Severe Drug Interactions Research Articles

An Indicator of Treatment Quality in Ambulatory Care in Switzerland: Potential drug interaction in older people with polpharmacy in primary care

Background The Swiss Society of General Internal Medicine (SGAIM) has chosen the topic "Recognising drug interactions and preventing side effects" as a quality indicator in the primary care setting. Methodology Retrospectively, in a group practice of 6 general practitioners (GPs), all patients aged 65 and over who were prescribed ≥ 5 long-term medications were identified in the year 2022. These medications were systematically checked for interaction reports using the Compendium® software. Results The 226 patients were on average 77 years old and took an average of 7 different medications. In 188 (83.2 %) individuals with drug interaction signals, the severity of the drug interaction was classified as mild in 164 (87.3 %), moderate in 21 (11.1 %) and severe in 3 (1.6 %). Diuretics, antidiabetics and ACE-inhibitors/sartans were most frequently involved. In case of severe drug interaction reports, antidepressant agents and amiodarone were most frequently involved. In the multivariate analysis, no statistically significant associations were identified between the number of drug interaction reports and age, gender or type of residence. Conclusion In over 65-year-olds with polypharmacy (≥ 5 medications) in a GP setting, a software-supported systematic drug interaction check identified drug interactions of the prescribed medication in nine out of ten patients. The vast majority of drug interaction reports were minor and not clinically relevant. The number of drug interactions as an indicator of quality of care is limited, as patient-specific information other than their medication regimens is not taken into account. GPs' classification in the clinical context and the context and the assessment of the benefits and risks of (poly-)medication is indispensable.

Warfarin in the Emergency Service: Drug Interactions and Clinical Considerations

Aim: Drug-drug interactions (DDIs) are common occurrences where one drug influences the blood concentrations or efficacy of another. Warfarin, known for its narrow therapeutic index, carries a heightened risk of severe drug interactions. Material and Methods: We retrospectively analyzed the records of 211 patients using warfarin at the Emergency Health Services clinic of Kırklareli Training and Research Hospital from January 1, 2020, to December 31, 2020. Patient demographics and drug regimens were documented, and drug interaction assessments were conducted using the drugs.com database. Results: Among the 211 patients, 17 exhibited signs of bleeding, including 5 with major bleeding and 12 with minor bleeding. Of these, 129 had INR values exceeding 2.5, while 82 had INR values below 2.5. Notably, 11 of the 17 bleeding patients had INR values above 2.5, with an average INR of 3.69. Analysis revealed that the 211 patients collectively used 111 different drugs, with an average of 3.81 drugs per prescription. Intriguingly, 33 of these drugs exhibited major, moderate, or minor inter-actions and were prescribed to 174 patients. Conclusion: In conclusion, cautious and selective prescription of medications is warranted for patients receiving warfarin due to the potential for significant drug interactions.

Polypharmacy and drug interactions in older patients with cancer receiving chemotherapy: associated factors

BackgroundPolypharmacy in older adults with cancer receiving chemotherapy leads to increased risks of drug interactions, translating in potential hazardous health outcomes. This study aims to assess the prevalence of polypharmacy, drug–drug interactions (DDIs), and severe-drug interactions (SDIs) in older patients with cancer. Antineoplastic agents (ANAs) involvement and possible risk contexts (comorbidities with cardiac risk, and high-risk medications) were also analysed.MethodsObservational study with older adults (≥ 65 years) diagnosed with cancer, who were treated with antineoplastic agents (ANAs); it was conducted in three hospitals from the north of Portugal. Data collection was obtained using self-reports and medical records. DDIs were identified and classified using Micromedex® software. Descriptive and association analyze statistics were performed. Statistical hypothesis tests with p value less than 0.05 were considered significant. All statistical procedures and analysis were performed with R version 4.1.3.ResultsWe enrolled 552 patients. Polypharmacy prevalence was 88.40%; 76.45% and 56.16% of the patients presented with DDIs and SDIs, respectively. SDIs with ANAs were found in 21.20% of the patients. High-risk medications were associated with a higher risk of polypharmacy, DDIs, and SDIs. Polypharmacy and DDIs were higher in patients with hypertension or diabetes. SDIs were higher in patients with diabetes.ConclusionPolypharmacy, potential DDIs and SDIs were highly prevalent in older adults with cancer. A careful review of the medication administered is necessary to decrease it. These findings warrant further research to optimize medication in this population and decrease problems related to medication, which may lead to emergency room visits and hospitalisations, compromising patient safety and/or ongoing treatments.

Evaluation of oral targeted anticancer drug interactions and their management by oncology pharmacists

AbstractIntroductionOral targeted anticancer drugs (OTADs) have become a key component of therapy for multiple malignancies, and their use continues to expand. While several studies have identified numerous drug interactions (DIs) associated with these oral therapies, very few have described the role of an oncology pharmacist in DI management.ObjectivesThe purpose of this study was to quantify moderate/severe DIs with OTADs at initiation and describe the role of the pharmacist in interaction detection and management.MethodsThis retrospective analysis was completed utilizing an electronic health record review of adult patients initiated on an OTAD with pharmacist documentation of medication review between July 2020 and July 2022. The outcomes of this study included the incidence of moderate/severe DIs, the distribution of pharmacokinetic/pharmacodynamic DIs, the incidence of pharmacist documentation of moderate/severe DIs, prescriber acceptance of documented pharmacist‐recommended interventions, the evaluation of severe DIs, and presence of DI related adverse effects within 60 days of OTAD initiation.ResultsTwo hundred sixty‐six patients were included. Forty‐six percent (122/266) of patients had at least one moderate/severe DI identified by investigators with a total of 220 moderate/severe DIs detected. Fifty‐eight percent (127/220) of the identified DIs were pharmacokinetic and 42% (93/220) were pharmacodynamic in nature. Pharmacist documentation was present for 36% (75/207) of the moderate DIs and 92% (12/13) of the severe DIs identified at OTAD initiation, and prescribers accepted 94% (82/87) of the pharmacists' recommended interventions. Lastly, 12.5% (26/208) of the incidence of adverse effects was potentially related to moderate/severe DIs within 60 days of OTAD initiation.ConclusionClinically significant (moderate/severe) DIs are common in patients receiving OTADs and may impact patient outcomes. Pharmacists can help to identify, prevent, and create a plan of action for the management of DIs and we advocate for their involvement in the management of OTAD therapies.

Clindamycin use evaluation retrospective observational study in critical care units in Alexandria Main University Hospital

BackgroundIrrational use of antibiotics in hospitals is one of the main health system problems. It leads to antibiotic resistance, adverse events, treatment failure, total treatment costs, and longer hospital stay. We aim to evaluate clindamycin use in critical care units in our hospital. It is a step to assess and then put strategies to improve the antibiotic use process.MethodsThis is a clindamycin use evaluation retrospective study. It was done in critical care units at Alexandria’s main university hospital. The clinical pharmacists reviewed 99 patients’ prescriptions over the last 4 months, recording patients' demographics, main diagnosis, comorbidities, type of infection, duplication of therapy, dose, the occurrence of diarrhea, serious drug interactions, clindamycin-defined daily dose per 1000 patients’ days), treatment duration and total cost of clindamycin.ResultsA total of 99 patients were included. Clindamycin was prescribed in appropriate indications in 57 patients (57/99 = 57.6%). Prescriptions with inappropriate indications were 42 (42/99 = 42.4%). Duplication of therapy with clindamycin was detected in 32 prescriptions (32.3%). Diarrhea was recorded in 4% of the cases. There were no severe drug interactions with clindamycin. Inappropriate indications were 320 defined Daily Dose (DDD) of total clindamycin consumption (765 DDD) and a cost of 29951.5 LE (42% of total cost). The prescribed dose of clindamycin was correct in all cases.ConclusionThere is irrational clindamycin use in critical care units in some cases regarding indications and treatment duplication. Although the prescribed doses were correct. Clindamycin misuse increased total consumption and cost.Trial registration numberNCT05223400 on 2 February 2022.

A COMPREHENSIVE ANALYSIS OF ANTIDIABETIC DRUG INTERACTIONS IN GERIATRIC NON-INSULIN DEPENDENT DIABETES MELLITUS PATIENTS

Objective: Type 2 diabetes mellitus (DM) is a disease that is the leading cause of blindness, heart disease, and kidney failure. Geriatric patients with type 2 DM and complications require multiple medications (polypharmacy), contributing to drug-drug interactions (DDIs). DDIs can affect the clinical outcome of patients. This study aims to analyze potential drug-drug interactions based on the mechanism and severity, determine the relationship between the number of medications and potential drug interaction, and determine the relationship between polypharmacy and the severity of clinical outcomes.
 Methods: This was an analytical observational with retrospective data collection through patient medical records of hospitalized patients treated with an antidiabetic and one or more other drugs that met the inclusion criteria, involving 81 patients using total sampling.
 Results: The result showed that out of 81 patients, there were 59 patients who potentially experienced drug-drug interactions (72.8%) with a total of 162 cases of drug interactions, and the most prevalent interaction mechanism was pharmacodynamic (84.0%) with a moderate severity level (57.4%). There was a significant relationship between the number of medications and potential drug-drug interactions (p<0.05). At the same time, there was no meaningful relationship between polypharmacy and the severity of drug interactions with clinical outcomes (p>0.05).
 Conclusion: An increase in the number of drugs is a predictor of drug interactions. Although drug interactions may theoretically occur, not all interactions will significantly affect patients.

Inpatient transition of methadone to Suboxone via rapid micro-induction in sepsis: a case report

ABSTRACT Buprenorphine is often preferred over methadone for medication-assisted treatment of opioid use disorder (OUD) because of its superior accessibility and less severe side effect and drug interaction profile; however, a transition from methadone to buprenorphine is made challenging by the prolonged half-life of methadone. Rapid micro-induction of buprenorphine is an up-and-coming strategy that allows the transition from a full opioid agonist to take place within 48 hours and without a traditionally required preceding period of opioid withdrawal syndrome. We report a case of successful inpatient transition from methadone to Suboxone in a patient with OUD and sepsis using a 48-hour rapid micro-induction protocol with pre-induction discontinuation of methadone and discuss the feasibility of this protocol in situations where the transition is time-critical.

Drug Interactions in Diabetic Ulcer Patients in an Indonesian Private Hospital

Diabetic ulcers can progress into tissue death, or gangrene, which create a risk for amputation. Measures for preventing other complications and accelerating wound healing in diabetic ulcers include blood sugar level control, diet adjustment, wound care, antidiabetic drug administration, and comorbid therapy. This leads to the use of various drugs that can potentially trigger drug interactions. This study aimed to identify possible drug interactions in the therapeutic management of diabetic ulcer patients treated in Husada Utama Hospital Surabaya, Indonesia, from January 2020–June 2022. This was a descriptive observational study using retrospective data from medical records. Results showed that 103 types of drugs were administered to 48 research samples with 41 of them experienced drug interactions (n=263 cases). Based on the severity of drug interactions, 31 cases were categorized as major cases (11.79%), with drug-class antibiotic-antiemetic interactions as the most frequent interactions. This study proves that it is essential for doctors and pharmacists.

A Cross-Sectional Study on Self-Medication Prevalence and Usage Patterns: An Alarming Concept Among the Saudi Population.

Self-medication (SM) has many potential drawbacks, including toxicity, drug resistance, severe adverse effects, drug interactions, drug abuse, and drug dependence, but it is still widely used for a variety of reasons, including time and money savings, symptom prevention or treatment of minor illnesses, a lack of access to doctors, etc. This study aimed to describe and analyse the usage of antibiotics without a prescription, self-medication practises, and patterns of using them among Saudis. In 13 provinces of Saudi Arabia, a community-based cross-sectional study was done. After gaining consent, data were gathered from 420 adults during face-to-face interviews using a questionnaire. SPSS was used to analyse the data once it had been entered into Microsoft Excel (Microsoft® Corp., Redmond, WA). Regarding self-medication, among 208 participants, there was a male predominance and among upper lower class with respect to socioeconomic status. The self-medication rate was found to be higher among graduates and professionals with respect to education and occupation. Self-medication was discovered to be more prevalent among metropolitan residents. The majority of those who started using self-medication got their knowledge from various advertisements. The most frequent symptom of self-medication was fever, followed by a common cold. The most commonly used medication was paracetamol, followed by cough syrups. Weight loss advertisements influence participants the most for self-medication, followed by hair loss and diabetes. TV advertisements have the highest influence on people practising self-medication. The study calls for greater knowledge of the impacts of antibiotic self-medication, which can be accomplished through efficient measures including behaviour change communication and encouraging more research into its causes and effects.

Investigating the Role of Clinical Decision Support Systems in Reducing Medical Errors

Introduction: This study aimed to investigate the role of clinical decision support systems in reducing medical errors from the perspective of physicians and nurses in the teaching and therapeutic hospitals . Method: This descriptive cross -sectional study was conducted in 2021 -2022 in two teaching and therapeutic hospitals in Ferdows City, Iran. Physicians and nurses have participated in the research. In this study, the census method was used, and the research community was considered the research sample. The questionnaire of Ariyai et al. was used as a data collection tool. After collecting the questionnaires, the data were analyzed using descriptive statistics methods . Results: 42 medical staff were included in the study. From a physician’s point of view, decision support systems can be helpful by reducing the risk of severe allergic reactions and drug interactions (60%), quick access to patient records (50%), and computerized order registries (30%). From nurses' point of view , eliminating problems related to doctors' handwriting (25%), avoiding disremember of repeating test s or imaging (18.8%), quick access to updated information during work (12.5%), and reducing the risk of embolism (9.4%) are the advantages of clinical decision support systems. Conclusion: due to the importance of developing a decision support system in hospitals and measuring the readiness of medical staff to adopt it, it is suggested that the necessary training s be provided .

Mebendazole Inhibits Histoplasma capsulatum In Vitro Growth and Decreases Mitochondrion and Cytoskeleton Protein Levels

Histoplasmosis is a frequent mycosis in people living with HIV/AIDS and other immunocompromised hosts. Histoplasmosis has high rates of mortality in these patients if treatment is unsuccessful. Itraconazole and amphotericin B are used to treat histoplasmosis; however, both antifungals have potentially severe pharmacokinetic drug interactions and toxicity. The present study determined the minimal inhibitory and fungicidal concentrations of mebendazole, a drug present in the NIH Clinical Collection, to establish whether it has fungicidal or fungistatic activity against Histoplasma capsulatum. Protein extracts from H. capsulatum yeasts, treated or not with mebendazole, were analyzed by proteomics to understand the metabolic changes driven by this benzimidazole. Mebendazole inhibited the growth of 10 H. capsulatum strains, presenting minimal inhibitory concentrations ranging from 5.0 to 0.08 µM. Proteomics revealed 30 and 18 proteins exclusively detected in untreated and mebendazole-treated H. capsulatum yeast cells, respectively. Proteins related to the tricarboxylic acid cycle, cytoskeleton, and ribosomes were highly abundant in untreated cells. Proteins related to the nitrogen, sulfur, and pyrimidine metabolisms were enriched in mebendazole-treated cells. Furthermore, mebendazole was able to inhibit the oxidative metabolism, disrupt the cytoskeleton, and decrease ribosomal proteins in H. capsulatum. These results suggest mebendazole as a drug to be repurposed for histoplasmosis treatment.

Titanate nanotubes as an efficient oral detoxifying agent against drug overdose: application in rat acetaminophen poisoning.

Voluntary drug intoxication is mainly due to drug overdose or the interaction of several drugs. Coma and its associated complications such as hypoventilation, aspiration pneumopathy, and heart rhythm disorders are the main hallmarks of drug intoxication. Conventional detoxification treatments, including gastric lavage or vomiting, administration of ipecac or activated charcoal (CH), and the use of antidotes, have proven to be inefficient and are generally associated with severe adverse effects. To overcome these limitations, titanate nanotubes (TiNTs) are proposed as an efficient emerging detoxifying agent because of their tubular shape and high adsorption capacity. In the present study, the detoxifying ability of TiNTs was evaluated on paracetamol (PR)-intoxicated rats. Results indicate that the loading ability of PR into TiNTs (70%) was significantly higher than that recorded for CH (38.6%). In simulated intestinal medium, TiNTs showed a controlled drug release of less than 10% after 72 h of incubation. In PR-intoxicated rats, TiNTs treatment resulted in a 64% decrease of PR after 4 h of poisoning versus 40% for CH. Concomitantly, TiNTs efficiently reduced PR absorption by 90% after 24 h of poisoning, attenuated the elevated levels of biochemical markers (i.e., alanine aminotransferase, aspartate aminotransferase, creatinine, and TNF-α) and mitigated oxidative stress by increasing the activity of superoxide dismutase and reducing the oxidized glutathione/total glutathione ratio, suggesting a histoprotective effect of TiNTs against paracetamol-induced toxicity in rats. In addition to their safety and high stability in the entire gastro-intestinal tract, biodistribution analysis revealed that TiNTs exhibited low intestinal absorption owing to their large cluster size of compact aggregate nanomaterials across the intestinal villi hindering the absorption of paracetamol. Collectively, these data provide a new and promising solution for in vivo detoxification. TiNTs are expected to have great potential for the treatment of voluntary and accidental intoxication in emergency care.

Warfarin and Thrombotic Mechanical Aortic Valve - Be Cautious to Avoid Severe Warfarin Drug Interactions in Patients with Suspected Infective Endocarditis after Mechanical Aortic Valve Replacement [Letter

Warfarin and Thrombotic Mechanical Aortic Valve - Be Cautious to Avoid Severe Warfarin Drug Interactions in Patients with Suspected Infective Endocarditis after Mechanical Aortic Valve Replacement [Letter

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.
 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.
 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.
 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.

Complementary and alternative therapies in the palliative setting.

Complementary and alternative medicine (CAM) encompasses a wide range of medication, herbal, dietary and physical therapies that are not usually considered within the realm of conventional therapeutics. Approximately two thirds of the Australian population use CAMs and only around half of this number will discuss their use of these products with their doctor. Clinical use is commonly seen in patients with life-limiting illness, often because they experience a high burden of symptoms. However, it is also the case that many of these therapies do not have demonstrated efficacy, particularly for the often broad list of conditions and symptoms for which they are chosen to be used. Further, depending on whether they are sold as medications, sold as food supplements or imported illegally and distributed via nonstandard therapeutic channels, several products have had reports of toxicity, severe adverse effects, batch irregularities and drug interactions with other therapies. This awareness, together with lack of standardisation of products and lack of interchangeability between brands has made prescribers unwilling to put patients at risk of harm by supporting their use. In this article, we cover general pharmacological principles around use of a small selection of chemicals used in a medical setting to enable some guidance for use.

The Association of Medication Complexity with COVID-19 Severity and its Impact on Pharmacotherapy Evaluation

Published on:August 2022Journal of Young Pharmacists, 2022; 14(3):322-326Original Article | doi:10.5530/jyp.2022.14.63 Authors: Yogendra Shrestha*, Rajesh Venkataraman, Jeet Bahadur Moktan, Sonakshi Mallikarjuna, Sindhu Shree Narayan, Manisha Hemmige Madappa, Priyanka Anekere SatyaDepartment of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka, INDIA. Abstract: Background: Off-level medicines do not provide adequate health outcomes since there is insufficient efficacy and/or toxicity evidence. Offlevel medicines are more vulnerable to adverse drug reactions (ADRs), which are a prominent cause of morbidity and mortality. Objective of the study is to determine the relationship between the medication complexity and severity of COVID-19 and its impact on pharmacotherapy evaluation. Materials and Methods: A prospective, cross-sectional study was conducted in the COVID ward where medication complexity was assessed for all prescriptions on admission using the Medical Regimen Complexity Index’s guidelines and subjected to pharmacotherapy evaluation. Results: Overall, the patients spent an average of 7.55 ± 3.60 days in the hospital. Each prescription contained an average of 6.54 ± 2.51 drugs. Polypharmacy was found in 82.70% (263) of the prescriptions, while medication duplication was found in 17.29% (55), severe drug interactions accounted for 83.01% (264), and drug dosage adjustment was performed in 10.06% (32). The mean medication complexity was 26.86 ± 7. 58. When comparing medication complexity concerning the severity of COVID-19, we found that the average medication complexity score for mild was 24.62 ± 6.04, moderate was 31.65 ± 8.39, severe was 35.19 ± 6.81, and critical was 28.59 ± 8.60. we found a statistically significant positive correlation between the medical complexity and the hospital stay (P-value, 0.000), and there was an association between the medication complexity and the Covid-19 severity (p <0.001). Conclusion: The assessment of the medication complexity in routine pharmacotherapy evaluations could be beneficial in alerting potential risks, suggesting additional focus wherever required, and decreasing the financial burden by reducing hospital stay. It demonstrated an association between medication complexity and the severity of COVID-19.Keywords: Pharmacotherapy Evaluation, Medication Complexity, Drug Interaction, Polypharmacy, Medication Duplication, Dosage Adjustment.

Community pharmacy-based SOAP notes documentation.

There is still scarce and sparse evidence regarding documentation of the subjective, objective, assessment and plan (SOAP) note in community pharmacies despite its long implementation history in clinical and academia settings. Hence, we aimed to document and maintain SOAP notes for individual patients visiting community pharmacies for their health problems.We conducted a community-based cross-sectional study at 2 community pharmacies in Nepal from July to December 2019. We recruited 400 patients from all age groups suffering from any health problem using simple random sampling. Patients’ subjective complaints were retrieved from their respective prescriptions and verified by interviewing them. Data were collected on the standard format of the SOAP notes and all data related to patients’ subjective and objective evaluations, and assessments and plans were descriptively analyzed with R programming 4.0.3. Drug interaction profile was checked with the Medscape Drug Interaction Checker.A total of 87 (21.8%) patients aged 42 to 51 years participated in the research, out of whom 235 (58.8%) were female, 208 (52%) illiterate, 359 (89.8%) were facing mild polypharmacy, and 40 (9.9%) were suffering from joint, leg, ankle, and knee pain. There were 41 minor (11.4%), 130 major (32.7%), and 3 severe (0.9%) drug interaction cases (i.e., medication-related problems), with 11 (2.8%) occurring between amlodipine and metformin, which required close monitoring. There were 226 (56.5%) cases with follow-up planned for the patients when necessary.This novel approach in documenting SOAP notes at community pharmacies during dispensing would be an extended form of the same being applied in clinical settings. Hence, this would open a new arena for the community pharmacists to expand their professionalism beyond the clinical and academia by documenting patients’ complex disease and medication profiles in their documentation.

Clinically Relevant Drug Interactions in the Cancer Setting.

Along with the fast pace of oncology drug approvals is the heightened opportunity for drug-drug, drug-food, and drug-herbal interactions. Attendees at the JADPRO Live Virtual 2021 conference learned about the pharmacodynamic and pharmacokinetic mechanisms of drug interactions and how to integrate appropriate therapeutic management strategies to optimize patient care and minimize the potential outcomes of severe drug interactions.

Ginkgo biloba: A Treasure of Functional Phytochemicals with Multimedicinal Applications.

Ginkgo biloba is an ancient plant species that is thought to provide a variety of health benefits to living organisms and contains plenty of bioactive components, making it a chemically diversified plant. G. biloba has been shown to have a variety of medicinal and pharmacological properties, including anticancer, antidementia, antidiabetic, antiobesity, antilipidemic, antimicrobial, antioxidant, antilipid peroxidation, antiplatelet, anti-inflammatory, hepatoprotective, antidepressant, antiaging, immunomodulatory, antihypertensive, and neuroprotective effects and is frequently used to treat neurological, cardiovascular, and respiratory diseases, such as tardive dyskinesia. Therefore, this review described the therapeutic applications of G. biloba. In addition to describing the therapeutic potential, this review also evaluates the chemical constituents, toxicity, adverse effect, synergistic effect, and the clinical studies of this plant which have been utilized for therapeutic benefits but have demonstrated other consequences. The capacity of G. biloba components to act as free radical scavengers is critical, and combining its extract with other plant extracts has been shown to synergistically boost antioxidant properties. G. biloba used long-term or at high doses that resulted in some adverse effects. Severe drug interactions have also been reported in both animals and humans when combined with other medications. The available data established from both preclinical and clinical studies confirm the potential of G. biloba plant extract in various diseases. Besides, the safety and efficacy of G. biloba continue to require verification through additional experimentation to guide medicinal use.

The study of drug interaction on pneumonia patients at RSUP Dr. M. Djamil Padang

Abstract Background: Pneumonia is one of the diseases that cause high rates of toddler deaths in the world. In Indonesia, pneumonia is the second cause of death of infants and toddlers after diarrheal diseases. Most pneumonia patients are treated with other diseases so many pneumonia patients receive more than two types of drugs in one prescription, this has the potential for drug interactions with drugs. Objective: The aim of this study was to look at potential occurrences of drug interactions in toddler patients at Dr.M. Djamil Padang Hospital hospitalized in 2019. Methods: This research was nonexperimental research design with cross-sectional descriptive methods of analysis and the data retrieved retrospectively. The patient's medical records were analyzed using the Drugs.com software and Medscape. Results: There were 62 patients who met the inclusion criteria. Among them, there were 5 pneumonia patients (8.1%) who experienced drug interactions with drugs, with the pharmacokinetic category as many as 3 cases (42.9%) affecting metabolism and drug interactions in the pharmacodynamic category by 4 cases (57.1%). Based on the severity of drug interactions, this study found 1 minor case (14.3%), 5 moderate cases (71.4%), and 1 major case (14.3%). Conclusion: From the results of the study it can be concluded that there was a potential for drug interactions in pneumonia toddler patients at Dr.M. Djamil Padang Hospital in the period 2019. Keywords: Bronchopneumonia, drug Interactions, toddler