Potential drug-drug interactions associated with clinical and laboratory findings at hospital admission

Concordance analysis of two databases to search for potential drug interactions in onco-hematologic patients

INTRODUCTION

Potential drug interactions exert a significant impact on patient safety, especially within intricate onco-hematological treatments, potentially resulting in toxicity or treatment failures. Despite the availability of databases for potential drug interaction investigation, persistent heterogeneity in concordance rates and classifications exists. The additional variability in database agreement poses further complexity, notably in critical contexts like onco-hematology.

AIM

To analyze the concordance of two databases for researching potential drug interaction in prescriptions for hematological patients at a University Hospital in the Midwest region of Brazil.

METHOD

Cross-sectional study developed in a Brazilian hospital. The search for potential drug interaction was conducted in Micromedex® and UpToDate®. The variables were: the presence of potential drug interaction, severity, mechanism, management, and documentation. Data was analyzed in terms of frequency (absolute and relative), Cohen's kappa, and Fleiss kappa.

RESULTS

The presence of potential drug interaction, showed a lack of concordance between the databases (k = -0.115 [95% CI: 0.361-0.532], p = 0.003). Regarding the mechanism, a strong agreement was observed (k = 0.805, p < 0.001 [95% CI: 0.550-0.941]). The management concordance showed a fair agreement, 46.8% (k = 0.22, p < 0.001 [95% CI: 0.099-0.341]). Stratifying the categories, significant concordance was observed in "Adjustment of dose + Monitoring" (k = 0.302, p = 0.018) and "Monitoring" (k = 0.417, p = 0.001), while other categories did not reach statistical significance.

CONCLUSION

Our study emphasizes the variability in potential drug interaction research, revealing disparities in severity classification, management recommendations, and documentation practices across databases.

Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

Introduction: Polypharmacy are commonly observed among older adults with cardiovascular disease. However, multiple medications lead to increased risk of drug-drug interactions (DDIs). Therefore, identification and prevention actions related to harmful DDIs are expected in older adults. The study aimed to describe the prevalence of potential DDIs (pDDIs) in discharge prescriptions among older adults with chronic coronary syndrome (CCS).

Methods: A single-center cross-sectional study was performed in a tertiary public hospital in Beijing, China. CCS patients aged 65 years and above who were admitted to cardiology wards over a 3-month period and alive at discharge were included. Electronic medical records and discharge prescriptions were reviewed. pDDIs were evaluated through the Lexi-Interact online.

Results: pDDIs were identified in 72.9% of the 402 individuals (n = 293). A total of 864 pDDIs were obtained. 72.1% of patients were found with C DDIs (n = 290) and 20.3% were categorized in D and X DDIs (n = 82). The only X DDI was between cyclosporine and atorvastatin. Under category D, glycemia alterations within antidiabetics and increased chances of bleeding with antithrombotic were the most common. Concomitant use of clopidogrel and calcium channel blockers was a frequent situation within category C, followed by synergic blood pressure lowering agents and increased rosuvastatin concentration induced by clopidogrel.

Conclusion: DDIs exposure was common in older CCS. DDIs screening tools should be introduced to alert potential adverse effects. Prescribers need to rigorously review or modulate therapies to prevent DDI-related adverse outcomes. Clinical pharmacists should be more involved in complex drug regimen management.

Comparison of different decision support software programs in perspective of potential drug-drug interactions in the oncology clinic

INTRODUCTION

One of the most intriguing situations for healthcare providers is cancer therapy. Drug-drug interactions (DDIs) account for 20-30% of all adverse effects. Cancer patients are more likely to have potential-DDIs since they are taking other drugs with anticancer treatments to prevent the side effects of chemotherapeutic agents. The purpose of this research is to compare various decision support software (CDSS) programs in terms of potential DDIs.

METHODS

A cross-sectional study was carried out. A clinical pharmacist assessed the treatment regimens of 231 cancer patients. pDDIs were evaluated using three sources: Lexicomp®, Medscape®, and Micromedex®. The ethical approval was given in November 2017 with decision number 21/286.

RESULTS

A total of 231 participants who were receiving therapy and had a median age of 61.5 ± 9.18 years were assessed. Almost half of the patients (49%) were female, and 155 had at least one comorbidity in addition to cancer. Medscape had a substantial pDDI ratio of 7.09%, Micromedex had a ratio of 11.15%, and Lexicomp had a ratio of 19.50%. The total number of pDDIs for major/X/contraindicated were 363-2716 (1.56-11.7 pDDI/patient) for Medscape®, 60-1723 (0.26-7.4 pDDI/patient) for Micromedex, and 145-984 (0.62-2.24 pDDI/patient) for Lexicomp®. One of the most common pDDI found was diclofenac and dexamethasone. Interactions between escitalopram and granisetron were also common, and different CDSSs made different recommendations.

CONCLUSIONS

In this study, significant disparities in the quantity and severity of CDSS across distinct CDSS were discovered. One of the major finding of our study was suboptimal prescribing. To address this issue, regulatory organizations should establish and verify validation and reporting mechanisms.

The impact of treatment choices on potential drug-drug interactions in hypertensive patients

AIMS

The aim of this study was to analyse potential drug-drug interactions (pDDIs) and their potential adverse drug reactions (ADRs) among hypertensive patients. Moreover, we investigated the possibility of reducing pDDIs with different treatment choices.

METHODS

This was a cross-sectional study including all outpatients with hypertension and two or more medications, treated in a university hospital in Serbia. Lexicomp Interact (Lexi-Comp, Inc., Hudson, OH) was used for identification of pDDIs and potential ADRs. Treatment choices were explored according to patient characteristics, treatment guidelines and the interacting potential of drugs. Data were analysed using descriptive analysis and multiple logistic regression.

RESULTS

A total of 350 patients were included in this study, with average age (77 [36-98] years and 6.1 [2.5]) medications. The majority of patients (86.0%) had at least one clinically significant pDDI, and the average was 3.78 (3.90) (range 1-25). Suggestions for treatment change aimed mainly at eliminating drug duplications, reducing the use of thiazide diuretics, sulfonylureas, alpha-lipoic acid and pentoxifylline and increasing the use of calcium-channel blockers, when appropriate. pDDIs would have decreased to 2.10 (2.52), P <.001, yet male gender, ≥6 medications, cardiovascular diseases, diabetes, benign prostatic hyperplasia, would be predictive of two or more pDDIs. The main potential adverse outcomes of pDDIs were hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis.

CONCLUSION

Careful choice of drugs can reduce but not eliminate pDDIs and their potential ADRs in hypertensive patients. Close monitoring for hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis is necessary.