Frequency Of Drug-drug Interactions Research Articles

Clinically Relevant Interactions with Anti-Infectives on Intensive Care Units-A Multicenter Delphi Study.

Patients in intensive care units (ICUs) are at high risk of drug–drug interactions (DDIs) due to polypharmacy. Little is known about type and frequency of DDIs within German ICUs. Clinical pharmacists’ interventions (PI) recorded in a national database (ADKA-DokuPIK) were filtered for ICU patients. Binary DDIs involving ≥1 anti-infective agent with >1 database entry were selected. A modified two-step Delphi process with a group of senior hospital pharmacists was employed to evaluate selected DDIs for clinical relevance by using a five-point scale and to develop guidance for clinical practice. In total, 16,173 PI were recorded, including 1836 (11%) DDIs in the ICU setting. Of the latter, 41% (756/1836) included ≥1 anti-infective agent, 32% (590/1836) were binary DDIs, and 25% (455/1836) were listed at least twice. This translates into 88 different DDIs, 74% (65/88) of which were rated as being clinically relevant by our expert panel. The majority of DDIs (76% [67/88]) included macrolides, antifungals, or fluoroquinolones. This percentage was even higher in DDIs being rated as clinically relevant by the experts (85% [55/65]). It is noted that an inter-professional discussion and approach is needed in the individual patient management of DDIs. The guidance developed might be a tool for decision support.

Evaluation of drug-drug interactions among dental prescriptions at different clinical settings of Sialkot, Punjab, Pakistan

Introduction: Drug plays a fundamental role in disease prevention and ultimately promotes healthy society. Inappropriate prescribing traditions are not only goes toward useless & unsafe treatment but also prolongation of illness and distress the patient and increased economic burden. Therefore evaluation of drug-drug interactions are considered a necessary starting in forming an effective drug utilization stewardship program with the leading objectives of upgrade the efficacy of treatment and reducing the microbial resistance; this study can also be helped as a pharmaco-epidemiological extent for carrying out of a national preventive drug policy. Objectives: To assess Drug-Drug interactions among dental prescriptions at different clinical settings of Sialkot, Punjab, Pakistan. Study Design: A descriptive observational study. Settings: A hospital based study was conducted in different clinical settings of Sialkot, Punjab, Pakistan. Period: Six months from January to June 2018 according to study criteria. Materials and Methods: The Sample size is 500 prescriptions were collected randomly in six months from January to June 2018 according to study criteria. A structured data form was used for collecting demographics, diagnosis, complications, present medications prescribed for each patient and find out number of prescriptions which shows drug-drug interactions and level of severity as well. MS Excel and descriptive statistics was used for find out the result of the study. Results: The current study finding shows that males have more prevalence i.e. 55.8% of dental problems compared to females (44.2%). Mostly patients were included in 51-60 age group (30.2%). 50.2% patients have pervious medication history and most common diagnosis was acute periapical infection (26.8%). Further mostly analgesics (26%) were prescribed followed by antibiotics (21.5%) with elevated body temperature (29.4%). Commonly six drugs per prescription prescribed (34.2%) least numbers of drugs prescribed per prescription is 2(8.2%). 30.6% prescriptions reported with drug-drug interaction in which 26.8% were prescribed in acute periapical infections. More frequently was observed between Glimepiride – Levofloxacin (25.5%) followed by levofloxacin-prednisolone (24.8%). Conclusion: It was concluded that the frequency of drug-drug interactions in prescriptions by dentist in private dental clinics of Sialkot is high but majority of drug interactions with other drugs were found to be of significant minor occurring at pharmacodynamics level.

Clinically relevant drug-drug interactions and the risk for drug adverse effects among home-dwelling older persons with and without type 2 diabetes.

Polypharmacy and age are known to increase the risk for potential drug interactions. Type 2 diabetes has been associated with polypharmacy and several comorbidities. Currently, there is no information on whether the frequency of clinically relevant drug-drug interactions and the risk for drug adverse effects differ between older persons with and without diabetes. The aim of this study was to investigate the frequency of drug-drug interactions and the risk for drug adverse effects in these two groups in primary care. The basic study population consisted of Finnish home-dwelling primary care patients aged≥65years (N=3039). For each person with diabetes, two controls were selected with adjusted age and gender. To collect data, electronic primary care patient records, a structured health questionnaire and a structured health examination conducted by a physician were utilized. Using the SFINX-PHARAO® database, drug-drug interactions and the risk for drug adverse effects were evaluated in 182 persons with type 2 diabetes and 176 persons without diabetes. There were no significant differences in the frequency of drug-drug interactions or the risk for drug adverse effects in persons with and without diabetes. At least one clinically relevant interaction was found in 81 (44.5%) persons with diabetes and 73 (41.5%) persons without diabetes. The most common drugs causing interactions included non-steroidal anti-inflammatory drugs (NSAIDs) and warfarin. There is no difference in the frequency of drug-drug interactions or risk for drug adverse effects in older home-dwelling persons with and without diabetes. Due to common comorbidities and commonly used drugs among persons with diabetes, drug-drug interactions involving warfarin or NSAIDs in particular should be carefully monitored to avoid drug adverse effects.

Drug-drug interactions in intensive care units and potential clinical consequences of these interactions

Aim: Drug-drug interactions (DDIs) are an important factor that can lead to serious health problems by increasing or decreasing the effects of drugs. This study aimed to evaluate the frequency of DDIs in the intensive care unit (ICU). Material and Methods: All patients who were hospitalized for more than 24 h in the ICU of our hospital between January and September 2018 and received 2 or more medications were included in this retrospective study. Frequency and severity of the DDIs were detected using the Rx Mediapharma and Lexi-Interact programs. Results: Of the 972 patients enrolled in the study, 2742 incidences of DDIs were detected in 626 patients (64%). Of the different drug pairs administered, 422 had DDIs, and 64 of those had 10 or more DDIs, constituting 67% of all of the DDIs. The most common potential clinical consequences of DDIs were increased risk of bleeding (12.3%), hyperkalemia (8.2%), arrhythmia (7.9%), and CNS depression (6.6%). Conclusion: The results indicated that DDIs in the ICU were very common in our hospital. Moreover, these results indicated that patients should be closely monitored for the prevention of adverse effects, such as electrolyte disturbance, bleeding risk, and arrhythmia of drugs.

Analysis of drug-drug interactions among patients receiving antiretroviral regimens using data from a large open-source prescription database.

Results of a study of contraindicated concomitant medication use among recipients of preferred antiretroviral therapy (ART) regimens are reported. A retrospective study was conducted to evaluate concomitant medication use in a cohort of previously treatment-naive, human immunodeficiency virus (HIV)-infected U.S. patients prescribed preferred ART regimens during the period April 2014-March 2015. Data were obtained from a proprietary longitudinal prescription database; elements retrieved included age, sex, and prescription data. The outcome of interest was the frequency of drug-drug interactions (DDIs) associated with concomitant use of contraindicated medications. Data on 25,919 unique treatment-naive patients who used a preferred ART regimen were collected. Overall, there were 384 instances in which a contraindicated medication was dispensed for concurrent use with a recommended ART regimen. Rates of contraindicated concomitant medication use differed significantly by ART regimen; the highest rate (3.2%) was for darunavir plus ritonavir plus emtricitabine-tenofovir disoproxil fumarate (DRV plus RTV plus FTC/TDF), followed by elvitegravir-cobicistat-emtricitabine-tenofovir disoproxil fumarate (EVG/c/FTC/TDF)(2.8%). The highest frequencies of DDIs were associated with ART regimens that included a pharmacoenhancing agent: DRV plus RTV plus FTC/TDF (3.2%) and EVG/c/FTC/TDF (2.8%). In a large population of treatment-naive HIV-infected patients, ART regimens that contained a pharmacoenhancing agent were involved most frequently in contraindicated medication-related DDIs. All of the DDIs could have been avoided by using therapeutic alternatives within the same class not associated with a DDI.

Potential Drug-Drug Interactions among Patients prescriptions collected from Medicine Out-patient Setting.

Objective:To identify and evaluate the frequency, severity, mechanism and common pairs of drug-drug interactions (DDIs) in prescriptions by consultants in medicine outpatient department.Methods:This cross sectional descriptive study was done by Pharmacology department of Bahria University Medical & Dental College (BUMDC) in medicine outpatient department (OPD) of a private hospital in Karachi from December 2015 to January 2016. A total of 220 prescriptions written by consultants were collected. Medications given with patient's diagnosis were recorded. Drugs were analyzed for interactions by utilizing Medscape drug interaction checker, drugs.com checker and stockley`s drug interactions index. Two hundred eleven prescriptions were selected while remaining were excluded from the study because of unavailability of the prescribed drugs in the drug interaction checkers.Results:In 211 prescriptions, two common diagnoses were diabetes mellitus (28.43%) and hypertension (27.96%). A total of 978 medications were given. Mean number of medications per prescription was 4.6. A total of 369 drug-drug interactions were identified in 211 prescriptions (175%). They were serious 4.33%, significant 66.12% and minor 29.53%. Pharmacokinetic and pharmacodynamic interactions were 37.94% and 51.21% respectively while 10.84% had unknown mechanism. Number wise common pairs of DDIs were Omeprazole-Losartan (S), Gabapentine- Acetaminophen (M), Losartan-Diclofenac (S).Conclusion:The frequency of DDIs is found to be too high in prescriptions of consultants from medicine OPD of a private hospital in Karachi. Significant drug-drug interactions were more and mostly caused by Pharmacodynamic mechanism. Number wise evaluation showed three common pairs of drugs involved in interactions.

Potential Drug-Drug Interactions in Hospitals of West Kazakhstan

Cardiac patients need more attention regarding drug–drug interactions (DDI) due to comorbidities and a large number of clinical recommendations. The frequency of DDI among cardiovascular medicines is high. However, reports of DDI in Kazakhstan are few. The aim of this research was to study prevalence and associations between predictors of potential DDI in cardiac hospitals of West Kazakhstan. A retrospective analysis of pharmacotherapy of 730 patients with cardiovascular diseases treated in the hospitals of Aktobe, Uralsk, Atyrau cities in 2014 was performed. Potentially dangerous (major) DDI identified with the Drug Interaction Checker source (FDA). The prevalence of major DDI and associated predictors studied. Logistic regression was used to study DDI predictors such as age, gender, polypharmacy, prescriptions and length of hospitalization. We identified 54 major DDI. Most of them were spironolactone/ACE inhibitors (11.9%), enoxaparin / clopidogrel (10.7%), fondaparinux /clopidogrel (10%), spironolactone / potassium chloride (7.8%), ACE inhibitors/ potassium chloride (7.7%). 53.8% (95% CI 50.9–58.3) of patients received at least one potentially inappropriate combination. Multivariate logistic regression showed a significant association DDIs with age of 65 years or more (p=0.0056 OR 1.02 95% CI 1.0064–1.0377) and number of prescriptions (p <0.0001 OR 1.2872 95% CI 1.18–1.40). We found a high prevalence (53.8%) of major potential DDI in cardiac hospitals of West Kazakhstan. Age (OR 1.02) and number of prescribed drugs (OR 1.28) slightly increase risk of DDI.

The impact of polypharmacy and drug interactions among the elderly population in Western Sicily, Italy.

Primary endpoint was to report polypharmacy distribution in the general population vs ≥65 years old people and to examine the frequency of drug-drug interactions (DDIs) in the Health Local Unit of Palermo, Italy, in relationship with patients' age. Drug prescription data for the year 2014 were extracted from the database of the Local Health Unit of Palermo Province, Italy. Patients were divided into five age groups (0-13, 14-64, 65-69, 70-74, and ≥75year old). The detection of potential DDIs in polypharmacy profiles was performed with NavFarma software (Infologic srl, Padova, Italia), with DDI classification provided by tool Micromedex Drug Reax (Truven Health Analitics, Michigan, USA). We analyzed data of 1,324,641 patients, and 15,801,191 medical prescription were recorded; of these, 11,337,796 regarded chronic conditions. The drug prescriptions reached the highest values in the 65-69 and 70-74 age groups (p = 0.005 and p = 0.008 vs age 14-64 respectively). An overall amount of 6,094,373 DDIs were detected, of which 47,173 were contraindicated. Median number of DDIs was higher in 65-69 and 70-74 age groups (p = 0.008 and p = 0.012 vs age 14-64, respectively). Regarding contraindicated DDIs a significant difference was detected comparing 14-64 vs ≥65 age groups (p = 0.010 vs 65-69 group, p = 0.005 vs 70-74 group and ≥75 group). Polypharmacy is a phenomenon acquiring increasing dimensions also in our province. It interests particularly the older subjects, and assumes a dramatic accent when it is put in relationship with the frequency of DDIs. A proactive vigilance about potential life threatening drug interactions is mandatory.

Potential drug-drug interactions and adverse drug reactions in dermatological inpatients.

To present information on the frequency of drug-drug interactions and adverse drug reactions, and to provide assistance on how to minimize these major problems in the pharmacological treatment of dermatological inpatients. The medications given to 1,099 dermatological inpatients were retrospectively analyzed for drug-drug interactions and adverse drug reactions using web-based drug interaction software (Diagnosia® Check). We report an overall frequency of relevant drug-drug interactions of 51.7%, with an average of 3.2 interactions per affected inpatient. Drug combinations that should have been avoided were found in 5.7% of the study population. Total drug count was the most important risk factor. Drug groups involved in the majority of interactions were analgesics, cardiovascular and antithrombotic agents, as well as antidepressants. The risk of developing adverse drug reactions was rated as "high" in 53.1% of inpatients. The top five adverse reactions in this patient group were bleeding, constipation, anticholinergic effects, sedation, and orthostatic effects. Potential drug-drug interactions as well as adverse drug reactions are alarmingly common in dermatological inpatients. Every other patient is at risk of experiencing such interactions or adverse reactions, and every twentieth patient receives a drug combination that should not be administered. Increased alertness is a must in order to identify patients at risk.

Assessing patients' information needs regarding drug–drug interactions

ObjectiveTo assess patients' information needs regarding drug–drug interactions (DDIs) to inform patient DDI education resources. DesignCross-sectional study. SettingOnline (United States in May 2011). ParticipantsRegistered users of an online medication monitoring service (MediGuard). InterventionOnline questionnaire. Main outcome measureParticipants' information needs regarding DDIs and perceived importance of questions related to detecting and preventing harm from DDIs. ResultsCharacteristics of the 100 surveyed participants were as follows: 57% women, 88% white, 96% non-Hispanic, 71% retired, mean (±SD) age 65.2 ± years (range 35–86). The number of prescription medications ranged from 2 to 22 (median 7) and the number of over-the-counter (OTC) medications from 1 to 10 (4). The most common concerns cited by participants were identification of interacting medications, seriousness of DDIs, interactions with OTC medications, interactions with foods, exacerbating comorbidities, short- and long-term adverse effects, signs and frequency of DDIs, and how to minimize adverse effects. Statistically significant differences based on gender, number of prescriptions, and number of OTC medications were observed in rankings of the importance of some DDI questions (P < 0.05). ConclusionPatient-centered DDI education programs should consider addressing the seriousness of DDIs, the effect of DDIs on comorbidities, and interactions with OTC medications and foods and determining methods for identifying, minimizing, and managing DDIs.

Frequency and nature of drug–drug interactions in a Dutch university hospital

Drug-drug interactions (DDIs) may lead to often preventable adverse drug events and health damage. Especially within hospitals, this might be an important factor, as patients are severely ill and multiple medications may be prescribed simultaneously. The objective of this study was to measure the frequency and nature of DDI alerts in a Dutch university hospital.All patients hospitalized in the University Medical Centre Utrecht in 2006 who were prescribed at least one medication were included. The frequency of DDIs was calculated as: (i) the percentage of patients experiencing at least one DDI, and (ii) the percentage of prescriptions generating a DDI alert. Based on the national professional guideline, DDIs were classified into categories of potential clinical outcome, management advice, clinical relevance (A-F) and available evidence (0-4).Of the 21 277 admissions included, 5909 (27.8%) encountered at least one DDI. Overall, the prescribing physician received a DDI alert in 9.6% of all prescriptions. The most frequently occurring potential clinical consequence of the DDIs was an increased risk of side-effects such as increased bleeding risk (22.0%), hypotension (14.9%), nephrotoxicity (12.6%) and electrolyte disturbances (10.5%). Almost half (48.6%) of the DDIs could be managed by monitoring laboratory values.Computerized DDI alerts may be a useful tool to prevent adverse drug events within hospitals, but they may also result in 'alert fatigue'. The specificity of alerts could significantly improve by the use of more sophisticated clinical decision support systems taking into account, for example, laboratory values.

Frequency and nature of drug–drug interactions in a Dutch university hospital

Drug-drug interactions (DDIs) may lead to often preventable adverse drug events and health damage. Especially within hospitals, this might be an important factor, as patients are severely ill and multiple medications may be prescribed simultaneously. The objective of this study was to measure the frequency and nature of DDI alerts in a Dutch university hospital. All patients hospitalized in the University Medical Centre Utrecht in 2006 who were prescribed at least one medication were included. The frequency of DDIs was calculated as: (i) the percentage of patients experiencing at least one DDI, and (ii) the percentage of prescriptions generating a DDI alert. Based on the national professional guideline, DDIs were classified into categories of potential clinical outcome, management advice, clinical relevance (A-F) and available evidence (0-4). Of the 21 277 admissions included, 5909 (27.8%) encountered at least one DDI. Overall, the prescribing physician received a DDI alert in 9.6% of all prescriptions. The most frequently occurring potential clinical consequence of the DDIs was an increased risk of side-effects such as increased bleeding risk (22.0%), hypotension (14.9%), nephrotoxicity (12.6%) and electrolyte disturbances (10.5%). Almost half (48.6%) of the DDIs could be managed by monitoring laboratory values. Computerized DDI alerts may be a useful tool to prevent adverse drug events within hospitals, but they may also result in 'alert fatigue'. The specificity of alerts could significantly improve by the use of more sophisticated clinical decision support systems taking into account, for example, laboratory values.

Frequency and Clinical Relevance of Drug Interactions with Lovastatin and Simvastatin

Concomitantly used cytochrome P450 (CYP) 3A4 inhibitors and inducers have been shown to alter the plasma concentrations of the HMG-CoA reductase inhibitors ('statins') lovastatin and simvastatin. Myopathy is a serious adverse effect of statins. Concurrent use of statins with fibrates in particular seems to increase the risk of this adverse effect. To evaluate the incidence and clinical consequences of the use of lovastatin or simvastatin with concomitant CYP3A4 inhibitors and inducers, and with fibrates. An observational database study of hospitalized patients treated in Turku University Hospital, Turku, Finland, covering the period 1 July 1996 to 30 June 2003, and of nationwide community data from the Finnish Prescription Register over the period 1 April to 30 June 2001 was conducted. In the hospital setting, the study population comprised 71 025 patients (93 467 treatment periods) over 7 years, with a total of 5320 treatment periods of lovastatin or simvastatin. The community-based, nationwide survey included all reimbursed prescriptions of lovastatin and simvastatin (n = 91 656) in Finland during a 3-month period. The frequency of drug-drug interactions involving lovastatin or simvastatin was studied. The efficacy and safety of the various statin/concomitant drug combinations was estimated by evaluating patients' laboratory data. Concomitant use of lovastatin or simvastatin with interacting medication was detected in 13.3% (704) and 6.9% (6338) of patients in hospital and community settings, respectively. Co-administration of lovastatin or simvastatin with CYP3A4 inhibitors or inducers did not have a clinically significant effect on serum lipid values. Plasma creatine kinase (CK) activity was significantly higher in patients receiving a statin and a fibrate compared with a statin only (433 U/L vs 209 U/L, p = 0.053). Co-administration of a statin and a CYP3A4 inhibitor did not increase CK activity. Although the pharmacokinetic interactions between lovastatin or simvastatin and CYP3A4 inhibitors and inducers are substantial, their clinical relevance seems to be limited, at least with lower statin doses. However, combining statins with fibrates, especially gemfibrozil, clearly increases the potential for muscular toxicity.

Analyse critique des prescriptions médicamenteuses en hémodialyse

Aim. – The aim of the study is to analyse haemodialysis patients' prescriptions accordance with legal registrations in 64 chronic haemodialysis patients during a one-month follow-up period. Results. – Patients are taking 9.6 ± 3 different drugs. A mean of 2.4 ± 1.3 prescriptions per patient disagree with the recommended drug use. The directions for use in this specific population are defective in 89%. Moreover, at least one drug-drug interaction is found in 78% of our patients. Conclusion. – Only 8% of the studied hemodialysis patients benefit from prescriptions in agreement with the legal recordings, as a consequence of the lack of drug studies in this particular population. Therefore, clinicians have to rely on their own experience to establish their prescriptions, which can involve their responsability in case of litigation. Furthermore, the frequency of drug-drug interactions in these polymedicated patients implies that a close pharmaceutical follow-up should be implemented.

Risk of adverse events with concomitant use of atorvastatin or simvastatin and glucose-lowering drugs ( thiazolidinediones, metformin, sulfonylurea, insulin, and acarbose)

Little is known about the frequency of drug-drug interactions between cholesterol-lowering drugs and the various classes of antidiabetic agents. In the present study, we examined a Food and Drug Administration (FDA) database to determine the frequency of adverse events in patients taking both an hydroxymethylglutaryl coenzyme A (HMG CoA) reducatase inhibitor (statin) and an antidiabetic medication.