mild" in severity, and "probably" preventable. The majority of the prescriptions have no known DDIs.

Evaluation of drug-drug interactions in hospitalized patients at Sociedad Española de Beneficencia

Background: drug-drug interactions are a frequent cause of adverse drug reactions, the use of more than 5 drugs is significantly related to serious interactions. Comorbidities in patients have precipitated the frequency of polypharmacy, which produces an enhanced incidence of morbidity and mortality, hospital stay and costs. Materials and methods: 50 records of hospitalized patients were analyzed in the period from May to July 2019, a search for drug interactions was carried out with the help of Medscape Drug-Interactions Checker and the Drugs Interactions Checker. Results: 68% of the records presented at least one pharmacological interaction, the majority associated with musculoskeletal pathology and abdominal pain syndrome (45 and 29%, respectively). On the other hand, 48% of the interactions were related to the use of non-steroidal anti-inflammatory drugs and the use of opioid pain relievers combined with sedatives or anesthetics. Conclusions: there is a significant incidence in drug interactions, most of them related to poor pain management, however, it is essential to know the pathophysiology of each patient's disease, and to understand that the benefit must be greater than the risk when indicating the best therapy for the patient.

Polypharmacy and potential drug-drug interactions in adult outpatients receiving cardiovascular drugs

Background: The prevalence of polypharmacy is rising and is particularly relevant to cardiovascular diseases. Assessing the extent of polypharmacy and potential drug-drug interactions (pDDIs) is an essential first step in improving safe and rational use of drugs. Aims and Objective: This study aims to study the frequency of polypharmacy and pDDI in adult outpatients receiving cardiovascular drugs. Materials and Methods: Prescriptions of all adult outpatients receiving at least one cardiovascular drug were considered for the study. A total of 2027 prescriptions were analyzed for estimating rate of polypharmacy. Out of these, 335 randomly selected prescriptions were analyzed with the help of an online drug interaction checker software for estimating rate of pDDIs, commonly involved drug pairs and severity of pDDI. Results: The rate of polypharmacy in cardiac outpatients was 56.93% and that of pDDI was 78.81%. The commonly involved drugs in interactions were amlodipine, atenolol, calcium carbonate, atorvastatin, metformin, furosemide, and aspirin. One-third of pDDIs were categorized to be of minor severity while half of the pDDIs belonged to monitor closely category. Conclusion: Polypharmacy and pDDI are common in cardiac outpatients.

Potential Drug-Drug Interactions in Patients Using Warfarin, Heparin, and Enoxaparin

Background: Drug-drug interactions can often lead to preventable adverse drug events and hospitalization. However, the clinical outcome of a potential drug-drug interaction that may range from minor alterations to major toxicity or loss of effect is often unknown. Drugs with narrow therapeutic index are more susceptible to the outcomes of interactions. Anticoagulants are one of the drug groups prone to drug-drug interactions and have important side effects. in this retrospective study, the frequency of drug-drug interactions involving warfarin, heparin and enoxaparin was investigated. Methods: Overall, 300 patients (including 55% males with an average age of 50.75 years) participated in this study, and for each anticoagulant, 100 patient orders were randomly selected from the hospital system. Drug-drug interactions were evaluated using the Micromedex drug interaction checker. Results: A total of 1691 drug-drug interactions (306 major, 253 moderate, and 89 minor interactions) were recorded of which only 648 (average 2.16) involved warfarin, heparin, or enoxaparin. Most interactions were recorded in patients admitted to the cardiovascular surgery (n=312) and cardiology (n=119) wards. There was a significant relationship between the number of drugs and the frequency of interaction. warfarin had the highest number of interactions (n=388). Conclusion: The frequency of drug interactions is high in patients on anticoagulant therapy. The efficacy and safety of these drugs can be affected by drug interactions. Accordingly, these interactions should always be considered, especially in patients with multiple drug use. Efficient monitoring strategies should be employed to optimize treatment while reducing adverse effects.

Potential Psychotropic and COVID-19 Drug Interactions: A Comparison of Integrated Evidence From Six Database Programs.

BackgroundDrug interactions are a significant issue in mental illnesses and coronavirus disease 2019 (COVID-19) infections. Inconsistency in drug interaction resources makes prescribing challenging for healthcare professionals. To assess the scope, completeness, and consistency of drug-drug interactions (DDIs) between psychotropic and COVID-19 medications in six specific drug information (DI) databases.MethodologyFor the comparison, six DI resources were used: Portable Electronic Physician Information Database, Micromedex®, Medscape.com, UpToDate®, Drugs.com drug interaction checker, and WebMD.com drug interaction checker. Using the Statistical Package for the Social Sciences (SPSS) software version 27 (IBM Corp., Armonk, NY), the gathered data were examined for scope, completeness, and consistency.ResultsScope scores were higher for PEPID© than all the other resources (p < 0.001) for each comparison. PEPID© had better overall completeness scores (median 5, Interquartile range [IQR] 5 to 5; p<0.05 for each comparison), except for Drugs.com (p < 0.05 for each comparison), and were more remarkable for Micromedex® (median 5, IQR 5 to 5). The Fleiss kappa scores among the six different DI sources were poor (k < 0.20, p < 0.05) for the category of information related to clinical effects and level of documentation, moderate agreement (k = 0.4 - 0.6, p < 0.05) for the severity and course of action of DDIs, and fair agreement (k = 0.4 - 0.6, p < 0.05) for mechanism.ConclusionA comprehensive, accurate information among DI resources is essential for healthcare professionals that will significantly impact patient care in the clinical practice. Banking on high-quality resources will help healthcare professionals to make an informed decision while prescribing to avoid inappropriate combinations that can adversely affect patient outcomes.

Intrabases divergences in the mHealth era: a drug interaction investigation in an infectious-diseases hospital setting

Introduction: Information on potential drug interactions (PDI) are obtained from databases available on the web or through mobile healthcare applications (mHealth), and can prevent unfavorable clinical outcomes for patients. This study compared PDI information available in Micromedex® drug interaction checker, its web version and its mHealth app. Method: A cross-sectional study realized based on a retrospective review of drug prescriptions in a reference hospital in infectology in the Midwest Region of Brazil, 2018. We selected all prescriptions containing two or more drugs. Drugs were classified according to the first level of the Anatomical Therapeutic Chemical (ATC) classification, according to the route of administration and the number of drugs prescribed. PDIs were classified according to the severity system and four-level evidence classification system. Results: This study selected 72 patients, predominantly male, median age of 38 years, average length of stay of 15.8 days, and most diagnosed with HIV/AIDS. The most frequently prescribed anatomical groups according to ATC were digestive system and metabolism (22.1%) and general anti-infectives for systemic use (21.6%). The average number of drugs per prescription was 10.8 (SD±6.7). The Micromedex® mHealth app found 381 PDIs while its web version detected 502 PDIs, with an average of 5.3 and 7.0 and frequency of 61.1% and 72.2%, respectively. According to the severity classification in mHealth and web versions, the following stood out, respectively: 221 and 321 severe; 139 and 149 moderate. The majority (&gt;65%) of identified PDIs had their documentation classified as reasonable. Conclusion: Digital tools although they aid decision-making, are not unanimous and consistent in detecting such interactions.

Drug-Related Problems Among Ambulatory Heart Failure Patients on Follow-Up at Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

PurposeThe purpose of this study was to assess drug-related problems (DRPs) among ambulatory heart failure (HF) patients attending at medical referral clinic of Debre Berhan Comprehensive Specialized Hospital, Ethiopia.Materials and MethodsA hospital-based cross-sectional study was conducted among 344 HF patients. Drug-related problems were classified using modified Cipolle’s DRP classification schemes and drug–drug interactions were assessed using Micromedex, up-to-date, and drug.com drug–drug interaction checkers. The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics were used to summarize patients’ characteristics. Univariable and multivariable binary logistic regression analysis was performed to identify associated factors with dependent variables. P < 0.05 was considered statistically significant.ResultsThe mean age of the study participants was 53.38 ± 18.84 years and nearly half (45%) were in the age group of 31–60 years. Drug-related problems were found in 80.8% of HF patients. A total of 416 DRPs were identified. Adverse drug reaction (35.58%) was the top DRPs identified followed by the need for additional drug therapy (30.53%) and ineffective drug therapy (26.9%), respectively. Diuretics (45%), beta-blockers (BBs) (12.42%), and angiotensin-converting enzyme inhibitors (ACEIs) (10%) were the commonly used drug classes by study participants. The presence of comorbidity (p ˂ 0.001) and level of education of study participants (p = 0.03) had a significant association with the occurrence of DRPs.ConclusionThe prevalence of DRPs among ambulatory HF patients was high. The presence of comorbidity and the educational level of study participants had a significant association with the occurrence of DRPs. Checking potential drug–drug interactions before starting a new therapy, monitoring adverse drug reactions, ensuring sustainable availability of medications, and regular education programs are recommended to minimize DRPs.

Assessment of Drug Interactions with Online Electronic Checkers in Multi-Pathological Patients

Introduction: Multi-pathological patients are at high risk of drug interactions and side effects. We aimed to assess the usefulness of 3 online drug interaction checkers. Methods: In a cross-sectional study, carried out in the Medicine Department of Hospital General of Castellon, Spain, in February 2020, we assessed drug interaction detection with 3 online electronic checkers, Drugs.com, Lexicomp®, and Medscape, and compared results obtained with the 3 tools. From every hospitalized patient, we obtained the list of drugs he or she had been taking until admission. Bivariable tests were used for analysis. p values <0.05 were considered significant. Results: We included data from 134 patients; 68 (51%) were male; median (and interquartile range) of their age was 82 (76–88) years. A total of 1,082 substance drugs were entered in the checkers. The number of highest grade interactions found with every program was Drugs.com 85, Lexicomp® 33, and Medscape 67. Positive correlations were found between age and number of drug substances prescribed (p = 0.009) and between number of drug substances prescribed and interactions found with any of the 3 checkers (p < 0.001 in all 3 cases). Regarding highest grade interactions, agreement among all 3 checkers was poor. Conclusions: The 3 online checkers we assessed found a large number of interactions. The 3 programs gave very discrepant results. Impact on Practice Statements: The analyzed programs, Drugs.com, Lexicomp®, and Medscape Interactions, found a large number of drug interactions in the studied patients. The 3 programs gave very discrepant results among them.

Drug Interactions and Drug Interaction Checkers

Drug Interactions and Drug Interaction Checkers

MPN-028: Heart Failure: A Cause of Polypharmacy, Drug-Drug, and Food-Drug Interactions in Essential Thrombocythemia

Introduction: Essential thrombocythemia (ET) is a rare BCR-ABL1-negative myeloproliferative neoplasm characterized by excessive production of platelets. Cardiovascular comorbidities, including chronic heart failure (HF), pose significant challenges in the management of ET. Polypharmacy, defined as the prescription of 5 or more drugs daily, and the risk of drug-drug (DDI) and food-drug (FDI) interactions have not been assessed so far in ET patients diagnosed with HF. Objective: To investigate the risk of polypharmacy, DDI, and FDI in ET patients with or without HF. Methods: The electronic medical records of the Internal Medicine Clinic of an emergency university hospital in Romania were searched from inception to February 2021. Electronic medical records were available since August 2014. We included all ET patients who had signed the written informed consent for participation in medical research and for whom information regarding the prescribed medications was available. The study was approved by the ethics council of the hospital. DDI and FDI were evaluated using an online drug interaction checker. Results: The study group included 15 ET patients of whom 4 suffered from HF (26.67%). Patients with ET+HF were older (77.75±7.93 versus 58.64±11.50 years, P=0.009) and were prescribed more drugs (9.25±3.40 versus 5.73±2.37 drugs/day, P=0.040) versus ET patients without HF. Patients diagnosed with ET and HF were also exposed to more potential DDI (10.25±9.50 versus 2.27±2.28, P=0.016) and FDI (3.50±3.00 versus 1.27±0.90, P=0.037). ET patients diagnosed with HF had a significantly higher number of potential major (3.25±2.63 versus 0.64±0.92, P=0.010) and moderate (5.75±5.68 versus 1.18±1.40, P=0.021) DDI, but the potential minor DDI were similar between the two groups. ET+HF patients were more likely to be at risk for major FDI (1.00±0.82 versus 0.18±0.40, P=0.020), but the risk of moderate and minor FDI was similar between ET patients with and without HF. Conclusions: HF can be considered a significant cause of polypharmacy, as well as potential DDI and FDI, in patients with ET. Further research is needed to clarify the impact of these findings on the current therapeutic management of ET, especially in patients with HF and other cardiovascular comorbidities.

Potential Drug-Drug Interactions in Hospitalized Medical Patients: Data From Low Resource Settings.

IntroductionAdverse events related to Drug-Drug Interactions (DDIs) are among the few common reasons for hospitalization worldwide; however, they can be prevented with an efficient patient-centered system. Different mechanisms have successfully limited the prevalence of DDIs in developed countries. There are limited data regarding DDIs from limited-resource settings. Furthermore, there is no cost-effective system that has shown promising results in preventing them in this setting. This study aims to assess the frequency of potential DDIs in a low-resource setting and to check its association with different factors such as poly-pharmacy and demographics.MethodsThrough this cross-sectional study, drug charts of patients admitted to a medical unit in November 2019 were analyzed using a structured questionnaire. A list of drugs co-prescribed to each patient was entered into the Medscape Drug Interaction checker to calculate the frequency and severity of potential DDIs.ResultsThe mean age of patients was 49 years, and on average, seven drugs were prescribed to each patient. Among 100 analyzed prescriptions, 400 potential DDIs were identified with a mean of 4±5.42 per patient. According to Medscape interaction checker classification, 2 DDIs were contraindicated, 28 were serious, 246 required close monitoring, and 124 were minor. The most frequently encountered drug interaction was "spironolactone with furosemide." There was a significant correlation of the occurrence of potential DDIs with increased numbers of prescribed drugs.ConclusionOur patient population was prescribed more drugs per patient than calculated in other settings. Poly-pharmacy is an independent risk factor for DDIs. Lastly, advancing age exposes patients to poly-pharmacy, and therefore, they are at a higher risk of developing DDIs.