Incidence Of Potential Drug-drug Interactions Research Articles

POTENTIAL DRUG-DRUG INTERACTIONS OF CARDIOVASCULAR DRUGS BASED ON LITERATURE IN GERIATRIC PATIENTS WITH CONGESTIVE HEART FAILURE AT Dr. M. DJAMIL PADANG HOSPITAL

Objective: Congestive Heart Failure (CHF) is a notable cardiovascular disease impacting global morbidity and mortality. Geriatric patients with CHF typically require multiple medications that can potentially cause drug-drug interactions and affect patient therapy outcomes. This study aims to determine the potential drug-drug interactions, the relationship between the average number of cardiovascular drugs per day and the potential drug-drug interactions, and the relationship between the severity of drug-drug interactions and the clinical symptoms and signs of the patients.
 Methods: The research method used was analytical observational with retrospective data collection through the medical records of inpatients in 2021. A total of 63 patients were included using the total sampling method.
 Results: Results revealed that furosemide was the most commonly prescribed cardiovascular medication (15.27%). Among the participants, 93.65% exhibited potential drug-drug interactions (332 occurrences), with the most frequent involving furosemide and bisoprolol (32 cases). Pharmacodynamic interactions were the dominant mechanism (85.24%), with moderate severity (65.06%) being common. A significant relationship existed between the average number of cardiovascular drugs per day and the potential drug-drug interactions (p<0.05). Nonetheless, there was no notable correlation discovered between the severity of the interaction and the presence of symptoms and clinical signs (p>0.05).
 Conclusion: When considering the high incidence of potential drug-drug interactions, it is expected that clinical pharmacists have the competence to analyze potential drug interactions to prevent harmful effects on patients.

Assessment of drug-drug interactions among patients with psychiatric disorders: A clinical pharmacist-led study

BackgroundDrug-drug interaction alters the efficacy of the drugs. Early identification can reduce unintended therapeutic outcomes. ObjectiveThe main objective of the present study was to assess the drug-drug interactions among patients with psychiatric disorders. MethodologyA prospective observational study was conducted for a period of eight months. A total of 112 psychiatric inpatients were enrolled in the study. The patients were monitored regularly to identify the incidence of potential and actual drug-drug interactions. The identified interactions were analyzed for their severity by using various standard references which included published scientific articles, online databases (e.g., UpToDate) and standard textbooks. Results and DiscussionThe mean age of the study population in years was found to be 37.93 ± 12.21 standard deviation. It was observed that the incidence of potential drug-drug interactions was 66.96%. A total of 201 potential drug-drug interactions were identified from 75 patients. Based on the severity assessment of the identified interactions, 52.73% were major, 37.31% were moderate, and 19.82% were minor. About 7.46% were contraindicated drug combinations. The data on the onset of interaction revealed that 34.82% were of delayed onset and 14.92% with rapid onset and 50.24% were not specified. The drug that was responsible for the majority of the interactions in the study was found to be olanzapine. ConclusionThe study revealed a high incidence of drug-drug interaction. Drug-drug interactions most frequently encountered among psychiatric patients were found to be major in terms of severity. The study concluded on the higher event of drug-drug interactions among the patients prescribed with olanzapine.

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.
 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.
 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%.
 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 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 among hospitalized cardiac patients

Background: Drug-drug interactions (DDIs) are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. The objective of our study was to identify potential drug-drug interactions among hospitalized cardiac patients and to identify the risk factors associated with these interactions.Methods: After obtaining approval from Institutional Ethical Committee, a prospective observational study was carried out among 367 hospitalized cardiac patients in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru. Cardiac patients prescribed at least 2 drugs and having hospital stay of more than 24 hour duration were enrolled into the study. The prescriptions were analysed for potential DDIs using MEDSCAPE multidrug interaction checker tool. Descriptive statistics, Student ‘t’ test, ANOVA and Pearson correlation coefficient were used to analyse the results.Results: The incidence of potential DDIs was 98% with 360 prescriptions having at least one potential DDI. A total of 38 potentially interacting drug pairs were identified among which majority were of significant grade while only 3 were serious. Majority of interactions were pharmacodynamic (76.3%) in nature. Aspirin/clopidogrel (71.1%) and pantoprazole/clopidogrel (69.8%) were the most common interacting pairs. Drugs most commonly involved were aspirin, clopidogrel, heparin, pantoprazole and ramipril. Age, female gender, polypharmacy, prolonged hospital stay, stay in ICU and diabetes mellitus were the risk factors found associated with the potential DDIs.Conclusions: Proper therapeutic planning, routine monitoring of cardiac in-patients and usage of online DDI database will avoid potentially hazardous consequences in cardiac in-patients.

Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital.

ObjectiveTo evaluate the incidence of potential drug-drug interactions in an intensive care unit of a hospital, focusing on antimicrobial drugs.MethodsThis cross-sectional study analyzed electronic prescriptions of patients admitted to the intensive care unit of a teaching hospital between January 1 and March 31, 2014 and assessed potential drug-drug interactions associated with antimicrobial drugs. Antimicrobial drug consumption levels were expressed in daily doses per 100 patient-days. The search and classification of the interactions were based on the Micromedex® system.ResultsThe daily prescriptions of 82 patients were analyzed, totaling 656 prescriptions. Antimicrobial drugs represented 25% of all prescription drugs, with meropenem, vancomycin and ceftriaxone being the most prescribed medications. According to the approach of daily dose per 100 patient-days, the most commonly used antimicrobial drugs were cefepime, meropenem, sulfamethoxazole + trimethoprim and ciprofloxacin. The mean number of interactions per patient was 2.6. Among the interactions, 51% were classified as contraindicated or significantly severe. Highly significant interactions (clinical value 1 and 2) were observed with a prevalence of 98%.ConclusionThe current study demonstrated that antimicrobial drugs are frequently prescribed in intensive care units and present a very high number of potential drug-drug interactions, with most of them being considered highly significant.

Incidence of potential drug interactions in a transplant centre setting and relevance of electronic alerts for clinical practice support

Adverse drug events may occur as a result of drug-drug interactions (DDIs). Information technology (IT) systems can be an important decision-making tool for healthcare workers to identify DDIs. The aim of the study is to analyse drug prescriptions in our main hospital units, in order to measure the incidence and severity of potential DDIs. The utility of clinical decision-support systems (CDSSs) and computerised physician order entry (CPOE) in term of alerts adherence was also assessed. DDIs were assessed using a Micromedex® healthcare series database. The system, adopted by the hospital, generates alerts for prescriptions with negative interactions and thanks to an 'acknowledgement function' it is possible to verify physician adherence to alerts. This function, although used previously, became mandatory from September 2010. Physician adherence to alerts and mean monthly incidence of potential DDIs in analysed units, before and after the mandatory 'acknowledgement function', were calculated. The intensive care unit (ICU) registered the greatest incidence of potential DDIs (49.0%), followed by the abdominal surgery unit and dialysis (43.4 and 42.0%, respectively). The cardiothoracic surgery unit (41.6%), step-down unit (38.3%) and post-anaesthesia care unit (30.0%) were comparable. The operating theatre and endoscopy registered the fewest potential DDIs (28.2 and 22.7%, respectively). Adherence to alerts after the 'acknowledgement function' increased by 25.0% in the ICU, 54.0% in the cardiothoracic surgery unit, 52.5% in the abdominal surgery unit, 58.0% in the stepdown unit, 67.0% in dialysis, 51.0% in endoscopy and 48.0% in the post-anaesthesia care unit. In the operating theatre, adherence to alerts decreased from 34.0 to 30.0%. The incidence of potential DDIs after mandatory use of the 'acknowledgement function' decreased slightly in endoscopy (-2.9%), the abdominal surgery unit (-2.7%), dialysis (-1.9%) and the step-down unit (-1.4%). Improving DDI alerts will improved patient safety by more appropriately alerting clinicians.

Drug-drug interactions in patients admitted to an infectious diseases unit in a trauma hospital

BackgroundThe current complexity of pharmacotherapy in patients with orthopaedic infections increases the risk of drug-drug interactions (DDI).PurposeThe aim of this study is to identify potential DDI (severe/moderate) and its clinical...

Patterns of prescription drug use and incidence of drug–drug interactions in patients reporting to medical emergency

Pharmaco-epidemiological studies detailing prescribing patterns of physicians are very few from developing countries. The present study describes the patterns of prescription of drugs by physicians working in different clinical settings in India and explores using the prescriptions the incidence of potential drug-drug interactions (DDI). This study was a cross-sectional observational study. The prescriptions of patients for any chronic medical condition and drug therapy received at the first point of contact with health care services for present medical emergency were analyzed for information. The prescriptions were also analyzed for potential DDI. Data were expressed as mean ± SD or median and inter-quartile range. Multiple logistic regression was used for variables likely to be associated with incidence of DDI. Of total 710 patients, 565 prescriptions were available for analysis. Of the chronic diseases, hypertension (17.7%) and diabetes mellitus (16.8%) were the commonest. Alcoholic liver disease had maximum average number of drugs prescribed (3.9). Supplements were the most commonly prescribed pharmacological agents for chronic disease (142/796). Patients in 35-50 years of age consumed maximum average number of drugs (1.9). Antibiotics were the most frequently prescribed agents (148/1240) followed by supplements (122/1240). We noted 296 mild and moderate potential DDI. Literacy of patients and polypharmacy were the factors associated significantly with DDI. Patients in India do not consume large number of allopathic medicines. The practice of prescribing supplements and antibiotics needs to be reviewed. Potential DDI are not an important problem. Prescription policies need significant revision.

The incidence of potential drug–drug interactions in elderly patients with arterial hypertension

To assess the incidence and type of potential, clinically significant drug-drug interactions in elderly outpatients with arterial hypertension. Three community pharmacies in Croatia. Eligible patients were aged 65 or older, treated for arterial hypertension and received 2 or more drugs. Potential interactions were identified by Lexi-Interact software. The software categorized each potential interaction according to clinical significance in five groups: (A) No known interaction; (B) Specified agents may interact, but there is little to no evidence of clinical concern; (C) Specified agents may interact in a clinically significant manner. Monitoring therapy is suggested; (D) The two medications may interact in a clinically significant manner. Modification of therapy is suggested; (X) Contraindicated combination. Interactions of level C, D and X were considered clinically significant. The incidence and type of potential drug-drug interactions. There were 265 patients included in the study. Potential, clinically significant drug interactions were identified in 240 (90.6%) patients, out of which 97.9% had interactions with clinical significance C, 20.4% D, and 0.8% X. The median number of drug interactions per patient was 4. We identified 215 drug combinations with the potential to cause clinically significant interaction, out of which 83.3% had clinical significance C, 16.3% clinical significance D, and 0.4% clinical significance X. Drug-drug interactions are common in elderly hypertensive patients. Computer-based screening could help pharmacists and physicians to recognize potential, clinically significant interactions.

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal.

To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of 'Moderate' type and 58% had a 'Delayed' onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a 'Good' documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during preintervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). There was an association between potential DDIs and age, sex, and polypharmacy.