Number Of Drug Interactions Research Articles

Drug interactions in incident NOACs users and risk of bleeding

Abstract Introduction Oral anticoagulants (NOACs) are known to have a better safety profile than Vitamin K antagonists, but their metabolism largely depends on the P-glycoprotein and CYP3A4. All drugs inhibiting those proteins may affect NOACs’ bioavailability, by increasing the risk of drug interactions, particularly the risk of bleeding. Purpose The objective was to describe the pattern of polypharmacy in a large cohort of NOAC users, at baseline and within one year after starting anticoagulant treatment. Materials and Methods All persons residing in the catchment areas of Caserta LHU during the years 2012–2020 were considered. From the source population, all patients with at least 1 year of database history and receiving at least one NOAC dispensing during the observation period were identified. Of these, incident (i.e. no NOAC dispensing within one year prior to the first dispensing date, Index Date) NOAC users were included into the cohort and represented the majority of the patients enrolled (97,4%). The comparison of the distribution of interacting drugs number dispensed Pre-ID (within three months before the Index date) and Post-ID (within 12 months after Index date) was explored stratified by high/low dose of anticoagulant. 20.491 incident NOAC users were identified from Caserta LHU and 16,367 (79.9%) NOAC incident users with at least one year of follow-up after ID were included in the analysis. NVAF was the main indication for use of the study cohort (64.3%) and almost 60% of incident NOAC users treated for NVAF received high-dose NOAC. The frequency of incident NOAC users with at least one hospitalization for major bleeding within one year after ID was calculated and stratified by high/low dose of NOACs and the number of drug interactions. A statistically significant test result was considered if p ≤ 0.05. Results The number of interacting drugs dispensed within one year after ID increased from pre-ID to post-ID. 2,077 (12.7%) incident NOAC users without any interacting drugs within 3 months pre-ID received 1 interacting drug within one year after ID. 11.3% and 8.4% of incident NOAC users increased from 1 interacting drug (Pre-ID) to 2 interacting drugs (Post-ID) and from 2 interacting drugs (Pre-ID) to 3-5 interacting drugs (Post-ID) (Table 1). The proportion of NOAC users with a major bleeding increased with the increasing number of interacting drugs, reaching 2.9% and 2.1% among low-dose and high-dose NOAC users with more than 9 interacting drugs (Table 2). Conclusions The results of the current analysis suggest that independently from the type and the dose of NOAC, the number of interacting drugs prescribed with NOACs tends to increase after the first administration of NOACs. Hemorrhagic events are more related to the number of interacting drugs instead of dose of anticoagulant.Table 1 Table 2

Assessment of potential drug-drug interactions in hospitalized patients with infectious diseases: an experience from a secondary care hospital

Background Polypharmacy is common among hospitalized patients with infectious infections owing to comorbidities or concomitant illnesses. This raises the likelihood of drug-drug interactions and creates uncertainty for healthcare providers. This study aimed to assess the potential drug-drug interactions (pDDIs) among hospitalized patients with infectious diseases in a secondary care hospital. Methods A prospective observational study was conducted in the internal medicine ward for six months after the ethics committee’s approval. Data were collected from patient case records, and prescriptions were screened for pDDIs from a portable electronic physician information database (PEPID) resource analyzed using SPSS, version 27.0. Results In total, 148 patient case records were analyzed, and 549 pDDIs were identified, with 66.8% having at least one or more DDIs. The mean number of drug interactions was 3.70 ± 4.58 per prescription. The most frequently encountered drug interactions were drug combinations such as bisoprolol with atorvastatin and aspirin with tazobactam/piperacillin. Bivariate analysis showed that age, comorbidities, length of hospital stay, and the number of drugs prescribed were risk factors associated with DDIs (p<0.05). In the multiple binary logistic regression analysis, DDIs were significantly associated with comorbidities and the number of prescribed medications (p<0.0001). Conclusions This study observed the prevalence of DDIs in hospitalized patients with infectious diseases of ‘moderate’ severity. Prescription screening using a drug information database assists in early identification and prevention of DDIs, enhancing drug safety and quality of patient-centered care.

Assessment of potential drug-drug interactions in hospitalized patients with infectious diseases: an experience from a secondary care hospital

Background Polypharmacy is common among hospitalized patients with infectious infections owing to comorbidities or concomitant illnesses. This raises the likelihood of drug-drug interactions and creates uncertainty for healthcare providers. This study aimed to assess the potential drug-drug interactions (pDDIs) among hospitalized patients with infectious diseases in a secondary care hospital. Methods A prospective observational study was conducted in the internal medicine ward for six months after the ethics committee’s approval. Data were collected from patient case records, and prescriptions were screened for pDDIs from a portable electronic physician information database (PEPID) resource analyzed using SPSS, version 27.0. Results In total, 148 patient case records were analyzed, and 549 pDDIs were identified, with 66.8% having at least one or more DDIs. The mean number of drug interactions was 3.70 ± 4.58 per prescription. The most frequently encountered drug interactions were drug combinations such as bisoprolol with atorvastatin and aspirin with tazobactam/piperacillin. Bivariate analysis showed that age, comorbidities, length of hospital stay, and the number of drugs prescribed were risk factors associated with DDIs (p<0.05). In the multiple binary logistic regression analysis, DDIs were significantly associated with comorbidities and the number of prescribed medications (p<0.0001). Conclusions This study observed the prevalence of DDIs in hospitalized patients with infectious diseases of ‘moderate’ severity. Prescription screening using a drug information database assists in early identification and prevention of DDIs, enhancing drug safety and quality of patient-centered care.

Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study

IntroductionProton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs.MethodsA retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10–2020.09) and a postintervention group (2020.10–2021.09). To reduce the bias of patients’ baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs.ResultsA total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05).ConclusionThe implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.

Factors affecting drug interactions and their clinical importance in geriatric outpatients

Introduction: Polypharmacy can lead to drug-drug interactions. The aim of this study was to determine the possible factors affecting the prevalence and clinical importance, and interrater reliability of clinical significance of drug interactions in geriatric outpatients. Materials and Method: Potential drug-drug interactions in 228 patients treated in an outpatient geriatric clinic were evaluated in this cross-sectional, retrospective study. The potential significance of the interactions was reviewed separately by a geriatrician and a clinical pharmacist. Results: A total of 1342 drugs were prescribed (median 6 [2-14], per patient). Mean age of the patients was 78±0.5 (65-96). Polypharmacy was present in 64.0% of the patients. A weak positive correlation was found between patient age and the number of drugs used (Rs =.205; p=.002). No drug interaction was detected in 18.0% of the patients. In the prescriptions of the remaining 187 patients 760 category C, 70 category D, and 18 category X interactions (Lexicomp®) were detected. A strong positive correlation was found between the number of drugs per patient and the number of drug interactions (Rs =.734; p&lt;.001). There was a strong correlation between the number of interactions and the presence of polypharmacy (rpb=.702, p&lt;.001). The measure of agreement between the clinicians was more pronounced for category D and X interactions (Cohen’s k=.714 and 1, p&lt;.001). Conclusion: Advanced age, a higher frequency of concomitant use of drugs, and polypharmacy are factors that require clinicians to be aware of drug-drug interactions. Clinical pharmacists can work with geriatricians in outpatient clinics to prevent drug interactions. Keywords: Drug Interactions; Polypharmacy; Health Services for the Aged; Pharmacist.

Pathogenetic mechanisms of cognitive impairment in cerebrovascular pathology and prospects for their correction using nootropic and neuroprotective agents

The article presents modern ideas about the pathogenesis of cognitive disorders in cerebrovascular pathology at the cellular level. Dysfunction of neurovascular units is associated with impaired microcirculation, hypoxia, deficiency of energy resources, development of neuroinflammation, increased nitric oxide synthesis and oxidative stress, glutamate excitotoxicity, intracellular calcium accumulation, endothelial dysfunction, impaired circulation of cerebrovascular fluid, venous outflow from the cranial cavity and utilization of brain metabolic products, including misshaped proteins. The above determines the possibility of the combined development of cerebrovascular and neurodegenerative diseases, primarily Alzheimer’s disease. Currently, mixed (vascularneurodegenerative) brain damage is considered as the main cause of cognitive disorders, which is confirmed by the data of post-mortem studies. Pathogenetic therapy of dementia with cholinesterase inhibitors and memantine does not eliminate the cognitive defect, but only slows down its progression. The impossibility of restoring the premorbid level of daily activity of the patient in the treatment of cognitive impairment at the stage of dementia dictates the need for the use of adjuvant nootropic and neuroprotective agents until the breakdown of the functional reserve, that is, at the stage of moderate cognitive impairment. Nicotinoyl gamma-aminobutyric acid has nootropic, tranquilizing, psychostimulant and antioxidant properties. Studies of the last decade have proven the ability of nicotinoyl gamma-aminobutyric acid to suppress neuroinflammation and apoptosis of cells of the central nervous system, increase the expression of angiogenic and cytoskeletal proteins, normalize the permeability of the blood-brain barrier, which can be used to improve the function of neurovascular units and correct vascular-neurodegenerative cognitive impairment. A small number of drug interactions with nicotinoyl gamma-aminobutyric acid allows it to be included in the complex therapy of comorbid patients.

Prevalence and Severity of Drug Interactions in a Referral Pediatric Hospital: An Observational, Retrospective Study

Background: Hospitalized infants and children are usually treated with many medications in the hospital. Concurrent use of multiple drugs, known as polypharmacy, is inevitable in critically ill patients. This study aims to investigate the possible interactions as well as their type and number, and their effect on the treatment process plus the duration of hospital stay of patients.&#x0D; Methods: In this descriptive study, the medical records of 189 patients admitted to the Intensive care unit (ICU) ward of Mofid Children's Educational Hospital in Tehran were prospectively studied over six months from August 2018 to March 2019. The collected data included disease diagnosis, patient medication information, age and gender, and treatment interventions. Interactions between drugs were identified using Up-to-date database, with the results analyzed by SPSS software.&#x0D; Results: The results revealed that hospitalization increased with an increasing number of drugs. The findings also indicated a direct relationship between the number of drug interactions and the duration of hospital stay. After examining the relationship between ICU outcome and the number of drug items as well as the number of drug interactions, it was found that there is a direct relationship between the two. There was also a direct relationship between Class D plus X interactions and mortality rate along with duration of stay.&#x0D; Conclusion: This study showed a direct relationship between drug interactions and the duration of hospitalization. In other words, as drug interactions increased, so did the duration of hospital stay.

Medication‐related problems in geriatric psychiatry—a retrospective cohort study

Information on medication-related problems (MRPs) in elderly psychiatric patients is scarce. In the present study, we analyzed the frequency and characteristics of MRPs in patients ≥60years treated on the gerontopsychiatric ward of Hannover Medical School in 2019. Taking advantage of an interdisciplinary approach, two independent investigators screened hospital discharge letters of 230 psychiatric inpatients for clinically relevant MRPs, followed by validation through an interdisciplinary expert panel. Drug interactions as a subset of MRPs were analyzed with the aid of two different drug interaction programs. 230 patients (63.0% female, mean age 73.7±8.4years, median length of stay 18days) were prescribed a median of 6 drugs. In total, 2180 MRPs were detected in the study population and 94.3% of the patients exhibited at least one MRP. Patients displayed a median of 7 MRPs (interquartile range 3-15). Pharmacodynamic interactions accounted for almost half of all MRPs (48.1%; 1048/2180). The number of drugs prescribed and the number of MRPs per patient showed a strong linear relationship (adjusted R2 =0.747). An exceedingly high proportion of elderly psychiatric inpatients displayed clinically relevant MRPs in the present study, which may be explained by the multimorbidity prevalent in the study population and the associated polypharmacy. The number of drug interactions was largely in accordance with previous studies. As a novel finding, we detected that a considerable proportion of elderly psychiatric inpatients were affected by potential prescribing omissions, potentially inappropriate duplicate prescriptions, and insufficient documentation.

Detection tools for prediction and identification of adverse drug reactions in older patients: a systematic review and meta-analysis

Tools to accurately predict and detect adverse drug reactions (ADR) in elderly patients have not been developed. We aimed to identify and evaluate reports on tools that predict and detect ADR in elderly patients (≥ 60 years). In this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Databases were searched until January 2022 using key terms “elderly,” “adverse drug reaction,” and “detection instruments.” Eighteen studies met the inclusion criteria, and they examined assorted interventions: STOPP/START version 1/2 (n = 10), Beers Criteria 2012 or 2015 (n = 4), Systematic Tool to Reduce Inappropriate Prescribing (STRIP) (n = 2), Tool to Reduce Inappropriate Medications (TRIM) (n = 1), Medication Risk Score (MERIS) (n = 1), Computerized alert systems (n = 1), and Norwegian General Practice-Nursing Home criteria (n = 1). The interventions affected the number of potential prescription omissions (OR, 0.50 [0.37–0.69]; p < 0.0001; four studies). No apparent reduction in the number of drug interactions within 2 months (OR, 0.84 [0.70–1.02]; p = 0.08; two studies) and mortality (OR, 0.92 [0.76–1.12]; p = 0.41; three studies) was observed. In conclusion, there is no definitive and validated assessment tool for detecting and predicting ADR in elderly patients. Thus, more research on refining existing tools or developing new ones is warranted.

The Impact of Drug Interactions in Patients with Community-Acquired Pneumonia on Hospital Length of Stay.

(1) Background: An aging society is frequently affected by multimorbidity and polypharmacy, which, in turn, leads to an increased risk for drug interaction. The aim of this study was to evaluate the influence of drug interactions on the length of stay (LOS) in hospitals. (2) Methods: This retrospective, single-centre study is based on patients treated for community-acquired pneumonia in the hospital. Negative binomial regression was used to analyse the association between drug interactions and the LOS in the hospital. (3) Results: The total cohort contained 503 patients, yet 46 inpatients (9%) that died were not included in the analyses. The mean age was 74 (±15.3) years, 35% of patients older than 65 years were found to have more than two drug interactions, and 55% had a moderate, severe, or contraindicated adverse drug reaction. The regression model revealed a significant association between the number of drug interactions (rate ratio (RR) 1.02; 95%-CI 1.01–1.04) and the severity of drug interactions (RR 1.22; 95%-CI 1.09–1.37) on the LOS for the overall cohort as well as for the subgroup of patients aged 80 years and older. (4) Conclusion: Drug interactions are an independent risk factor for prolonged hospitalisation. Standardised assessment tools to avoid drug interactions should be implemented in clinical routines.

A Study on the Prescription Pattern of Antimicrobial Agents Used in the Treatment of Infectious Disease

Antibiotics are anti-infective agents produced from natural sources, whereas antimicrobial agents are generated through chemical synthesis. It was a prospective and observational study and was conducted in the medicine, OBG, and urology departments in Sagar Hospitals. The study was conducted over a period of 18 to 20 months. Among 542 participants, 325 (60%) were males, while 217 (40%) were females. The frequency of patients surviving different hospital departments was 416 (76.6%), and they survived the medicine department. Moreover, the urology department had 80 (14.8%) patient visits, while in the obstetrics and gynaecology departments, only 46 (8.5%) patients visited. It was found that the percentage and order of various micro-organisms isolated as Neisseria meningitides 20 (3.7%) and a lesser number of organisms were found in K. Pneumonia 01 (0.2%), respectively. The cephalosporin class of drugs is commonly prescribed in empirical and prophylactic therapy because they are more effective in infectious diseases Furthermore, 36 patients out of 542 had drug interactions; quinoline derivatives, such as Ciprofloxacin, typically have a higher number of drug interactions. Among 542 patients, 38 had severe drug reactions in that most of the reactions were dermatological reactions caused by cephalosporin drugs. Most of our physicians prescribed based on patient characteristics and behaviors, and the recovery rate was also good. In our study, we observed common outcomes of DIs, such as increased theophylline toxicity and digoxin toxicity, increased laboratory values, and also reduced some drugs' effectiveness. Correlations of drug and disease characteristics were found more in ciprofloxacin drugs.

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

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

A STUDY DESCRIBING THE USAGE PATTERN OF ANTIMICROBIALS WITH INSIGHTS INTO ANTIMICROBIAL DRUG-DRUG INTERACTIONS AMONG ADULT POPULATION IN HOSPITAL SETTINGS

The study aims to describe the use of antimicrobials among adult population in hospital settings with emphasis on the antimicrobial therapy provided and potential antimicrobial drug-drug interactions identified. 108 adult patients who were prescribed antimicrobials were considered for this retrospective study which was carried out over a period of 3 months. It was identified that antimicrobials prescribed were largely antibacterial (91.2%) with Piperacillin + Tazobactam (24 times) and Cefuroxime (15 times) being the most commonly prescribed antimicrobials on treatment and discharge, respectively. Upon assessing the antimicrobial therapy, it was identified that antimicrobials were predominantly prescribed empirically (57.4%) and monotherapy was observed more, both on treatment (52.8%) and discharge (47.2%). A total of 79 different potential antimicrobial drug-drug interactions were identified, out of which, 64.6% were major interactions. Ciprofloxacin + Metronidazole drug-drug interaction was the most common drug interaction observed 6 times, whereas clarithromycin and ciprofloxacin caused the greatest number of interactions with a frequency of 10 instances each. Ondansetron was the non-antimicrobial drug that caused the greatest number of drug interactions (21.2%). The present study reinforces that antibiotics and other antimicrobials are a group of very commonly prescribed medications in the hospital with a variety of indications. An important, but often unheeded aspect of therapy is antimicrobial interactions with other drugs, which this study has highlighted.

Pattern of systemic antibiotic use and potential drug interactions: Evaluations through a point prevalence study in Ankara University Hospitals.

Background/aim Most of the hospitalized patients are on a number of drugs for comorbidities and/or to prevent nosocomial infections. This necessitates a careful consideration of drug interactions not only to avoid possible toxicities but also to reach the highest efficiency with drug treatment. We aimed to investigate drug interactions related to systemic antibiotic use and compare three different databases to check for drug interactions while characterizing the main differences between medical and surgical departments. Materials and methods This point prevalence study covered data on 927 orders for patients hospitalized between June 3 and 10, 2018 in Ankara University Hospitals. Systemic antibiotic use and related drug interactions were documented using UptoDate, Drugs, and Medscape and comparisons between the departments of medical and surgical sciences were made. Results The number of orders, or the number of drugs or antibiotics per order were not different between the medical and surgical sciences departments. A total of 1335 antibiotic-related drug interactions of all levels were reported by one, two, or all three databases. UptoDate reported all common and major interactions. Pantoprazole was the most commonly prescribed drug and appeared in 63% of all orders. Among 75 different molecules, ceftriaxone and meropenem were the two most prescribed antibiotics by the surgical and medical departments, respectively. Conclusion A dramatic variance existed amongst antibiotics prescribed by different departments. This indicated the requirement for a centralized role of an infectious diseases specialist. Especially for the hospitalized patient, prophylactic coverage with at least one antibiotic brought about a number of drug interactions. A precise evaluation of orders in terms of drug interactions by a clinical pharmacist (currently none on duty) will reduce possible drug-related hazards.

Assessment of Potential Drug-Drug Interactions and its Associated Factors in Medical Intensive Care Unit of a Tertiary Care Hospital in Nepal

Drug interaction may cause an increase in the toxicity of a drug, increases the likelihood of adverse drug reactions, or cause a reduction in the efficacy of particular drug therapy, which may worsen the patient’s condition directly or indirectly. This study aims to assess the potential drug-drug interactions (pDDIs) and their associated factors in the Medical Intensive Care Unit (MICU). We carried out a descriptive retrospective study based on the hospital records of 100 MICU patients. Micromedex Interaction application, designed by Truven Health Analytics Inc., was used to screen prescribed medications. We found 219 drug interactions out of 856 drugs prescribed. The average number of drug interactions per patient was 2.19. The frequency of drugs prescribed, the number of days in MICU, and age had a positive correlation with the occurrence of pDDIs. There were 44.7% major pDDIs; pharmacodynamic being the commonest mechanism for it. Most patients in MICU were at the risk of developing pDDIs. A substantial number of interactions had a major severity. Therefore, there is a need for active surveillance for pDDIs to prevent patient harm during particular drug therapy.

The role of edoxaban in preventing thromboembolic complications in patients with atrial fibrillation

Edoxaban is a selective direct factor Xa inhibitor. Edoxaban in a dose of 60 mg per day is an effective and safe option in the prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation, including in combination therapy in patients after percutaneous coronary interventions. ENGAGE AF-TIMI 48 is currently the most extensive study comparing direct oral anticoagulants and warfarin in patients with atrial fibrillation, both in terms of number of participants and duration of observation. For edoxaban, an adequate approach to dose reduction has been developed in patients with alikely increase in plasma concentration due to renal impairment, low body weight or inter-drug interactions. Such dose reduction does notlead to an increase in the frequency of ischemic complications.Edoxaban is characterized by an optimal safety profile in patients with chronic moderate kidney disease, a small number of drug interactions and a convenient mode of administration. In patients with atrial fibrillation and concomitant ischemic heart disease, the use of Edoxaban is associated with a decrease in the frequency of myocardial infarctions, as well as strokes and episodes of systemic thromboembolism in comparison with warfarin. The drug can be successfully used as anticoagulant support for cardioversion and catheter ablation for atrial fibrillation.Edoxaban intake does not require routinelaboratory control. In case of unexpected situations (life-threatening bleeding, urgent surgical intervention) in patients receiving edoxaban, to assess the degree of anticoagulation should use the determination of anti-Xa activity. Clinical studies of a specific antidote of edoxaban - andexanet alfa are ongoing. Before approval of the specific antidote in severe andlife-threatening bleedings against the background of edoxaban administration, the use of prothrombin complex concentrate should be considered. Data on the effective and safe use of edoxaban in routine clinical practice have been accumulated.

THE PREDICTORS OF POTENTIAL DRUG-DRUG INTERACTIONS AMONG DIABETIC HYPERTENSIVE ADULT OUTPATIENTS IN A KENYAN REFERRAL HOSPITAL

Objective: To characterize the predictors of potential drug-drug interactions among adult diabetic hypertensive outpatients at Kenyatta National Hospital.&#x0D; Methods: This cross-sectional study collected and analyzed data on potential drug interactions from 104 diabetic hypertensive outpatients (aged ≥18 y) at the Department of Endocrinology Outpatient Clinic of Kenyatta National Hospital from 1st May 2019 to 31st August 2019. The main outcome measure was the prevalence of potential drug-drug interactions and their predictors among the study population.&#x0D; Results: There was a female preponderance (70.2%). The mean age of the study participants was 61.6 y (SD±10.8). The prevalence of potential drug interactions was high at 57.7%. The average number of drug interactions was one interacting pair per patient, with a majority of the prescriptions (81.0%) having moderate drug-drug interactions. Patients receiving&gt;2 drugs were almost three times more likely to have drug-drug interaction compared to those prescribed ≤ 2 drugs (AOR=2.79; 95% CI: 1.11-7.28); p=0.029). Participants who were at stage 4 of hypertension were 2.5 times more likely to have a drug-drug interaction compared to the other stages of hypertension (AOR=2.52; 95% CI 1.31-4.89; p=0.007).&#x0D; Conclusion: Polypharmacy and stage 4 hypertension are independently associated with drug-drug interactions among patients with both diabetes and hypertension. Future studies should characterize the specific type of drug interactions and possible targets of minimization of drug-drug interactions.

Drug Interactions in Iranian Veterans With Chronic Spinal Cord Injury - A Descriptive Study

Background: Veterans with chronic spinal cord injury usually have various comorbidities. They are, therefore, visited by different doctors and use different medications. It is necessary to monitor the health of these veterans. One of the important issues in this regard is the attention to drug interactions. The purpose of this study was to investigate the drugs used and their interactions.Methods: This descriptive study of the cross-sectional studies was carried out retrospectively in 2015 under the Shefa Neuroscience Research Center’s supervision, examining the medical records of veterans with spinal cord injury participating in the health screening program at Khatam Alanbiya hospital in Tehran. Demographic data, comorbidities, used drugs, and the level of involvement collected. According to the FDA, drug interactions among the drugs used for each patient has evaluated and classified into three severe, moderate, and weak groups. SPSS v. 21 analyzed data.Results: The study population consisted of 404 men, ranging in age from 41 to 74, with a mean of 51.6 ± 6.4 years. One hundred forty-two of them (35.1%) had a complete injury, and 262 veterans (64.8%) had an incomplete injury. Only 17 veterans (4.2%) had no drug interactions. The number of drug interactions varied from 1 to 38, with an average of 5.9 ± 12.8 interactions per patient. The total number of interactions was 2856, of which 32.5% were weak, 55.3% moderate, and 12.2% severe, with a 95% confidence interval. Among the severe drug interactions in the study, the highest number belonged to the antidepressant drugs.Conclusion: This study highlights the necessity of developing a strategy for investigating and preventing drug interactions in veterans with chronic spinal cord injury. It has recommended that physicians pay more attention to other medications used by the patient and prescribe as little as possible of the drug and the drug with the least number of interactions.

Análise das interações medicamentosas e perfil epidemiológico de indivíduos com diabetes mellitus na atenção primária

Objetivo: analisar as interações medicamentosas e o perfil epidemiológico de indivíduos com diabetes mellitus (DM). Método: estudo quantitativo com aplicação de questionário a 42 pacientes com DM pertencentes a um Centro de Saúde da Família (CSF). Os dados foram coletados em 2018, em três etapas: encontro no CSF, visitas domiciliares e busca em prontuário eletrônico; seguido de análise das interações medicamentosas nas bases Drug Interactions Checker Drug Information e DrugBank. Resultados: a idade média dos pacientes foi de 68,36 anos. O número total de associações entre fármacos foi de 1355 (média de 32,26/paciente). O total de medicações que interagem foi de 479 (11,40 interações/paciente). Em 65% as combinações não interagiram, 4% foram interações leves, 26,05% moderadas e 1,70% graves. Conclusão: a quantidade de interações medicamentosas é expressiva, predominando as de grau moderado. A idade dos pacientes e presença de comorbidades podem estar associadas à polimedicação, contribuindo para ocorrência dessas interações.

Frequency and risk factors of polypharmacy and drug interactions among patients in general intensive care unit of Golestan Hospital, Ahvaz, southwest of Iran

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Objective&lt;/title&gt; &lt;p&gt;This study was aimed to evaluate polypharmacy and drug interactions in intensive care units.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Materials and methods&lt;/title&gt; &lt;p&gt;This epidemiologic-descriptive study was performed on the records of 80 patients admitted to the intensive care unit with a duration of more than 48 hours from 2018-10-23 to 2019-01-21. The patients' records, including polypharmacy, type and number of drug interactions as well as factors such as age, gender, hospitalization duration, number of drug-prescribing physicians were investigated. To determine drug interactions, Free &lt;italic&gt;Lexi-Comp&lt;/italic&gt; &lt;italic&gt;iOS&lt;/italic&gt; software version 4.0.1 was used.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Findings&lt;/title&gt; &lt;p&gt;Of 80 participants in this study, 58, and 22 patients (72.5%, and 27.5%) were respectively male and female, with a mean age of 39.9 years; besides, 46.2%, and 25.3% of patients were hospitalized due to trauma, and non-traumatic cerebral hemorrhage, respectively. The average hospitalization was six days. The average number of drug-prescribing physicians and medications received was 5 and 10, respectively. The majority of patients (91.2%) received over five drugs. The majority of drug interactions (70%) were in C-Class, and 1.2% were in X-Class. Also, 85% of the studied samples had at least one drug interaction.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusion&lt;/title&gt; &lt;p&gt;Polypharmacy and drug interactions were common in patients hospitalized in the intensive care unit ward. Risk factors for increasing drug interactions were the length of stay and number of medications prescribed, and for polypharmacy, length of stay, number of medications-prescribing physicians, and number of prescription medications.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;