Potential Drug-drug Interactions In Prescriptions Research Articles

Prevalence and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city, southwestern Uganda.

Drug-drug interactions (DDIs) influence the effectiveness of medication and thus determine the treatment outcomes of diseases managed with pharmacotherapy. This study aimed to determine the prevalence, severity, and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city. DDIs were identified and classified basing on risk and severity using Lexicomp drug interaction database. STATA version 13 was used to analyze the collected data. Descriptive statistics were used to summarize the severity of potential DDIs identified. Bivariate and multivariate logistic regression was employed to identify different factors associated with the presence of potential DDIs. A total of 295 prescriptions from 18 private pharmacies were studied and the prevalence of clinically significant potential DDIs was 37.6%. About half (149, 50.5%) of the patients were females, the majority (199, 67.5%) were adults 18-59 years of age whereas most (208, 70.5%) had a comorbid condition. Over one half (162, 54.9%) of the prescriptions were received from hospitals and majority of the prescriptions had 4 drugs prescribed (n= 175, 59.32%). Having one or more comorbidities and prescribing of therapeutic drug categories including anti-fungal, antihypertensives, analgesics, or corticosteroids were significantly associated with potential DDIs. The prevalence of potential drug-drug interactions in outpatient setting in Mbarara city was high and majority of the potential DDIs were of moderate severity. Having 1 or more comorbidities and prescribing of therapeutic drug categories including antifungals, antihypertensives, analgesics, or corticosteroids were significantly associated with potential DDIs.

DEVELOPING A LIST OF POTENTIAL CLINICALLY SIGNIFICANT DRUG - DRUG INTERACTIONS AT FAMILY MEDICINE CLINIC

Objectives: To investigate the prevalence of potential DDIs in prescriptions of outpatients and to develop a list of potential clinically significant drug-drug interactions (DDIs) at Family Medicine Clinic. Materials and Method: The construction of the list was based on the consensus of four drug interaction compendia. A cross-sectional descriptive study method was used with 3208 outpatient prescriptions from October 1, 2019 to December 31, 2019 to detect the interactions which appeared on the developed list. Results: The list of 14 clinically important drug interactions was developed. The rate of occurrence of these interactions in the outpatient prescriptions is 0,7%. The drugs involved were amlodipine, simvastatin, prednisolone, metformin, cefuroxime pantoprazole. Age, the number of diagnosed diseases and the number of drugs prescribed were associated with the risk of having potential drug-drug interactions. Conclusion: Analysis of prescription data found that some potential DDIs were identified. Clinical pharmacology should be enhanced to minimize these interactions and ensure proper, safe and effective drug use. Key words: Drug interaction, clinical pharmacist, Family medicine clinic

Interações medicamentosas em prescrições para idosos hospitalizados com Síndrome Coronariana Aguda

Objetivou-se determinar a taxa de interações medicamentosas potenciais teóricas em prescrições para idosos diagnosticados com Síndrome Coronariana Aguda em um hospital de ensino. Estudo descritivo exploratório com análise de 607 prescrições através de bases de dados informatizadas para identificar e classificar as interações de acordo com a intensidade (maior, moderada ou menor), mecanismo (farmacocinético ou farmacodinâmico) e relevância da documentação. Foram detectadas 10.162 interações, distribuídas entre 554 tipos de combinações diferentes dentre os medicamentos prescritos, e 99% das prescrições apresentaram pelo menos uma e máximo de 53 interações, destacando-se a prevalência de maiores e moderadas. Houve correlação entre o número de interações e o número de medicamentos prescritos e o tempo de hospitalização. Este estudo contribui para a delimitação do padrão de prevalência das interações medicamentosas em prescrições para Síndrome Coronariana Aguda, além de subsidiar a importância da implantação efetiva da Farmácia Clínica em hospitais de ensino.

Detection of potential drug-drug interactions in prescriptions dispensed in hospital pharmacy

This prospective observational study examined the severity, type and frequency of potential drug-drug interactions (PDDIs) in prescriptions dispensed in the hospital pharmacies of M.S. Ramaiah Memorial Hospital and M.S. Ramaiah Hospital, Bangalore, Karnataka. A total of 500 prescriptions were collected over a period of 5 months. PDDIs were identified and analysed using Micromedex database. The frequency of PDDIs was 71.8%, with at least one interacting combination with major (14.20%), moderate (72.70%) and minor (13.09%) interactions. Out of the total PDDIs identified, 60% were pharmacodynamic interactions, 38% were pharmacokinetic interactions and 2% had interaction of unknown mechanism. The largest number of active drugs prescribed with major PDDIs were related to the cardiovascular system (32.63%), central nervous system (22.28%), gastrointestinal tract and drug metabolism (13.37%).The results of the present study showed a high frequency of PDDIs in prescriptions received at hospital pharmacies.

A study on potential drug – drug interaction among prescriptions dispensed at State Pharmaceutical Corporation, Anuradhapura

Background The drug-drug interactions (DDI) are a common cause for medical error. Our aim was to find the frequency and severity of potential DDI in prescriptions dispensed at State Pharmaceutical Corporation (SPC), Anuradhapura. Methods A cross sectional study was conducted at SPC, Anuradhapura. Ethical clearance was obtained from the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. Medscape drug interaction checker was used to identify potential DDI. There are three types of interactions; serious, significant and minor. Results Thousand prescriptions over a period of four months were collected. There were 1376 potential drug interactions in 466 prescriptions with a mean of 1.4 (SD 2.4) per prescription. There were 94 (6.8%) serious, 1017 (73.9%) significant and 265 (19.3%) minor DDI. The maximum amount of DDI per prescription in serious, significant and minor was 05, 15 and 04 respectively. The total maximum DDI was 21. DDI involved 178 drugs. Respectively, methotrexate (MTX) (10%), aspirin (11%) and metformin (10%) were the most frequently implicated drugs in serious, significant and minor interactions. Common serious pharmacokinetic DDI are MTX-meloxicam, clopidogrel-omeprazole, clopidogrel-esomeprazole and phramacodynamic DDIs are MTX-leflunomide, atorvastatin-vitamin B3 and atorvastatin-fenofibrate. The most common potential DDI was aspirin with losartan caused by dual mechanism; a pharmacodynamic antagonism and increase in serum potassium (4%). Conclusion Potential drug-drug interactions are common and prescribers need to use a device such as mobile app to check and prevent it.

Assessment of Potential Drug-Drug Interactions in Prescriptions of Patients with Chronic Diseases in Community Setting

OBJECTIVES : To assess the potential drug drug interactions in prescriptions of patients with chronic diseases and also to evaluate the severity and prevalence of potential drug drug interactions. METHODOLOGY : This was a cross- sectional observational study carried out over a period of six months in three selected community pharmacies of a Mysuru city. The prevalence of potential drug drug interactions was calculated and the predictors of potential drug drug interactions were determined by applying student t- test and chi-square test. The study criteria for enrolling subjects in our research study were patients of either gender who are coming to community pharmacy with prescriptions and exclusion criteria were patients receiving medicines other than allopathic. RESULTS AND DISCUSSION : A total of 800 prescriptions of patients with chronic diseases such as Diabetes Mellitus, Hypertension, Acute Coronary Syndrome etc were reviewed for potential drug-drug interactions (PDDIs) during our study period. 69.62% (n=557) of the study patients had two to four drugs in their prescriptions and the remaining 30.37% (n=243) of study patients had more than five drugs in their prescription. The prevalence of prescriptions with potential drug drug interactions among the study population was found to be 39.37%. Similar result was observed in the study conducted by H.Kafeel et al in Karachi where the prevalence of PDDIs in prescriptions dispensed by the community pharmacies was 40%. Among 500 potential drug drug interactions, moderate (n=354, 70.8%) in severity (n=354, 70.8%) were high compared to major (n=126, 25.2%) and minor (n=20, 4%) PDDIs. Comparing the age of patients with and without PDDIs, mean standard deviation age of the patients with PDDIs was more (58.68 (9.96) years) than patients without PDDIs (56.85 (11.34) years) and it was found to be statistically significant (P = 0.020). During the span of six month research study highest recorded PDDIs (22.4%) were beta adrenergic blockers and oral hypoglycaemic agent (glimepride + metformin ) followed by beta blockers and dihydropyridine calcium channel blocker (10.6%). CONCLUSION : The predictors of PDDIs identified in our study were age, number of drugs prescribed and presence of co-morbidities (n=618, 77.2%) such as Hypertension with Diabetes Mellitus, Hypertension with Congestive Cardiac Failure etc. Interaction between beta adrenergic blockers and glimepride + metformin was the most commonly observed interaction in our study.

Potential drug-drug interactions in prescriptions dispensed in community and hospital pharmacies in East of Iran.

Objective:This study aim to evaluate and compare type and prevalence of drug-drug interactions (DDIs) in prescriptions dispensed in both community and hospital setting in Zabol, Iran.Methods:A total of 2796 prescriptions were collected from community and inpatient and outpatient pharmacy of Amir-al-momenin only current acting hospital in Zabol, Iran. The prescriptions were processed using Lexi-Comp drug interaction software. The identified DDIs were categorized into five classes (A, B, C, D, X).Findings:Overall 41.6% of prescriptions had at last one potential DDI. The most common type of interactions was type C (66%). The percentage of drug interactions in community pharmacies were significantly lower than hospital pharmacies (P < 0.0001).Conclusion:Our results indicate that patients in Zabol are at high risk of adverse drug reactions caused by medications due to potential DDIs. Appropriate education for physicians about potentially harmful DDIs, as well as active participation of pharmacists in detection and prevention of drug-related injuries, could considerably prevent the consequence of DDIs among patients.

PHC-002 Analysis of the Incidence of Potential Drug Interactions in Hospitalised Patients

BackgroundPrescriptions with more than one drug increase the risk of drug-drug interactions, treatment failure, large pharmacological effects and adverse events.Purpose To estimate the frequency of potential drug-drug interactions in prescriptions...

Potential Drug-Drug Interactions in Prescriptions to Patients over 45 Years of Age in Primary Care, Southern Brazil

BackgroundFew cross-sectional studies involving adults and elderly patients with major DDIs have been conducted in the primary care setting. The study aimed to investigate the prevalence of potential drug-drug interactions (DDIs) in patients treated in primary care.Methodology/Principal FindingsA cross-sectional study involving patients aged 45 years or older was conducted at 25 Basic Health Units in the city of Maringá (southern Brazil) from May to December 2010. The data were collected from prescriptions at the pharmacy of the health unit at the time of the delivery of medication to the patient. After delivery, the researcher checked the electronic medical records of the patient. A total of 827 patients were investigated (mean age: 64.1; mean number of medications: 4.4). DDIs were identified in the Micromedex® database. The prevalence of potential DDIs and major DDIs was 63.0% and 12.1%, respectively. In both the univariate and multivariate analyses, the number of drugs prescribed was significantly associated with potential DDIs, with an increasing risk from three to five drugs (OR = 4.74; 95% CI: 2.90–7.73) to six or more drugs (OR = 23.03; 95% CI: 10.42–50.91). Forty drugs accounted for 122 pairs of major DDIs, the most frequent of which involved simvastatin (23.8%), captopril/enalapril (16.4%) and fluoxetine (16.4%).Conclusions/SignificanceThis is the first large-scale study on primary care carried out in Latin America. Based on the findings, the estimated prevalence of potential DDIs was high, whereas clinically significant DDIs occurred in a smaller proportion. Exposing patients to a greater number of prescription drugs, especially three or more, proved to be a significant predictor of DDIs. Prescribers should be more aware of potential DDIs. Future studies should assess potential DDIs in primary care over a longer period of time.

Analysis of the incidence of potential drug interactions in cardiology and internal hospitalised patients

BackgroundPrescriptions with more than one drug increase the risk of drug-drug interactions, treatment failure, large pharmacological effect and adverse events.PurposeThe objectives of this study were to estimate the frequency of...

Prevalence of potential drug interactions in an Iranian general hospital

The hazards of prescribing many drugs, including side-effects, drug-drug interactions and difficulties of compliance have long been recognized as particular problems when prescribing. This study estimates the rate and factors associated with potential drug-drug interactions in prescriptions from wards of An Iranian General Hospital. Data were retrieved from the pharmacy of a general hospital (200 beds) during one year period 2010. Potential drug-drug interaction were identified using a computerized drug-drug interaction database system (Prescription Analyzer 2000, Sara Rayane Co., Iran). Patients of both genders and 15 years-old or more were included in this study. Prescriptions with two or more drugs prescribed were selected during one year period 2010. Gender number of drugs and therapeutic drug classes on prescriptions were explored as associated factors to drug-drug interaction. The overall prevalence of potential drug-drug interaction was 20.3%. The risks of severe potential drug interactions were relatively high and the rate of potential drug-drug interaction was significantly higher in women (60.6%) and the patients aged over 60 years old (57.1%). The frequency of the potentially severe drug-drug interaction was 10.8% with digoxin-furosemide as the most common interacting pair (5.91%). A positive correlation was found between drug-drug interaction, patient's age, number of drugs and drugs acting on cardiovascular system. So cardiology women inpatients, age more then 60 years old, and patients prescribed digoxin and angiotensin-converting enzyme inhibitors should be closely monitored for adverse outcomes from drug-drug interaction.

A study of drug-drug interactions in cancer patients of a south Indian tertiary care teaching hospital

Drug interactions in oncology are of particular importance owing to the narrow therapeutic index and the inherent toxicity of anticancer agents. Interactions with other medications can cause small change in pharmacokinetics or pharmacodynamics of chemotherapeutic agents that could significantly alter their safety and efficacy. To identify and document the potential drug-drug interactions in prescriptions of patients receiving cancer chemotherapy. Settings and Design : A tertiary care teaching hospital based prospective study. Patients admitted in the medical oncology wards with different types of malignancies and receiving cancer chemotherapy during the period of June 2009 to November 2009 were included in the study. A detailed data collection was done in a specially designed proforma with ethical approval and consent of patients and their prescriptions were subjected to drug-drug interaction screening using Drug Interaction Fact Software Version-4 and standard references. Incidence of drug-drug interactions, their types, correlation between age, cancer type, number of drugs prescribed and incidence of drug interactions were analyzed. Logistic regression analysis and Odds ratio were performed to identify the incidence of drug-drug interactions and their correlation with the factors above mentioned. A total of 75 patients (32 males and 43 females; median age 56 years, age range 23-74) were enrolled in the study and their prescriptions were screened. 213 interactions were identified of which, 21 were major, 121 were moderate and 71 were minor. There were 13 (6.1%) clinically significant interactions between anticancer drugs and 14 (6.5%) drug-drug interactions between anticancer drugs and other drugs prescribed for co-morbidities. There was a positive correlation between number of drugs prescribed and drug interactions (P=0.011; OR 0.903). Though there was not any life threatening interactions, the potential interactions were brought to the oncologist purview for ensuring patients safety and to avoid undesirable effects.

Potential drug–drug interactions in prescriptions dispensed in community pharmacies in Greece

To evaluate the nature, type and prevalence of potential drug-drug interactions (DDIs) in prescriptions dispensed in community pharmacies in Thessaloniki, Greece. Secondary objectives included the classification of DDIs as per pharmacotherapeutic class of the medications and the investigation of the relationship between medical specialties and the frequency of potential DDIs, as well as the relationship between DDIs and prescription size. Setting DDIs are a common cause of adverse drug reactions (ADRs) among patients using multiple drug therapy. In Greece a reliable computerized surveillance system for monitoring potential DDIs is not yet fully established. As a result, the prevalence of such DDIs in prescriptions dispensed by community pharmacies in Greece is unknown. We conducted a prospective, descriptive study. Over a 3-month period (November 2007-January 2008), a total of 1,553 handwritten prescriptions were collected from three community pharmacies in Thessaloniki, Greece. The prescriptions were processed using the Drug Interactions Checker within the www.drugs.com database. The identified potential DDIs were categorized into two classes, major and moderate, according to their level of clinical significance. Overall 213 prescriptions had one or more potential DDIs and a total of 287 major and moderate DDIs were identified. Potential DDIs were identified in 18.5% of all prescriptions. Major DDIs were identified in 1.9% of all prescriptions and represented 10.5% of all DDIs detected, whereas moderate DDIs were identified in 16.6% of all prescriptions and represented 89.5% of all DDIs detected. The rate of DDIs increased with prescription size. The most common drug involved in major DDIs was amiodarone which interacts with potassium-wasting diuretics, digoxin, simvastatin and acenocoumarol. Our results indicate that patients in Greece are at risk of ADRs caused by medications due to potential DDIs. An appropriate surveillance system for monitoring such interactions should be implemented and physicians should be more aware of potentially harmful DDIs. Pharmacists can contribute to the detection and prevention of drug-related injuries, especially of clinically meaningful DDIs that pose a potential risk to patient safety.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil

Drug interactions form part of current clinical practice and they affect between 3 and 5% of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007. Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. Most of the patients were female (69.8%), married (59.4%) and in the age group of 60 years or over (56.3%), with an income less than or equal to three minimum monthly salaries (81.3%) and less than eight years of schooling (69.8%); 90.6% of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5%). The frequency of drug interactions was 66.6%. Among the 154 potential drug interactions, 4.6% were classified as major, 65.6% as moderate and 20.1% as minor. The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.