Incidence Of Drug-drug Interactions Research Articles

Balancing the Interactions: Assessing Antiplatelet and Antiretroviral Therapy Drug-Drug Interactions in People Living with HIV.

The clinical effect of drug-drug interactions (DDIs) between antiplatelets and antiretrovirals (ART) on bleeding, thrombosis, and other major adverse cardiovascular events (MACE) is unknown. The objective of this retrospective study was to assess the incidence of DDI at P2Y12 inhibitor (P2Y12inh) initiation and the effect of DDI on patient outcomes. Adult people living with human immunodeficiency virus (PLWH; HIV) receiving ART newly initiated on an oral P2Y12inh were included. The primary outcome was the incidence of DDI between ART and P2Y12inh at P2Y12inh initiation. Secondary outcomes included bleeding events, MACE, and switches in P2Y12inh. There were 149 PLWH included, of these, 119 (80%) were initiated on clopidogrel, 23 (15%) on ticagrelor, and 7 (5%) on prasugrel. 93 PLWH (60%) had a DDI at time of P2Y12inh initiation, with highest incidence in the clopidogrel group (n=84, 71%), followed by ticagrelor (n=9, 39%) and none with prasugrel. Within 1 year, MACE occurred in 12 PLWH, with DDI present at the time of 4 events. There were 29 bleeding events occurring within 1 year, including 17 events with DDI at time of event. However, 88% of DDI in patients with bleeding events were expected to decrease the efficacy of P2Y12inh. Though we observed high incidence of DDI between P2Y12inh and ART in PLWH, MACE and bleeding events at 1 year did not correlate with DDI. It remains unknown if DDI presence at P2Y12inh initiation with ART causes clinical outcomes of concern, or if underlying platelet reactivity in PLWH is associated with these events.

The Impact of Customized Screening Intervals on the Burden of Drug-Drug Interaction Alerts: An Interrupted Time Series Analysis.

Fixed and broad screening intervals for drug-drug interaction (DDI) alerts lead to false positive alerts, thereby contributing to alert fatigue among healthcare professionals. Hence, we aimed to investigate the impact of customized screening intervals on the daily incidence of DDI alerts. An interrupted time series analysis was performed at the University Hospitals Leuven to evaluate the impact of a pragmatic intervention on the daily incidence of DDI alerts per 100 prescriptions. The study period encompassed 100 randomly selected days between April 2021 and December 2022. Preceding the intervention, a fixed and broad screening interval of 7 days before and after prescribing an interacting drug was applied. The intervention involved implementing customized screening intervals for a subset of highly prevalent or clinically relevant DDIs into the hospital information system. Additionally, the sensitivity of the tailored approach was evaluated. During the study period, a mean of 5731 (± 2909) new prescriptions per day was generated. The daily incidence of DDI alerts significantly decreased from 9.8% (95% confidence interval (CI) 8.4;11.1) before the intervention, to 6.3% (95% CI 5.4;7.2) afterwards, p < 0.0001. This corresponded to avoiding 201 (0.035*5731) false positive DDI alerts per day. Sensitivity was not compromised by our intervention. Defining and implementing customized screening intervals was feasible and effective in reducing the DDI alert burden without compromising sensitivity.

A cross-sectional study on the potential drug-drug interaction risk ofCOVID-19 patients in hospital.

To investigate the incidence of and risk factors for potential drug-drug interactions (DDIs) among elderly patients with corona virus disease 2019 (-COVID-19) in hospital and to explore management strategies to reduce the occurrence of potential DDIs and ensure patient medication safety. This was a descriptive, retrospective cross-sectional study among patients aged 65 years and older who were hospitalized with COVID-19. Potential DDIs associated with prescriptions containing two or more medicines were analyzed with Lexicomp software, the incidence of DDIs was calculated, recommendations for medication adjustment were formulated, and the χ2-test and binary logistic regression were used to analyze related risk factors. A total of 772 prescriptions were analyzed, 527 (68.26) of which involved 5,732 potential DDIs. The results of this study showed that a total of 152 (28.84%) prescriptions had 270 X risk class potential DDIs (i.e., avoid combining), 313 (59.39%) prescriptions had 1,161 D risk class potential DDIs (i.e., consider therapy modification), and 476 (90.32%) prescriptions had 4,301 C risk class potential DDIs (i.e., monitor therapy). The study findings showed that the total number of drugs (p<0.001), the length of hospital stay (p<0.001), and the number of comorbidities (p<0.001) were risk factors affecting the occurrence of potential DDIs. This study identified factors associated with potential DDIs, which can assist in changing medication strategies, preventing adverse drug reactions, and improving clinical efficacy.

Psychiatrists’ and Infectious Disease Physicians’ Awareness and Knowledge Level of Drug-Drug Interactions Between Antiretrovirals and Psychotropics: A Comparative Questionnaire-Based Study

Objectives: The incidence of drug-drug interactions (DDIs) increases with psychotropics in people living with HIV (PLWH). This study aimed to compare the knowledge of infectious disease physicians (IDPs) and psychiatrists about DDIs as primary outcome and to assess their knowledge, attitudes and awareness of DDIs as secondary outcome. Materials and Methods: The quantitative and comparative questionnaire methods were administered to IDPs and psychiatrists in online survey. The questionnaire included open-ended and multiple-choice questions on physicians’ sociodemographic and attitudes to DDIs and three hypothetical case scenarios. Information including patients’ age, sex, social and medical history, laboratory findings and all drugs were provided in each scenario. After providing brief DDI information, the case scenario question was asked again with pretest-posttest design. Results: Attitudes of 31 IDPs and 29 psychiatrists against ART-psychotropic DDIs were examined. Thirty-five (58.3%) of physicians emphasized that ‘average’ perceived competence in DDIs knowledge. Moreover, 53 physicians (88.3%) were affected by DDIs on prescription behavior. When we asked physicians that how often they informed their patients about DDI, 45 (75%) responded ‘often/always’. Major DDI was defined correctly by psychiatrists [12 (41.4%) vs. 23 (79.3%)] and IDPs [24 (77.4%) vs. 29 (93.5%)] before and after information brief (p

A Clinical-Based Drug Interaction Alert (CIDIA) System for Preventing Drug Interaction and Its Associated Factors at Rural Primary Care Centres

Objectives: Drug-drug interaction (DDI) occurs following the prescription of more than one drug. DDI and its associated factors in Indonesia’s country’s primary care have not been reported.&#x0D; Materials and Methods: Through this descriptive cross-sectional study, we analysed the DDI incidence using the Clinical-Based Drug Interaction Alert (CIDIA) alert system. Purposive research was carried out by analysing prescriptions (n=2410) from nine primary health cares.&#x0D; Results: CIDIA alert system detected 7.5% DDI incidence in all prescriptions, categorized as mild (63%), moderate (36%) and serious (1%). Significant DDI incidence was observed in female patients (p&lt;0.01), in patients older than 18 years (p&lt;0.01) and in patients receiving three or more drugs (p&lt;0.01). The most frequent incidence of DDI from each category was paracetamol-domperidone; dexamethasone-mefenamic acid and captopril-allopurinol.&#x0D; Conclusion: CIDIA alert system has been shown to provide beneficial support in detecting DDI incidence. Careful consideration should be addressed particularly towards female patients, older patients, and patients receiving three or more drugs in preventing DDI incidence.&#x0D; Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 667-675

Drug-Drug Interactions of Direct Oral Anticoagulants (DOACs): From Pharmacological to Clinical Practice.

The direct oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, are becoming the most commonly prescribed drugs for preventing ischemic stroke in patients with non-valvular atrial fibrillation (NVAF) and for the treatment and prevention of venous thromboembolism (VTE). Rivaroxaban was also recently approved for the treatment of patients with a recent acute coronary syndrome (ACS). Their use demonstrated to have a favorable risk-benefit profile, with significant reductions in stroke, intracranial hemorrhage, and mortality compared to warfarin, but with increased gastrointestinal bleeding. Nevertheless, their safety profile is compromised in multimorbidity patients requiring contemporary administration of several drugs. Comorbidity and polypharmacy have a high prevalence in elderly patients, who are also more susceptible to bleeding events. The combination of multiple treatments can cause relevant drug–drug interactions (DDIs) by affecting the exposure or the pharmacological activities of DOACs. Although important differences of the pharmacokinetic (PK) properties can be observed between DOACs, all of them are substrate of P-glycoprotein (P-gp) and thus may interact with strong inducers or inhibitors of this drug transporter. On the contrary, rivaroxaban and, to a lower extent, apixaban, are also susceptible to drugs altering the cytochrome P450 isoenzyme (CYP) activities. In the present review, we summarize the potential DDI of DOACs with several classes of drugs that have been reported or have characteristics that may predict clinically significant DDIs when administered together with DOACs. Possible strategies, including dosage reduction, avoiding concomitant administration, or different time of treatment, will be also discussed to reduce the incidence of DDI with DOACs. Considering the available data from specific clinical trials or registries analysis, the use of DOACs is associated with fewer clinically relevant DDIs than warfarin, and their use represents an acceptable clinical choice. Nevertheless, DDIs can be significant in certain patient conditions so a careful evaluation should be made before prescribing a specific DOAC.

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.

Evaluation of drug-drug interactions in chronic kidney disease patients: A single-center experience

Drug-drug interactions (DDIs) result from the simultaneous consumption of two or more drugs that alter the patient’s response to the initial drug. The treatment regimen in patients with kidney disease is very diverse and may be associated with several diseases that increases the risk of DDIs. This study was carried out to investigate the DDIs incidence in patients with chronic kidney disease (CKD) in the nephrology ward. This descriptive-analytical study was performed in a 4-month period in 2017. The patients’ information such as age, sex, list of drugs during hospitalization, and kidney disease stage were recorded from patients’ medical records. Drug-drug interactions were extracted using LexiComp Online. In this study 48.55% of patients were male, 51.45% were female and 53.2% of patients were in stage 5 of kidney disease. There was a significant correlation between the incidence of drug-drug interactions with stage 5 of disease (P=0.02). The highest number of interactions was categorized as type C and interaction between atorvastatin and pantoprazole was the most frequent interaction. The maximum range of prescription drugs was between 6 and 10 items by 49.7% of patients. There was a significant correlation between the incidence of drug-drug interactions and the number of prescribed drugs (P=0.03). Drug-drug interactions are common in patients with chronic kidney disease. Based on the results, the number of prescribed drugs and the stage of the disease is effective in drug-drug interactions incidence. It is possible to reduce drug complications and increase the life span of patients by recognizing drug-drug interactions.

Incidence of Drug-drug Interactions in Prescriptions of General Practitioners and Specialists in Bangladesh

Aim: Drug-drug interactions (DDI) can cause unexpected side effects, changes in drug efficacy, metabolism or overall action of any particular drug and DDI is one of the major prescription errors. DDI can be caused by using concomitant administration of a second drug. This study aims to find DDI in prescriptions of 10 different medical specializations of Bangladesh. &#x0D; Study Design and Methodology: This study is based on the evaluation of prescription, type, and clinical significance of drug-drug interaction. For this study, 21088 prescriptions were evaluated from 45 different medical institutions and 10 different specializations including general practitioners, cardiologists, medicine specialists, general surgeons, gynecologists, ENT specialists, neurologists, urologists, pediatricians, and ophthalmologists. After the collection of prescriptions, all prescribed medications were checked by using several sources to point out the probable interactions.&#x0D; Results: Among all the prescriptions most DDI was found from cardiologists (6.17%) and the least DDI was found from pediatricians (3.29%). Clopidogrel and warfarin were the most common medications causing drug interaction while drug interaction with cardiovascular drugs and antibiotics generic were most common among all. Polypharmacy, absence or shortage of pharmacists, workload, miscommunications and lack of knowledge were found as the leading causes of DDI.&#x0D; Conclusion: Active participation of the pharmacist in crosschecking the prescribed medication, proper communication of the physician and patients, relevant workshops regarding DDI and distribution of the workload of the physicians in different levels can play a role in minimizing DDI.

Assessment of potential drug - Drug interaction among the patients receiving cancer chemotherapy: A cross-sectional study

Objectives: To identify and assess the various potential drug-drug interactions (pDDIs) among the patients receiving cancer chemotherapy, using the database from Lexicomp® Solutions with the ultimate goal of raising awareness among clinicians for safe medication usage. Materials and Methods: It is a prospective, cross-sectional study engaged at a tertiary care hospital in South India. Data regarding clinically prescribed drugs were obtained from the patients admitted to the oncology unit of a tertiary care hospital within the time frame of 6 months (June 2018 to December 2018). Frequency and clinical relevance, the onset, and Severity of pDDIs were assessed using the database from Lexicomp® Solutions version 4.1.2. Data were analyzed using the descriptive statistics. Statistical significance was analyzed using the Mann–Whitney and Chi-square tests. Pearson's correlation coefficient was used to identify the correlation between the incidence of drug-drug interactions with age, the number of drugs prescribed, and the type of cancer. Results: A total of 895 pDDIs were seen, including 261 with chemotherapeutic drugs and 634 with supportive medication. It was observed that around 14.18% of cyclophosphamide showing interaction with Ondansetron among chemotherapeutic drugs, whereas 9.14% of lithium presenting interaction with Ondansetron among supportive therapy. A statistically significant higher interaction was noted among supportive medications provided when compared to anticancer drugs (P = 0.001). Conclusions: The majority of pDDIs observed among the patients receiving chemotherapy with supportive medications as compared to anticancer chemotherapy. There is an urgent need for special safety measures to monitor and prevent drug interactions in the oncology unit.

Consider clinically relevant drug interactions when prescribing edoxaban

Edoxaban, a factor Xa inhibitor, is a direct oral anticoagulant (DOAC). DOACs may have a lower incidence of drug-drug interactions (DDIs) than vitamin K antagonists such as warfarin. Nonetheless, DOACs can have clinically relevant pharmacokinetic and pharmacodynamic DDIs. Careful consideration of potential DDIs is needed when prescribing edoxaban, and clinically relevant DDIs may be prevented by avoiding offending combinations, spacing out the timing of the drugs or by halving the dose of edoxaban where indicated.

Potentially inappropriate medications involved in drug-drug interactions at hospital discharge in Croatia.

Background The potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) can significantly affect patient safety in the elderly, especially at transition of health care. Objective The aim of this study is to evaluate PIMs involved in potentially clinically significant DDIs in prescribed pharmacotherapy of elderly patients at hospital discharge. Setting Internal Medicine Clinic of University Hospital Dubrava, Zagreb, Croatia. Method During a 16-month period, the pharmacotherapy data were assessed using Lexicomp Online screening software to identify category C (monitor drug therapy), D (consider therapy modification) and X (avoid combination) DDIs. The European Union (EU)(7)-PIM criteria were applied to detect inappropriately prescribed medications involved in DDIs. Clinical pharmacists obtained data from patients' medical records and patient/caregiver interviews. Main outcome measure The incidence of PIMs involved in potentially clinically significant DDIs. Results A total of 364 consecutive elderly patients were enrolled in the study. The mean number of prescription medications at discharge was 9.3. Overall, 2833 potentially clinically significant DDIs were identified: 2445 (86.3%) of them were category C, 347 (12.3%) category D and 41 (1.4%) were category X interactions. A total of 1164 PIMs were involved in 31.2% of category C interactions, 60.2% of category D interactions and 43.9% of category X interactions. The most frequent PIMs involved in potentially clinically significant DDIs were tramadol, benzodiazepines, moxonidine, vildagliptin and metoclopramide. Conclusion A very high incidence of DDIs in elderly patients and a high incidence of PIMs involved in DDIs was determined at hospital discharge.

TO ESTIMATE THE INCIDENCE OF POTENTIAL DRUG-DRUG INTERACTION IN STROKE PATIENTS ADMITTED IN A TERTIARY CARE HOSPITAL, TELANGANA

Objective: To determine the frequency and pattern of potential drug-drug interactions in hospitalized stroke patients.&#x0D; Methods: A retrospective study was carried out among patients treated for ischemic and haemorrhagic stroke at a tertiary care hospital, Hyderabad for a period of 1 y. A total of 177 prescriptions were analyzed during the study period. The potential drug-drug interactions were identified using Clinirex software.&#x0D; Results: Among the 177 prescriptions, 63.8% were male and 36.2% were female. Out of 177, 79 % of prescriptions had shown potential drug-drug interactions. The patients prescribed with more than 5 drugs developed higher incidence of drug-drug interactions. Based on severity scale we observed 12% major, 71% moderate and 17% minor drug-drug interactions. The incidence of pharmacodynamic interactions was 68% and the pharmacokinetic interactions were 32%.&#x0D; Conclusion: This study suggests that patients with stroke are frequently exposed to potential drug-drug interactions. The incidence of potential drug-drug interactions was higher in patients above 40 y. Most of the prescriptions contained polypharmacy which may lead to increased risk of hospitalization and higher health care cost. It is essential to identify potential drug-drug interactions especially in elderly patients as early as possible in order to prevent adverse drug reactions and ensure patient’s safety.

Incidence of antiretroviral drug-related problems in the treatment of HIV among hospitalized patients in the Hospital Santa Clara, Bogotá

ResumenIntroducción. El tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana (HIV) se ha relacionado con diversos problemas de los medicamentos que causan o pueden causar la aparición de resultados negativos. En este contexto, es importante determinar su incidencia, caracterizarlos y clasificarlos para diseñar estrategias que minimicen su impacto.Objetivo. Estimar la incidencia global y de cada uno de los problemas relacionados con los medicamentos antirretrovirales utilizados en el tratamiento del HIV en una cohorte de pacientes hospitalizados en una institución de tercer nivel de Bogotá.Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo de cohorte en pacientes de 18 años o más de edad con diagnóstico de infección por el HIV y en tratamiento antirretroviral, hospitalizados entre el 1° enero de 2015 y el 31 de diciembre de 2016 en el Hospital Santa Clara de Bogotá.Resultados. La incidencia global de los problemas relacionados con los medicamentos antirretrovirales fue de 0,90 (IC95% 0,85-0,93). La incidencia de las interacciones medicamentosas fue de 0,85 (IC95% 0,80-0,90), la de las reacciones adversas de 0,28 (IC95% 0,22-0,35) y la del error de prescripción de 0,12 (IC95% 0,08-0,17).Conclusión. Los problemas relacionados con los medicamentos deben estudiarse, diagnosticarse, prevenirse y tratarse para que el personal de salud pueda anticiparse a su aparición, disminuir su incidencia, implementar planes de manejo del riesgo y optimizar el cumplimiento del tratamiento antirretroviral.

Potential Drug-drug Interactions at a Referral Pediatric Oncology Ward in Iran: A Cross-sectional Study.

Incidence of drug-drug interactions (DDIs) has been widely reported; however, such reports in pediatric oncology patients still remain scarce. We studied frequency and demographic correlates of moderate and major DDIs at a pediatric oncology ward in Isfahan, Iran. All pediatric oncology patients admitted to the Omid hospital during a 6-month period (2017) who received at least 2 anticancer or non-anticancer drugs concomitantly were included in our study. Potential DDIs between anticancer and non-anticancer drugs during hospitalization was identified using Lexi-Interact on-line software. We detected 194 DDIs with moderate or major severity for our included 115 patients. Mechanistically, most of DDIs (56.4%) were pharmacodynamic. Systematic use of corticosteroids (82.0%), antimetabolites (77.0%), and antiemetic drugs (69.5%) were the most frequent medication classes responsible for detected DDIs. The interaction between aminoglycosides and the third generation cephalosporins was the most common (13.9%) non-anticancer DDI. The only identified interaction between 2 anticancer drugs was doxorubicin with cyclophosphamide. Age, sex, and the number of administered medications were associated with DDIs. Potential moderate or major DDIs occur frequently among pediatric cancer patients. More studies are needed to assess clinical and economic implications of DDIs in pediatric oncology patients.

Incidence of Drug-Drug Interactions among Patients Admitted to the Department of General Medicine in a Tertiary Care Hospital

<p style="text-align: justify;"><strong>Background:</strong> Drug-Drug Interactions (DDIs) contribute to increased rate of morbidity and mortality increasing the need for intense monitoring of patient safety which can be achieved by detecting and preventing morbidities associated with DDIs. <strong>Objective and Methodology:</strong> The present work was a prospective study carried out for a period of six months, to assess the incidence of DDIs in patients admitted to the Department of General Medicine at a tertiary care hospital. <strong>Results:</strong> Prescriptions of 411 patients were analysed, out of which 165 (40.15%) prescriptions were identified with potential DDIs whereas clinical manifestations of actual DDIs were observed and reported in 23 (5.6%). A total of 657 DDIs were observed of which 6 (0.9%), 240 (36.5%), 374 (56.9%) and 33 (5.6%) were of contraindicated, major, moderate and minor severity respectively. Based on the mechanism 310 (47.2%) of the identified DDIs were pharmacodynamic and 243 (36.9%) were pharmacokinetic interactions. There was a positive correlation between the number of DDIs and risk factors such as length of hospital stay, number of drugs prescribed and co-morbidities. <strong>Conclusion:</strong> This study concludes that awareness on the most prevalent DDIs can help the practitioners to prescribe drugs with a low risk for DDIs and prevent the concomitant use of dangerous drug combinations. <p style="text-align: justify;"><strong>Key words:</strong> Drug-drug interactions, General medicine, Pharmacodynamic, Pharmacokinetic, Severity, Risk factors.

Characterization of drug-drug interactions in patients whose substance intake was objectively identified by detection in urine

ABSTRACTBackground: Identification of drug-drug interactions (DDIs) typically relies on patient medication lists which are prone to inaccuracies. This study describes use of a mass spectrometry test to detect recently ingested substances in urine with subsequent identification of DDIs.Research design and methods: This was a retrospective analysis of the prevalence of DDIs identified in patients with chronic pain, addiction and/or behavioral health conditions in the U.S. Relationships between patient demographics, polypharmacy and the occurrence of DDIs were also described.Results: Of 15,004 patients, 2964 (20%) had a DDI identified. There was a positive association between the number of substances detected in urine and the number of interactions identified (r = 0.5033, p-value = 0.0001). Of patients with polypharmacy, 15.6% had contraindicated or severe interactions identified compared to only 3.2% of those without polypharmacy. For polypharmacy patients, the youngest population studied had a much higher likelihood of having one or more DDIs identified compared to the other age groups (p-value = 0.0002).Conclusions: By utilizing a mass spectrometry test to objectively detect recently ingested substances followed by identification of DDIs, healthcare providers may be able to better characterize the true incidence of DDIs. Study findings may not be generalizable to healthcare populations outside of pain management, addiction treatment, and behavioral health.

Monitoring Polypharmacy in Healthcare Systems Through a Multi-Setting Survey: Should We Put More Attention on Long Term Care Facilities?

BackgroundPolypharmacy is a main issue of patient safety in all healthcare settings (i.e. increase adverse drug reactions and incidence of drug-drug interactions, etc.). The main object of the study was to evaluate the prevalence of polypharmacy and the appropriateness of drugs prescriptions in the regional health system (RHS) of Friuli Venezia-Giulia Region, Italy.Design and methodsWe carried out a point prevalence study in May 2014; 1582 patients ≥65 years were included from: 14 acute hospitals, 46 Long Term Care Facilities (LTCFs) and 42 general practitioners’ (GPs) clinics. Data analysis included the evaluation of potentially inappropriate prescriptions (PIPs) taking Beers criteria as a reference.ResultsPatients in therapy with 10 drugs or more were 13.5%: 15.2% in hospitals, 9.7% in GPs’ clinics and 15.6% in LTCFs. According to Beers criteria we identified 1152 PIPs that involved globally almost half of patients (46.0%): 41.9% in hospitals, 59.6% in LTCFs and 37.0% in GP’s clinics. The 53.9% of patients received at least one mainly kidney excreted drug; for these patients the evaluation of serum creatinine was overall present in the 87.7% (747/852): 96.4% in hospital ones, 87.5% in GPs’ clinics and 77.8% in LTCFs. LTCFs residents were significantly (P<0.05) more exposed to PIPs and less monitored for the renal function.ConclusionsA reliable estimation of the phenomenon in all the main healthcare settings is a necessary prerequisite to set tailored policies for facing polypharmacy within a RHS; the results showed the necessity to put a special attention on LTCFs.Significance for public healthWe believe that our research is appropriate for your journal because concerns a very important issue for healthcare systems: the management of drugs in elderly people, in particular our study evaluated the topic of polypharmacy and potentially inappropriate prescriptions in a whole regional healthcare system, considering the three main care settings: acute hospitals, long term care facilities and general practitioners’ clinics. We also analysed the problem included all the medications that patients assumed, not only ones that were reimbursed by healthcare system. Considering these premises this study permitted to have a wide point of view for setting tailored policies and it underlines the importance of creating a system that starts from real data and in this way will allows to compare and measure improvement actions.

Incidence of Potential Drug-Drug Interactions in a Limited and Stereotyped Prescription Setting - Comparison of Two Free Online Pharmacopoeias.

Background: Drug-drug interactions (DDIs) are very common adverse events in health care delivery settings. The use of electronic pharmacopeias can potentially reduce the incidence of DDIs, but they are often thought to be cumbersome to use. This study is aimed at studying the incidence of potential DDIs in a surgical department, where a limited number of drugs are used in stereotyped combinations. We also compared two popular drug compendia in detecting potential DDIs.Methods: The prescriptions of selected patients were entered into Epocrates® and Medscape® for Android smartphones. Potential DDIs were generated and their categories were noted. The warnings generated by Epocrates® were compared with those generated by Medscape® and an agreement index was calculated.Results: Three hundred and thirty-one patients were included for analysis who had received a total of 2,878 drug orders. The incidence of potential DDIs was very high - 89% of all prescriptions. Phenytoin was the drug most commonly implicated, followed by furosemide. Of the DDIs detected, 0.14% were potentially serious and the drug combinations were contraindicated. There was a significant discrepancy between the categories of potential DDIs detected by Epocrates® and Medscape®. No clinically significant DDI was detected in any patient in this cohort.Conclusions: Despite routinely using only a limited number of drugs in stereotyped combinations, prescriptions in surgical departments may not be immune from a significant incidence of DDIs. The use of free apps could reduce the incidence of DDIs, enhance patient safety, and also aid in educating trainees.

Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future

ABSTRACTBackground: Information regarding the incidence of drug-drug interactions (DDIs) and adverse drug events (ADEs) among paediatric patients in Nigeria is limited.Methods: Prospective clinical audit among paediatric outpatients in four general hospitals in Nigeria over a 3-month period. Details of ADEs documented in case files was extracted.Results: Among 1233 eligible patients, 208 (16.9%) received prescriptions with at least one potential DDI. Seven drug classes were implicated with antimalarial combination therapies predominating. Exposure mostly to a single potential DDI, commonly involved promethazine, artemether/lumefantrine, ciprofloxacin and artemether/lumefantrine. Exposure mostly to major and serious, and moderate and clinically significant, potential DDIs. Overall exposure similar across all age groups and across genders. A significant association was seen between severity of potential DDIs and age. Only 48 (23.1%) of these patients presented at follow-up clinics with only 15 reporting ADEs.Conclusion: There was exposure to potential DDIs in this population. However, potential DDIs were associated with only a few reported ADEs.