Major Drug-drug Interactions Research Articles

Implementing a drug interaction protocol for oral systemic anti-cancer therapy with focus on CDK4/6 inhibitors.

302 Background: Oral anti-cancer therapies (OACTs) are being increasingly used. Despite their convenience, OACTs introduce challenges with adherence, prescribing errors, and high incidence of drug-drug interactions (DDIs). Currently, there are limited guidelines for DDI checking. Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) have revolutionized the management of metastatic ER+/HER2- breast cancer. While an overall survival benefit has been demonstrated with Ribociclib, its use can be problematic due to frequent DDIs and the risk of QTc prolongation. DDIs are routinely checked in our center with two interaction checkers, but they are not always documented due to a lack of a standardized protocol. This study aims to evaluate current DDI checking practices, identify common DDIs, and implement a systematic DDI protocol. Methods: A retrospective review was conducted on patients (pts) prescribed CDK4/6i in our center from Jan 2023 to Apr 2024. Data on pt demographics, treatment, DDI documentation, toxicity, and survival were collected. Retrospective DDI checks using Lexi-Interact and Drugs.com were performed. Results: A total of 65 pts were included, with 38 on Ribociclib and 27 on Palbociclib. The median follow-up was 11.6 months (range: 1-71). The median age of pts on Ribociclib was 54 (range: 35-77), compared to 61 (range: 44-82) on Palbociclib. The median number of medications was three with Ribociclib and five with Palbociclib. Seven pts (26%) were prescribed Palbociclib due to contraindications to Ribociclib, including cardiac disease (n=2), QTc-prolonging medications (n=4), and advanced age (n=1). DDI checks were documented in 46% of Ribociclib and 14% of Palbociclib pts (p=0.0063). There was a weak negative correlation between DDI documentation and toxicity, stronger in the Palbociclib arm (-0.079 for Ribociclib vs. -0.335 for Palbociclib). Retrospective checks revealed DDIs in 50% of Ribociclib and 52% of Palbociclib pts. Major DDIs were identified in 21% of Ribociclib and 7% of Palbociclib pts (p=0.133). Common major DDIs involved opioids and QTc-prolonging medications, most frequently antidepressants. Grade ≥3 toxicity occurred in 49% of Ribociclib vs. 64% of Palbociclib pts (p=0.21). Ribociclib caused more rash, liver toxicity, and diarrhea, while Palbociclib had significantly more grade ≥3 neutropenia (48% vs. 21%, p=0.042). No QTc prolongation was observed. Dose reductions were more common with Palbociclib (48% vs. 32%, p=0.27). There was no significant difference in survival data. Conclusions: Our findings highlight the importance of systematic DDI checks in pts receiving OACTs. Implementing a standardized protocol could reduce adverse interactions and improve pt outcomes. Further studies are needed to validate these findings and develop DDI guidelines. A standardized DDI protocol has now been developed for our center, with plans to re-audit after implementation.

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

Drug-drug interactions with oral anticoagulants: information consistency assessment of three commonly used online drug interactions databases in Switzerland.

Background: Toxicity or treatment failure related to drug-drug interactions (DDIs) are known to significantly affect morbidity and hospitalization rates. Despite the availability of numerous databases for DDIs identification and management, their information often differs. Oral anticoagulants are deemed at risk of DDIs and a leading cause of adverse drug events, most of which being preventable. Although many databases include DDIs involving anticoagulants, none are specialized in them. Aim and method: This study aims to compare the DDIs information content of four direct oral anticoagulants and two vitamin K antagonists in three major DDI databases used in Switzerland: Lexi-Interact, Pharmavista, and MediQ. It evaluates the consistency of DDIs information in terms of differences in severity rating systems, mechanism of interaction, extraction and documentation processes and transparency. Results: This study revealed 2'496 DDIs for the six anticoagulants, with discrepant risk classifications. Only 13.2% of DDIs were common to all three databases. Overall concordance in risk classification (high, moderate, and low risk) was slight (Fleiss' kappa = 0.131), while high-risk DDIs demonstrated a fair agreement (Fleiss' kappa = 0.398). The nature and the mechanism of the DDIs were more consistent across databases. Qualitative assessments highlighted differences in the documentation process and transparency, and similarities for availability of risk classification and references. Discussion: This study highlights the discrepancies between three commonly used DDI databases and the inconsistency in how terminology is standardised and incorporated when classifying these DDIs. It also highlights the need for the creation of specialised tools for anticoagulant-related interactions.

Investigation of polypharmacy and potential drug-drug interactions in a group of hospitalized pediatric patients: a single-center study

Aims: Polypharmacy involves the use of multiple medications to manage one or more clinical conditions. This study aimed to determine the prevalence of polypharmacy and potential drug-drug interactions during hospitalizations in childhood and to investigate the nature of common interactions.
 Methods: Data for this retrospective cross-sectional observational study were obtained from the hospital database records of pediatric patients admitted to the pediatric department of a university hospital during the first six months of 2020. A total of 601 pediatric prescriptions from 877 hospitalizations involving 2620 medications were examined for drug-drug interactions using the drugs.com/interaction checker tool.
 Results: Of the evaluated 601 patients, 48.1% were female and 51.9% were male children. The mean age of the hospitalized patients was 4.78±5.2 years, ranging from 0 to 18 years, with a median age of 2 years. The mean length of the hospital stay was 5.5 (min 1-max 56) days. The mean number of prescribed medications per child was 4.38±2.4 (min-max 1-16). Potential interactions were identified in 49.1% of the prescriptions. The prescription rate of antimicrobial treatment for hospitalized patients was 86%, and this group had a high occurrence of major drug-drug interactions (p

Major Drug-Drug Interaction Exposure Among Medicaid-Insured Children in the Outpatient Setting.

Drug-drug interactions (DDIs) can cause adverse drug events, but little is known about DDI exposure in children in the outpatient setting. This study aimed to determine the prevalence of major DDI exposure and factors associated with higher DDI exposure rates among children in an outpatient setting. We performed a cross-sectional study of children aged 0 to 18 years with ≥1 ambulatory encounter, and ≥2 dispensed outpatient prescriptions study using the 2019 Marketscan Medicaid database. DDIs (exposure to a major DDI for ≥1 day) and the adverse physiologic effects of each DDI were identified using DrugBank's interaction database. Primary outcomes included the prevalence and rate of major DDI exposure. We used logistic regression to assess patient characteristics associated with DDI exposure. We examined the rate of DDI exposures per 100 children by adverse physiologic effects category, and organ-level effects (eg, heart rate-corrected QT interval prolongation). Of 781 019 children with ≥2 medication exposures, 21.4% experienced ≥1 major DDI exposure. The odds of DDI exposure increased with age and with medical and mental health complexity. Frequently implicated drugs included: Clonidine, psychiatric medications, and asthma medications. The highest adverse physiologic effect exposure rate per 100 children included: Increased drug concentrations (14.6), central nervous system depression (13.6), and heart rate-corrected QT interval prolongation (9.9). One in 5 Medicaid-insured children with ≥2 prescription medications were exposed to major DDIs annually, with higher exposures in those with medical or mental health complexity. DDI exposure places children at risk for negative health outcomes and adverse drug events, especially in the harder-to-monitor outpatient setting.

Polypharmacy and drug-drug interactions in metastatic breast cancer patients receiving cyclin-dependent kinase (CDK) 4/6 inhibitors

Introduction Cyclin-dependent kinase (CDK) 4/6 inhibitors have significantly changed the treatment strategy for patients with locally advanced or metastatic hormone receptor positive (HR+), human epidermal growth factor 2 negative (HER2) breast cancer. The purpose of the study was to determine the prevalence of drug-drug interactions (DDI) in breast cancer patients using CDK 4/6 inhibitors and the extent of DDI reflected in the clinic and to increase clinical awareness among physicians. Method The data of 115 metastatic breast cancer patients using CDK 4/6 inhibitors who were admitted to the Medical Oncology outpatient clinic between July 2021 and July 2023 were retrospectively reviewed. The Drugs.com® Drug Interaction Checker application was used for the interaction between the CDK 4/6 inhibitor and other drugs. Results Among patients included in the study, 97.3% had at least one additional drug use. We have identified a total of 170 potential DDI risks in 63.5 % of patients. Among these, 50.5% had a major potential DDI. In our study, there was a potential risk of QT prolongation in 45.2% of 170 DDI, an increase in the potential toxicity of the additional drug in 44.1%, an increase in the potential toxicity of the CDK 4/6 inhibitor in 5.3%, a decrease in the potential efficacy of the CDK 4/6 inhibitor in 2.9%, a decrease in the potential efficacy of the additional drug in 1.1%, and a serious potential infection risk in 1.1%. Most of the drug interactions were QT prolongation and increased toxicity of the additional drug. In terms of cardiovascular events, grade-2 and grade-3 QTc prolongation was found in 4.3% and 1.7% of these interactions, respectively. When evaluated in terms of CDK 4/6 inhibitor subtype, there was a potential risk of DDI at major level with Ribocilib and at moderate level with Palbociclib. Conclusion If CDK 4/6 inhibitors interact with concomitant drugs, they may cause an increase in the incidence of cardiac side effects and a decrease in the effect of the CDK 4/6 inhibitor or additional drug or an increase in toxicity. Increasing awareness of this issue will help to reduce the rates of side effects or toxicity and provide effective antitumour therapy.

1568. Evaluating the Appropriateness of Antiretroviral Therapy in the Critical Care Setting

Abstract Background The care of patients with HIV in the intensive care unit (ICU) can be complex as they may develop acute kidney injury and therefore necessitating continuous renal replacement therapy, need feeding tubes, and are prescribed new medications. Issues regarding drug-drug interactions, fluctuating renal & hepatic function, adverse effects, oral administration issues including crushing of tablets are challenges that may arise. The purpose of this study was to evaluate the appropriateness of antiretroviral (ARV) therapy in the ICU. Background - HIV and ICUs In 2018, almost half of Americans living with HIV were aged 50 and older. Co-morbidities associated with ICU admissions include cardiovascular, renal, hepatic, and pulmonary disease. Medication errors are defined as: incorrect/incomplete regimen, incorrect dose, incorrect renal adjustment, incorrect administration, and major drug-drug interaction. Methods This was a retrospective, observational, quality improvement project that reviewed charts from January 2018 to August 2022. Adult patients that were admitted to the the ICU at Long Island Jewish Medical Center and receiving ART for HIV were included. Patients receiving ARV for indications other than HIV were excluded. Using the medical record system, data was collected: demographics, renal and hepatic dysfunction, ARV ordered (e.g., tablet formulation, combination/single tablet), completeness of treatment regimen, drug-drug interactions, feeding placement, and concomitant medications. Descriptive statistics were utilized. Results Of the 68 patients screened, 43 were included in the study. The mean age was 57 ± 13 years, 60.5% males, and majority of patients were admitted to the medical ICU (55.8%). The median CD4 count was 250 cells/μL and 37.2% of the patients had undetectable viral loads. A total of 18 patients (41.9%) required a gastric tube during their ICU stay. ID was consulted in 41.9% of the cases. Inappropriate ART was found in 46.5% of patients with drug-drug interactions, inappropriate tablet crushing, and renal dose adjustment needed being the most prevalent reasons for inappropriateness. 27 patients (62.8%) had opportunities for interventions. which included failure to re-initiate ARV sooner (n = 8), inappropriate ARV crushing (n = 8), ARV use contraindicated at time prescribed (n = 6), ARV not reconciled once stable (n = 5), and drug-drug interactions (n = 4). An intervention could have been made 5 days sooner on average. 20 patients identified with an inappropriate ART regimen and patients could have had more than one reason for inappropriateness so total 26 identified reasons for inappropriate ART Most reasons for inappropriateness were related to patient’s renal function, ART administration, and drug-drug interactions followed by incomplete regimen. The other reason for inappropriateness was that patient was not re-initiated on ART during ICU stay when it was appropriate to do so. 27 patients identified with one or more areas for improvement– these were interventions that could have been made. Most areas for improvement included earlier ARV re-initiation either to the same regimen from home PTA or a more appropriate regimen (such as a kidney or liver-sparring regimen) Other areas identified included inappropriate formulation/administration of ART, contraindications such as AKI were present at the time ART was ordered, addressing drug-drug interactions, Other = address drug-drug interactions (4), earlier initiation of new ARV regimen (patient was tx-naïve) (1), earlier initiation of adjusted ARV regimen (1), incomplete regimen (1) Conclusion The study demonstrates that there are opportunities for improvement in the care of HIV in the ICU setting. Daily assessments of ART for re-initiation, dose adjustment, appropriate administration is crucial. Disclosures All Authors: No reported disclosures

Potential Drug-Drug Interactions and Related Factors among Geriatric Outpatients of a Tertiary Care Hospital.

(1) Background: Drug-drug interactions (DDIs) possess the potential to lead to a range of clinically significant consequences in the older population. (2) Aims: To investigate the prevalence and associated factors of DDIs among older patients within an outpatient setting of a university hospital. (3) Methods: This is a descriptive analysis of patients aged ≥65 years, who received a minimum of two medications. The electronic medical records were obtained from the outpatient clinic of a tertiary care hospital between November 2021 and November 2022. The outcomes were analyzed using descriptive and regression analysis. (4) Results: The study enrolled 10,877 patients, with a mean age of 74.3 ± 6.8 years. The prevalence of major DDI was 36.8%. Factors associated with major DDI were age (odds ratio [OR] 1.03), female sex (OR 1.23), polypharmacy (OR 2.27-13.78), metabolic disease (OR 1.89), psychiatric disorder (OR 1.79), cardiovascular disease (OR 1.51), musculoskeletal disease (OR 1.37), central nervous system disease (OR 1.24), and tuberculosis (OR 0.18). There was a significant difference observed in the primary healthcare facilities for emergency medicine (OR 1.72), orthopedics (OR 1.36), internal medicine (OR 1.29), and radiology (OR 0.45). (5) Conclusions: Major DDI was prevalent among older patients receiving care at outpatient settings. Several factors linked to major DDIs were identified. Developing appropriate strategies to improve the prescription process and avoid any missed interactions with geriatric patients is recommended.

Hospitalization Among Patients Treated With Molnupiravir: A Retrospective Study of Administrative Data

Molnupiravir is an oral antiviral agent authorized for emergency use to treat mild to moderate cases of coronavirus disease 2019 (COVID-19) in adults at high risk for progression to severe clinical outcomes. This study aimed to describe patient characteristics and health outcomes in a cohort of adult patients treated with molnupiravir in an outpatient setting in the United States. This was a retrospective cohort study of adults identified in the HealthVerity database with a pharmacy claim for molnupiravir between December 24, 2021, and April 14, 2022. Hospitalization and health care use were assessed over the 28 days after the molnupiravir pharmacy claim. Among 26,554 patients identified, 71.1% were aged ≥50 years and 58.9% were female. A total of 8794 patients (33.1%) had received at least 1 dose of the COVID-19 vaccine. The most prevalent risk factors for severe COVID-19 identified were hypertension (45.1%), steroid and/or immunosuppressant use (39.6%), and being obese or overweight (24.6%), with 79.1% of patients having ≥1 risk factor. The majority (61.0%) of patients were prescribed comedications contraindicated with or had the potential for major drug-drug interactions with ritonavir-containing regimens. Within 28 days after initiating molnupiravir, 3.3% of patients were hospitalized for any cause and 1.7% for COVID-19-related reasons. Among all hospitalized patients, 9.2% were admitted to an intensive care unit, 3.9% received oxygen, and 3.8% required mechanical ventilation. The majority of patients treated with molnupiravir in early 2022 had at least one risk factor for severe COVID-19 and had comedications that could require treatment modification or monitoring if given a ritonavir-containing regimen. Hospitalization was uncommon after treatment with molnupiravir, with COVID-19-related inpatient admission in <2% of patients. Among those hospitalized, patient use of intensive care and oxygen-based resources was infrequent. The study design, however, does not permit any conclusions regarding the effectiveness of molnupiravir.

Antifungal Drug-Drug Interactions with Commonly Used Pharmaceutics in European Pediatric Patients with Acute Lymphoblastic Leukemia.

Leukemia is one of the leading childhood malignancies, with acute lymphoblastic leukemia (ALL) being the most common type. Invasive fungal disease is a concerning problem also at pediatric hemato-oncology units. Available guidelines underline the need for antifungal prophylaxis and give recommendations for proper treatment in various clinical scenarios. Nonetheless, antifungal agents are often involved in drug-drug interaction (DDI) occurrence. The prediction of those interactions in the pediatric population is complicated because of the physiological differences in adults, and the lack of pharmacological data. In this review, we discuss the potential DDIs between antifungal agents and commonly used pharmaceutics in pediatric hemato-oncology settings, with special emphasis on the use of liposomal amphotericin B and ALL treatment. We obtained information from Micromedex® and Drugs.com® interaction checking databases and checked the EudraVigilance® database to source the frequency of severe adverse drug reactions that resulted from antifungal drug interactions. Several major DDIs were identified, showing a favorable safety profile of echinocandins and liposomal amphotericin B. Interestingly, although there are numerous available drug interaction checking tools facilitating the identification of potential serious DDIs, it is important to use more than one tool, as the presented searching results may differ between particular checking programs.

Potential drug-drug interactions in hospitalized patients with COVID-19.

Most hospitalized patients with COVID-19 require complex pharmacotherapy due to underlying diseases, and polypharmacy may significantly increase the risk of drug-drug interactions (DDIs) and, in consequence, trigger adverse effects. The aim of this study was to assess the risk of potential DDIs during hospitalization in COVID-19 patients. A retrospective analysis of pharmacotherapy in 75 patients (age, Mean±SD, 63.6±14.9) with a proven diagnosis of SARS-CoV-2 infection was conducted. The analysis included drugs administered to treat comorbidities and the COVID-19 treatment. 524 moderate and 112 major interaction cases were revealed in the analyzed COVID-19 patients, and 84% of the patients were exposed to at least one major DDI. Drugs that caused the most frequently observed DDIs include macrolides, low molecular weight heparins, glucocorticosteroids, quinolones, and antihypertensive drugs. Most COVID-19 patients have comorbidities requiring polypharmacy, which increases the risk of DDIs. Therefore, additional monitoring should be considered due to potential adverse effects, drug conversion, and deprescription.

Effect of Clinical Decision Support System and Clinical Pharmacists’ Practice in Preventing Drug-drug Interactions among Inpatients in Bac Ninh General Hospital

Drug-drug interaction is one of the drug-related problems that can reduce therapeutic efficacy or increase the risk of undesirable effects. Subjects and methods: interventional study design with before-after comparison. In the pre-intervention period, we retrospectively carried out all electronic prescriptions and medical records of inpatients treated from 01/11/2021 to 31/01/2022. In the post-intervention period, we prospectively performed monitoring reports on the drug-drug interaction warning system and medical records of inpatients from 01/02/2022 to 31/03/2022. Results: The proportion of patients exposed to drug-drug interactions (DDIs) decreased significantly from 4.27% in the pre-intervention period to 3.56% in the post-intervention period (p&lt;0.05). There were no medical records with contraindicated DDIs in the post-intervention period. The percentage of patients for contraindication DDIs with conditions determined to patients with the condition was 39.33% and 27.59%, respectively, in the pre-and post-intervention phases. Medical records rate with major DDIs decreased significantly in the post-intervention period (2.95% vs 3.68%; p&lt;0.05). Conclusion: Clinical decision support systems with drug-drug interaction warnings and clinical pharmacy activities help to reduce the frequency of DDIs. The results show that the combination of these two measures initially brings about effective DDIs management in hospitals.

GLP-1 agonists for people living with HIV and obesity, is there a potential?

Obesity trends and metabolic dysregulation are rising in people living with HIV using antiretrovirals (ARVs). Underlying causes and preventive strategies are being investigated. Two glucagon like-peptide 1 (GLP-1) agonists, liraglutide and semaglutide, were formerly approved as glucose-lowering drugs and have been recently approved for long-term weight loss in people with obesity. Due to the lack of therapeutic guidelines or clinical trials in people with HIV, we discuss the potential benefits, safety aspects and pharmacological considerations of prescribing liraglutide and semaglutide in people with HIV. Clinical experience is limited to two clinical cases of diabetic people with HIV using liraglutide after which a successful weight loss and glycaemic control were observed. None of the adverse events associated with liraglutide and semaglutide usage indicate an additional risk for people with HIV. Extra caution showed be warranted when initiating GLP-1 agonist therapy in people with HIV taking protease inhibitors who have pre-existing risk factors for heart rate variability to reduce the incidence of RP interval prolongation. GLP-1 agonists are metabolized by endopeptidases, and thus do not generate major drug-drug interactions with most drugs, including ARVs. GLP-s agonists are known to inhibit gastric acid secretion, which warrants caution and close monitoring when combined with atazanavir and oral rilpivirine, two ARVs that require low gastric pH for an optimal absorption. Theoretical considerations and a few available clinical observations support semaglutide and liraglutide prescription in people with HIV, with, thus far, no indications of concern regarding efficacy, safety or pharmacological interactions with ARVs.

Potential Drug Interactions in Hospitalized Hematologic Cancer Patients: New Update with New Chemotherapy Regimens.

This cross-sectional study aimed to assess the frequency of potential drug-drug interactions (DDIs) and demographic correlates of moderate and major DDIs among patients with hematologic cancer at a referral hematology hospital in Iran. In this study, for 6 months, all patients suffering from hematologic cancers admitted to the tertiary oncology hospital, Omid, Isfahan, were considered. Data from all medications prescribed to patients during hospitalization were analyzed using the online Lexicomp® drug interaction checker, recording all interactions classified by risk level: C, D, or X. A total of 674 DDIs were detected in 109 patients. The prevalence of treatments with at least one clinically relevant interaction was 95%, being 57.9% for those at level C and 31.5% for levels D and X. According to the frequency, the main interaction was between aprepitant and corticosteroids, followed by the interaction between aprepitant and vincristine. The most common interaction between antineoplastic agents was between doxorubicin and cyclophosphamide. In terms of mechanism, most of DDIs (54.9%) were pharmacodynamics. Only the number of administered medications was associated with DDI occurrence. Potential DDIs of moderate to major severity are common among patients with hematologic malignancies. This underscores the importance of implementing different strategies to mitigate this clinically significant risk.

Pharmacists' Medication Counseling Practices and Knowledge and Satisfaction of Patients With an Outpatient Hospital Pharmacy Service.

The degree of communication between patients and pharmacists has a significant impact on the process of medication counseling. The purpose of this study was to evaluate pharmacists' practices of medication counseling and to assess patients' knowledge of medications and satisfaction with pharmacy services at Woldia Comprehensive Specialised Hospital (WCSH). A cross-sectional study involving 23 pharmacists and 339 patients was carried out between February and May 2022 at WCSH. A self-administered structured questionnaire was used to assess the medication counseling activities of pharmacists, whereas interview-based questionnaires were used to evaluate patients' knowledge of the drugs prescribed to them and their level of satisfaction with outpatient hospital pharmacy services. The Statistical Package for Social Sciences (SPSS) Version 25.0 was used to analyze the data. Around two-thirds of pharmacy professionals (73.9%) agreed that they were satisfied with their counseling activities. But a very low number of them always provided counseling regarding the purpose of medications (13%), major drug-drug interactions (26.1%), possible side effects (30.4%), the importance of compliance (30.4%), storage conditions (34.8%), and drug-food interactions (39.1%). Among the 339 patients involved in the study, less than half (46.3%) of them had sufficient knowledge of their dispensed medication at the exit interview. Only nearly half of the patients (54.3%) agreed that they were satisfied with the pharmacy service. Despite the fact that a significant proportion of the pharmacy professionals agreed that they were satisfied with their counseling practices, their level of involvement in major counseling activities was limited, which impacted the knowledge of patients about their medication and patients' satisfaction with pharmacy services. This might be because of potential barriers in terms of workload and lack of resources. The findings may indicate that pharmacy services need to improve through identifying potential gaps and tackling barriers.

Prescribing pattern of anti-hypertensive medications among hypertensive outpatients at selected hospitals of South Gondar Zone, Amhara, Ethiopia: a hospital based cross sectional study

BackgroundIrrational prescription has a lion share for uncontrolled blood pressure. There is no study assessing prescription pattern among hypertensive patients at the study sites. Therefore, the objective of the current study was to evaluate prescription patterns for hypertension and blood pressure (BP) control at randomly selected hospitals of South Gondar Zone.MethodsA hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021. Hypertensive patients were selected by systematic random sampling proportionally from study hospitals. Structured questionnaires were used to collect socio-demographic chacteristics and adherence. Data abstraction form was used to collect prescription patterns, BP level and other necessary information. The association of prescription patterns and other variables with blood pressure control was determined by using binary logistic regression.ResultsAll recruited 423 patients were included in data analysis. Among prescriptions for hypertension, on average 93.5% were found to be in line with WHO guideline. About 53% of prescriptions for hypertension were monotherapies. Patient level low medication regimen complexity, and monotherapy were associated with blood pressure control (Ajusted Odds Ratio [AOR] = 2.04, [1.07–3.91]; AOR = 3.83 [1.42–10.35], respectively). Patients with inappropriate drug selection, and non-adherence were less likely to have controlled BP (AOR = 0.47 [0.26–0.85]; AOR = 0.52 [0.34–0.85], respectively). Moreover, patients who didn’t have health insurance and follow regular aerobic exercise were less likely to have controlled BP (AOR = 0.42 [0.26–0.68]; AOR = 0.53 [0.32–0.88], respectively).ConclusionDiuretics were the most frequently prescribed drug in monotherapy and in combination with calcium channel blockers (CCBs) as dual therapy. On average, more than 90% of prescription was in accordance with WHO guideline and around one-third of participants experienced at least one moderate or major drug-drug interaction. Patient level low medication regimen complexity and monotherapy were positively associated with BP control whereas, non-adherence, inappropriate drug selection, having no health insurance, and didn’t follow regular aerobic exercise were negatively associated with BP control. Clinicians should be adherent to treatment guidelines and focus on modifiable factors to improve BP control.

Gender-based analysis of antibiotic prescribing trends for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore

Respiratory tract infections (RTIs), caused by microorganisms such as bacteria and viruses, are a leading cause of morbidity and mortality in children worldwide. Antibiotic resistance is a serious concern, and proper prescribing practices are necessary to avoid life-threatening situations. Thus, this study aims to conduct a gender-based analysis and compare antibiotic prescribing patterns for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore. This comparative cross-sectional study was conducted at Children’s Hospital in Lahore, Pakistan, for three months and enrolled 250 pediatric patients who met the inclusion criteria, including 155 males and 95 females. Data were collected through face-to-face interviews and reviewing hospital records. The results of the study showed that the average number of drugs per prescription was 3.06 ± 1.29 (male) and 3.12 ± 1.5 (female), while the average number of antibiotics per prescription was 2.25 ± 0.60 (male) and 2.17 ± 0.58 (female). The most prevalent medical conditions were bronchopneumonia (53.55% males and 58.95% females), followed by respiratory distress (20.00% males) and pneumonia (16.13% males and 16.84% females). The most commonly prescribed drugs were J01DD04: Ceftriaxone (78.71% males and 71.58% females), J01CR02: Amoxicillin/Clavulanate (59.35% males and 56.84% females), and J01GB06: Amikacin (41.29% males and 45.26% females). A low percentage of prescriptions had major drug-drug interactions (8.39% males and 10.53% females), while most prescriptions had no drug-drug interactions (81.94% males and 84.21% females). There was no significant difference between male and female patients for caregiver, indications for antibiotic prescriptions, the class of active agent prescribed, and drug interactions. Our study findings indicate that most male and female patients admitted to the hospital with lower respiratory tract infections were prescribed antibiotics alongside analgesics and antipyretics. Furthermore, our analysis revealed minimal drug interactions among the prescribed medications. Importantly, we observed a similar antibiotic prescribing trend among male and female pediatric patients, highlighting the consistency in treatment approaches.

Predicting drug-drug and drug-gene interactions in a community pharmacy population.

Drug-drug interactions (DDIs) are among the most common causes of adverse drug reactions and are further complicated by genetic variants of drug-metabolizing enzymes. The aim of this study is to quantify and describe potential DDIs, drug-gene interactions (DGIs), and drug-drug-gene interactions (DDGIs) in a community-basedpopulation. This was an analysis of deidentified retail pharmacy prescription data for 4761 individuals. Data were first assessed for DDIs, and individuals were stratified to a risk category using the logic of a commercially available digital DDGI tool. To calculate the frequency of potential DGIs and DDGIs, genotypes were imputed and randomly allocated to the cohort 100 times via Monte Carlo simulation according to each variant's frequency in the general population. The probability of a DDI of any impact was 26.0% and increased to 49.6% (95% CI, 48.4%-50.7%) when drug-metabolizing phenotypes were ascribed according to the distribution of variants of 11 genes as found in a Caucasian population. There was a 7.8% probability of major DDIs, which increased to a 10.1% (95% CI, 9.5%-10.8%) probability with the addition of genetic contributions. The probability of DDGIs of any impact was correlated with the number of medications. Antidepressants, antiemetics, blood products and modifiers, analgesics, and antipsychotics had the highest probability of DDGIs. The probability of drug interaction risk increased when phenotypes associated with genetic polymorphisms were attributed to the population. These data suggest that pharmacogenomic assessment may be useful in predicting drug interactions and severity when evaluating patient medication profiles.

DRUG-DRUG INTERACTIONS IN PSYCHIATRIC PATIENTS: IDENTIFYING HIGH-RISK COMBINATIONS AND MITIGATION STRATEGIES

Psychiatric patients are at a high risk of severe adverse drug events (ADEs) due to potential drug-drug interactions (DDIs). These interactions can worsen existing health conditions and complicate treatment outcomes. Objective: This study aimed to identify and evaluate the drug-drug interactions (DDIs) of psychoactive drugs among mental health patients and propose effective prevention measures. A retrospective study was conducted at the Department of Pharmacy, Lady Reading Hospital, Peshawar, from January 1, 2021, to July 31, 2021. The study included all psychiatric patients treated during this period. Medication records were re-examined to identify drug-drug interactions (DDIs) using reliable drug interaction databases. Adverse effects resulting from these interactions were documented. Statistical analysis assessed the frequency and severity of the identified DDIs. Mitigation strategies were developed based on the probability and clinical relevance of the interactions. These strategies included drug adjustments, regular monitoring of patients, and patient education aimed at reducing the risk of adverse effects. The major DDIs frequently occur with commonly used psychiatric medications such as antipsychotics, antidepressants, and mood stabilisers. Common adverse effects included sedation, cardiovascular complications, and increased risk of serotonin syndrome. Mitigation measures, such as drug adjustment, regular monitoring, and patient education, were suggested to reduce the risk of adverse effects. Psychiatric patients are predisposed to severe ADEs due to DDIs, which are often difficult to predict. Mitigation measures such as appropriate drug adjustments and patient education are essential to enhance patient safety and treatment outcomes.

The Evolving Landscape of ASCVD Risk Among Patients With HIV.

Summarize the multiple atherosclerotic cardiovascular disease (ASCVD) risk factors commonly present in persons living with human immunodeficiency virus (HIV). Identify factors for clinical assessment and risk stratification in persons with HIV (PWH). Discuss the clinical challenges of dyslipidemia management among the HIV population, including avoidance of major drug-drug interactions (DDIs). Implement appropriate and safe statin therapy in PWH and elevated ASCVD risk.