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Santamaria F, Roberto M, Buccilli D, Civita MAD, Giancontieri P, Maltese G, Nicolella F, Torchia A, Scagnoli S, Pisegna S, Barchiesi G, Speranza I, Botticelli A, Santini D. Clinical implications of the Drug-Drug interaction in cancer patients treated with innovative oncological treatments. Crit Rev Oncol Hematol 2024:104405. [PMID: 38838928 DOI: 10.1016/j.critrevonc.2024.104405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
In the last two-decades, innovative drugs have revolutionized cancer treatments, demonstrating a significant improvement in overall survival. These drugs may present several pharmacokinetics interactions with non-oncological drugs, and vice versa, and, non-oncological drugs can modify oncological treatment outcome both with pharmacokinetic interaction and with an "off-target impact" on the tumor microenvironment or on the peripheral immune response. It's supposed that the presence of a drug-drug interaction (DDI) is associated with an increased risk of reduced anti-tumor effects or severe toxicities. However, clinical evidence that correlate the DDI presence with outcome are few, and results are difficult to compare because of difference in data collection and heterogeneous population. This review reports all the clinical evidence about DDI to provide an easy-to-use guide for DDI management and dose adjustment in solid tumors treated with inhibitors of the cyclin-dependent kinases CDK4-6, Antibody-drug conjugates, Poly ADPribose polymerase inhibitors, androgen-receptor targeted agents, or immunecheckpoints inhibitors.
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Affiliation(s)
- Fiorenza Santamaria
- Department of Experimental Medicine, Sapienza University of Rome, Italy; Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy
| | - Michela Roberto
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy.
| | - Dorelsa Buccilli
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Italy
| | - Mattia Alberto Di Civita
- Department of Experimental Medicine, Sapienza University of Rome, Italy; Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Italy
| | - Paola Giancontieri
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Italy
| | - Giulia Maltese
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Italy
| | - Francesco Nicolella
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Italy
| | - Andrea Torchia
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Simone Scagnoli
- Department of Experimental Medicine, Sapienza University of Rome, Italy; Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy
| | - Simona Pisegna
- Department of Experimental Medicine, Sapienza University of Rome, Italy; Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy
| | - Giacomo Barchiesi
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy
| | - Iolanda Speranza
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy
| | - Andrea Botticelli
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Italy
| | - Daniele Santini
- Medical Oncology A, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
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Lule AP, Delic OB, Katunguka K, Muwonge F, Yadesa TM. Prevalence and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city, southwestern Uganda. BMC Pharmacol Toxicol 2024; 25:2. [PMID: 38167526 PMCID: PMC10763418 DOI: 10.1186/s40360-023-00719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Allan Phillip Lule
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda.
| | - Ogwal Basil Delic
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
| | - Keneth Katunguka
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
| | - Francis Muwonge
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
- Department of Clinical Pharmacy and Pharmacy Practice, Kampala International University, Ishaka, Uganda
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Hamadouk RM, Alshareif EM, Hamad HM, Yousef BA. The Prevalence and Severity of Potential Drug-Drug Interactions in Internal Medicine Ward at Soba Teaching Hospital. Drug Healthc Patient Saf 2023; 15:149-157. [PMID: 37933264 PMCID: PMC10625782 DOI: 10.2147/dhps.s436458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
Background Multiple drug therapies are commonly used to achieve a desired therapeutic goal, especially in hospitalized patients. However, drug-drug interactions might occur and threaten the patients' safety. Objective This study aims to assess the prevalence and severity of potential drug-drug interactions (PDDIs) in the internal medicine ward at Soba Teaching Hospital. Methods A retrospective cross-sectional hospital-based study was carried out in the internal medicine ward at Soba Teaching Hospital from June 2021 to December 2021. The data was collected from patients' medical records. PDDIs were identified using Lexicomp® drug interaction software. Results A total of 377 patients were included in this study, and overall prevalence of PDDIs was 62.9%. We have identified 989 potential DDIs and 345 pairs of interacting drugs, the mean of the PDDIs per patient was 4.17 ± 4.079. Among 345 PDDIs most were of moderate interactions 70.1% (n=242) followed by Minor interactions 19.1% (n=66). The most common type of interaction was of category C representing 63.5% (n=219). A significant association was observed between the occurrence of PDDIs with patients' age, presence of chronic diseases, length of hospital stay, and number of medications received by the patients. Conclusion Drug-drug interactions were highly prevalent in the internal medicine ward. Therefore, certain attempts are required to increase the awareness of the physicians about these interactions and minimize their occurrence.
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Affiliation(s)
- Riham M Hamadouk
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Almughtaribeen University, Khartoum, Sudan
| | | | - Huda M Hamad
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Bashir A Yousef
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
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Zafar R, Rehman IU, Shah Y, Ming LC, Goh HP, Goh KW. Comparative analysis of potential drug-drug interactions in a public and private hospital among chronic kidney disease patients in Khyber Pakhtunkhwa: A retrospective cross-sectional study. PLoS One 2023; 18:e0291417. [PMID: 37773947 PMCID: PMC10540949 DOI: 10.1371/journal.pone.0291417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a significant public health challenge due to its rising incidence, mortality, and morbidity. Patients with kidney diseases often suffer from various comorbid conditions, making them susceptible to potential drug-drug interactions (pDDIs) due to polypharmacy and multiple prescribers. Inappropriate prescriptions for CKD patients and their consequences in the form of pDDIs are a major challenge in Pakistan. AIM This study aimed to compare the incidence and associated risk factors of pDDIs among a public and private sector hospital in Khyber Pakhtunkhwa, Pakistan. METHOD A retrospective cross-sectional study design was conducted to compare pDDIs among public and private sector hospitals from January 2023 to February 2023. Patients profile data for the full year starting from January 1 2022 to December 302022, was accessed All adult patients aged 18 years and above, of both genders, who currently have or have previously been diagnosed with end-stage renal disease (ESRD) were included. For assessing pDDIs, patient data was retrieved and checked using Lexicomp UpToDate® for severity and documentation of potential drug-drug interactions. RESULTS A total of 358 patients' data was retrieved (with n = 179 in each hospital); however, due to incomplete data, n = 4 patients were excluded from the final analysis. The prevalence of pDDIs was found to be significantly higher in private hospitals (84.7%) than in public hospitals (26.6%), with a p-value <0.001. Patients in the age category of 41-60 years (AOR = 6.2; p = 0.008) and those prescribed a higher number of drugs (AOR = 1.2; p = 0.027) were independently associated with pDDIs in private hospitals, while the higher number of prescribed drugs (AOR = 2.9; p = <0.001) was an independent risk factor for pDDIs in public hospitals. The majority of pDDIs (79.0%) were of moderate severity, and a significant number of patients (15.1%) also experienced major pDDIs, with a p-value <0.001. The majority of pDDIs had fair documentation for reliability rating in both public and private hospitals. CONCLUSION The prevalence of pDDIs was higher among CKD patients at private hospitals, and most of the pDDIs were of moderate severity. A considerable number of patients also experienced major pDDIs. The risk of experiencing pDDIs was found to be higher in older patients and among those prescribed a higher number of drugs.
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Affiliation(s)
- Roheena Zafar
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
- Department of Pharmacy, North West General Hospital and Research Center, Hayatabad Peshawar, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Yasar Shah
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Hui Poh Goh
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
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Sulaiman DM, Shaba SS, Almufty HB, Sulaiman AM, Merza MA. Screening the Drug-Drug Interactions Between Antimicrobials and Other Prescribed Medications Using Google Bard and Lexicomp® Online™ Database. Cureus 2023; 15:e44961. [PMID: 37692178 PMCID: PMC10492649 DOI: 10.7759/cureus.44961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/12/2023] Open
Abstract
Aim This study aimed to critically appraise the drug-drug interaction (DDI) screening performance of Google Bard (Google AI, Mountain View, California, United States) by comparing it with the authorized Lexicomp® Online™ database (Wolters Kluwer Health, Philadelphia, Pennsylvania, United States). Methods This cross-sectional study was conducted between April 2023 and August 2023, and enrolled 414 prescriptions that had been collected randomly between April 2023 and June 2023. These prescriptions were processed individually by Lexicomp online and Google Bard to screen for DDIs between antimicrobials and other prescribed medications. Results The total number of DDIs based on Lexicomp and Google Bard were 90 and 68, respectively. Cohen's Kappa (κ) values showed that there was a nil to slight agreement between Lexicomp and Google Bard regarding the DDI risk rating (κ=0.01). Regarding the severity rate, there was a slight agreement between them (κ=0.02), but in terms of reliability rate, there was no agreement (κ =-0.02). Conclusion This study unveiled differences between Lexicomp and Google Bard regarding their DDI identification, severity rating, and reliability rates. It is fundamental to consider that both tools have their strengths and weaknesses and, therefore, should not be individually depended on for final clinical decisions. However, Lexicomp can be considered authoritative in screening DDIs, but Google Bard currently lacks the necessary precision and reliability for conducting such screenings.
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Affiliation(s)
- Dilveen M Sulaiman
- Department of Pharmacology, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Suhail S Shaba
- Department of Pharmaceutics, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Hind B Almufty
- Department of Clinical Pharmacy, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Asmaa M Sulaiman
- Department of Clinical Pharmacy, Azadi Teaching Hospital, Duhok, IRQ
| | - Muayad A Merza
- Department of Internal Medicine, Azadi Teaching Hospital, Duhok, IRQ
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Lalatović N, Pantović S, Nedović-Vuković M, Kostić M. Risk Factors for Potential Drug-Drug Interactions in Outpatients with Dyslipidemia. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1466-1475. [PMID: 37593497 PMCID: PMC10430412 DOI: 10.18502/ijph.v52i7.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 08/19/2023]
Abstract
Background Patients with dyslipidemia are usually multimorbid and require polypharmacy. Therefore, it is important to identify potential drug-drug interactions (pDDIs) in time to prevent their consequences. We aimed to identify and analyze risk factors contributing to their occurrence to guide health professionals. Methods A prospective cross-sectional study of 216 outpatients with dyslipidemia was conducted from May 2021 to April 2022 in Podgorica, the capital of Montenegro. pDDIs were identified using Medscape, Epocrates, and Drugs online interaction checkers. Multivariate regression analysis was performed to evaluate the potential predictors of interactions. Results pDDIs were detected in 212 (98.1%) participants, whereas pDDIs with high clinical significance were detected in 25.46%, 40.74%, and 58.8% of subjects by Drugs, Epocrates, and Medscape, respectively. Polypharmacy emerged as a risk factor for the occurrence of pDDIs in all three checkers in each category of clinical significance. The use of non-steroidal anti-inflammatory drugs and antiplatelet drugs contributes to the incidence of severe pDDIs B=1.014, 95%CI 0.681-1.346, P=0.000 and B=0.492, 95%CI 0.286-0.698, P=0.000, by Epocrates and Medscape respectively. The number of prescribers per patient was a protective factor against moderate pDDI B= -0.858, 95%CI -1.572-(-0.144), P=0.019 and B= -0.956, 95%CI -1.671-(-0.241), P=0.009, by Medscape and Epocrates, respectively, but a risk factor for the occurrence of minor pDDIs B=0.373, 95%CI 0.033-0.712 P=0.032 and B=0.143, 95%CI 0.042-0.244, P=0.006, by the same checkers. Conclusion Knowledge of the risk factors contributing to the occurrence of pDDIs is important for the development and implementation of strategies for their prevention, and given the high prevalence of dyslipidemia, understanding these factors seems crucial nowadays.
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Affiliation(s)
| | - Snežana Pantović
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Mirjana Nedović-Vuković
- Department of Health Statistics and Informatics, Center for Health System Development, Institute of Public Health, Podgorica, Montenegro
| | - Marina Kostić
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences University of Kragujevac, Kragujevac, Serbia
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Létinier L, Bezin J, Jarne A, Pariente A. Drug-Drug Interactions and the Risk of Emergency Hospitalizations: A Nationwide Population-Based Study. Drug Saf 2023; 46:449-456. [PMID: 37046156 DOI: 10.1007/s40264-023-01283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Several studies suggest a significant risk of hospitalization because of drug-drug interactions in the general population. However, to our knowledge, this risk has never been measured precisely in a large population. OBJECTIVE We aimed to estimate the risk of emergency hospitalization associated with exposure to the contraindicated concomitant use of interacting drugs in the general population. METHODS A self-controlled case-series analysis was carried out on a cohort of 150,000 subjects randomly selected from the French national health insurance database, between 01/01/2016 and 31/12/2016. Exposure to the contraindicated concomitant use of interacting drugs was defined as the overlapping period of dispensings of drugs contraindicated because of clinically meaningful drug-drug interactions. The main outcome, incidence rate ratios, comparing the incidence rate of emergency hospitalizations during each category of exposure time periods with that during the reference period, was estimated using the conditional Poisson regression model. RESULTS Over the study period, 967 subjects were exposed to at least one contraindicated concomitant use of interacting drug and 177 had been exposed and presented at least one emergency hospitalization. Compared to the unexposed follow-up time, the risk of emergency hospitalization increased during exposure to contraindicated concomitant use of interacting drug periods (incidence rate ratio: 2.41; 95% confidence interval 1.55-3.76). This could translate into 7200 (4500-8900) potentially preventable emergency hospitalizations yearly in France. CONCLUSIONS We evidenced an almost 2.5-fold increase in the risk of emergency hospitalizations during periods of exposure to contraindicated concomitant use of interacting drugs, with a potential public health impact exceeding 7000 preventable hospitalizations yearly in France. These results confirm the need to reinforce training in prescription practices and tools for prevention concerning contraindicated concomitant use of interacting drugs. These would especially concern drugs involved in an increase in long QT syndrome when associated such as citalopram, and highly prescribed drugs with a risk of overdose if co-prescribed with cytochrome P450 inhibitors, such as antigout and lipid-lowering drugs.
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Affiliation(s)
- Louis Létinier
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France.
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France.
| | - Julien Bezin
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France
| | - Ana Jarne
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Inserm UMR 1219, University of Bordeaux, Bordeaux, France
| | - Antoine Pariente
- Service de Pharmacologie Médicale, CHU Bordeaux, Université de Bordeaux, 146, rue Léo Saignat, BP36, 33076, Bordeaux Cedex, France
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Drug binding and drug-drug interaction considerations in individuals with obesity before and after bariatric surgery: a retrospective cross-sectional study. MEDICINE IN DRUG DISCOVERY 2023. [DOI: 10.1016/j.medidd.2023.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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Chen Y, Ding L. Potential drug-drug interactions in outpatients with depression of a psychiatry department. Saudi Pharm J 2023; 31:207-213. [PMID: 36942274 PMCID: PMC10023543 DOI: 10.1016/j.jsps.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022] Open
Abstract
Objective This study aims to explore the prevalence and associated risk factors for potential drug-drug interactions (pDDIs) in prescriptions among outpatients with depression, and report the widespread relevant drug interactions. Methods The cross-sectional retrospective study was conducted on outpatients in a psychiatric hospital. We included prescriptions of outpatients with a principal diagnosis of depression from April 1st to June 30th in 2021. The patients were ≥ 18 years old and treated with two or more drugs including at least one psychotropic drug. pDDIs were detected and identified mainly using Medscape's drug interactions checker. Gender, the number of concomitant drugs, age and diagnosis were analysed as potential risk factors for the occurrence of pDDIs by logistic regression. Results A total of 13,617 prescriptions were included in the present analysis, and 4222 prescriptions (31.0%) were at risk of 8557 pDDIs. The risk of pDDIs in patients who were prescribed 4-6 drugs (OR: 3.49, 95% CI: 3.11-3.91, p < 0.001) or 7 or more drugs simultaneously (OR: 7.86, 95% CI: 1.58-39.04, p < 0.05) increased compared with patients prescribed 2-3 drugs. Patients with recurrent depressive disorders (OR: 1.18, 95% CI: 1.02-1.36, p < 0.05) had an increased risk of pDDIs compared with patients with depressive episodes. In terms of severity of pDDIs identified by Medscape's drug interactions checker, 0.7%, 16.4%, 77.5% and 5.4% of pDDIs were classified as contraindicated, serious, monitor closely and minor, respectively. The most common pDDI was escitalopram + quetiapine (374 prescriptions), which was classified as serious and monitor closely due to different mechanisms of interaction. Increased central nervous system (CNS)-depressant effect was the most frequent potential clinical adverse outcome of the identified pDDIs. Conclusions pDDIs in outpatients with depression were prevalent in this retrospective study. The number of concomitant drugs and severity of the disease were important risk factors for pDDIs. The pDDIs of the category monitor closely were the most common, and the CNS-depressant effect was the most frequent potential clinical adverse outcome.
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Al-Ashwal FY, Sulaiman SAS, Sheikh Ghadzi SM, Kubas MA, Halboup A. Prevalence and predictors of clinically significant statin-drug interactions among Yemeni patients taking statins for primary and secondary prevention of cardiovascular disease. Curr Med Res Opin 2022; 38:889-899. [PMID: 35481428 DOI: 10.1080/03007995.2022.2072088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Statins are extensively used in clinical practice for the primary and secondary prevention of cardiovascular diseases. Statins are usually taken in combination with other medications. This may increase the risk of statin-drug interactions. The study aimed to evaluate the prevalence, patterns, and predictors of clinically significant statin-drug interactions among patients on statin therapy. MATERIAL AND METHODS A cross-sectional study was conducted at the cardiology, endocrine, and internal medicine outpatient clinics in four tertiary care hospitals in Sana'a, Yemen. Lexicomp Drug Interaction database was used to analyze the prescriptions for potential statin-drug interactions. Binary and multivariable logistic regression were utilized for analysis. RESULTS Of the total number of patients (634), 114 individuals (18%) had a total of 122 statin-drug interactions. According to Lexicomp risk classification, 102 (83.6%) DDIs were class C (monitor therapy), 19 (15.6%) were class D (therapy modification), and only one (0.8%) class X (avoid combination). Simvastatin use was significantly associated with the presence of category D and X DDIs (15.9% vs. 1.6%, p < .001). Polypharmacy (OR = 2.571, p < .001) and having ≥3 comorbidities (OR = 2.512, p < .001) were the only variables associated with the presence of statin-drug interactions (C, D, and/or X). CONCLUSION Patients with polypharmacy and those with three or more comorbidities had a higher risk for statin-drug interactions. Therefore, routine screening by physicians and pharmacists for potential interactions should occur before prescribing or dispensing any medication to avoid clinically significant statin-drug interactions.
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Affiliation(s)
- Fahmi Y Al-Ashwal
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Clinical Pharmacy Department, University of Science and Technology Hospital (USTH), Sana'a, Yemen
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Mohammed Abdullah Kubas
- Clinical Pharmacy Department, University of Science and Technology Hospital (USTH), Sana'a, Yemen
| | - Abdulsalam Halboup
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen
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Rosmasari R, Esha P, Figueras A. Identification of Potential of Drug-Drug Interaction and Its Affecting Factors: A cross-sectional study among hospitalized coronary heart disease patients. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220404155622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Coronary Heart Disease (CHD) patients are at risk of suffering from drug interactions, leading to a higher risk of mortality and morbidity among these patients. This study aims to identify the potential drug-drug interactions (PDDIs) and CHD patients' related factors.
Methods:
A cross-sectional study was performed among the CHD patients to identify the PDDIs from 2014 to 2017 at Secondary Hospital. The PDDIs were categorized according to the interaction mechanism, onset, severity, and documentation.
Results:
Among 91 CHD patients, 151 PDDIs were identified consisting of pharmacodynamics mechanism and delayed onset, 50.33% and 83.44%, respectively. Furthermore, there was a correlation between the number of PDDIs and the number of drugs (r = 0.496; p < 0,001).
Conclusion:
: This study revealed that the more the drugs were prescribed to CHD patients, the more the PDDIs risk would occur. The regular monitoring of the CHD patient’s prescriptions is noteworthy to avoid the PDDIs.
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Affiliation(s)
- Reny Rosmasari
- Department of Pharmacy Profession, Universitas Muhammadiyah Yogyakarta, Indonesia
| | - Pramitha Esha
- Department of Pharmacy Profession, Universitas Muhammadiyah Yogyakarta, Indonesia
- Department of Pharmacy Profession, Universitas Muhammadiyah Yogyakarta, Indonesia
| | - Albert Figueras
- Department of Pharmacology. Universitat Autònoma de Barcelona, , E-08035-Barcelona, Spain
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12
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The Prevalence of Potential Drug-Drug Interactions in CKD-A Retrospective Observational Study of Cerrahpasa Nephrology Unit. Medicina (B Aires) 2022; 58:medicina58020183. [PMID: 35208508 PMCID: PMC8875967 DOI: 10.3390/medicina58020183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Chronic kidney disease (CKD) is usually linked with polypharmacy and patients are invariably at risk of complex medication regimens. The present study was designed to estimate the potential drug-drug interactions (pDDIs) through the prescription patterns provided to patients of the Nephrology Transplant Unit of Cerrahpasa Medical Faculty patients. Materials and Methods: 96 patients were included in the study. pDDIs among every combination of the prescribed drug were analyzed using the Thomson Reuters Micromedex. Results: We found 149 pDDIs making 2.16 interactions per prescription with incidence rates of 69.7%. Approximately 4.1% of interactions were of significant severity, 75.1% moderate severity, and 20.8% were classified as minor pDDIs. The most frequent interactions were found between iron and aluminum, calcium or magnesium-containing products (21.37%), calcium channel blockers and beta-blockers (8.96%); and aspirin and aluminum, calcium, or magnesium-containing products (7.58%). We identified 42 drug pairs with probability of clinical significance. The most commonly reported clinical outcomes of the pDDIs were hypo- or hypertension (39.24%), decreased drug efficacy (24.05%), and arrhythmia (9.49%). Aluminum, calcium, or magnesium-containing drug products (33.10%) constituted the primary class of drugs involved in interactions. Conclusions: This study showed pharmacodynamics (49%), pharmacokinetics (42.94%) interactions, polypharmacy and gender as determinant of pDDIs. A comprehensive multicenter research is required to decrease the morbidity and ease the state burden.
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Rababa'h A, Mardini A, Ababneh M, Rababa M, Hayajneh M. Medication errors in Jordan: A systematic review. Int J Crit Illn Inj Sci 2022; 12:106-114. [PMID: 35845119 PMCID: PMC9285130 DOI: 10.4103/ijciis.ijciis_72_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 11/04/2022] Open
Abstract
Medication errors (MEs) present a significant issue in health care area, as they pose a threat to patient safety and could occur at any stage of the medication use process. The objective of this systematic review was to review studies reporting the rates, prevalence, and/or incidence of various MEs in different health care clinical settings in Jordan. We searched PubMed, HINARI, Google, and SCOPUS for relevant published studies. We included observational, cross-sectional or cohort studies on MEs targeting adults in different health-care settings in Jordan. A total of 411 records were identified through searching different databases. Following the removal of duplicates, screening of title, abstract and full-text screening, 24 papers were included for the final review step. Prescribing errors was the most common error reported in the included studies, where it was reported in 15 studies. The prevalence of prescribing errors ranged from 0.1% to 96%. Two studies reported unintentional discrepancies and documentation errors as other types of MEs, where the prevalence of unintentional discrepancies ranged from 47% to 67.9%, and the prevalence of documentation errors ranged from 33.7% to 65%. In conclusion, a wide variation was found between the reviewed studies in the error prevalence rates. This variation may be due to the variation in the clinical settings, targeted populations, methodologies employed. There is an imperative need for addressing the issue of MEs and improving drug therapy practice among health-care professionals by introducing education and training.
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Georgiev KD, Hvarchanova N, Stoychev E, Kanazirev B. Prevalence of polypharmacy and risk of potential drug-drug interactions among hospitalized patients with emphasis on the pharmacokinetics. Sci Prog 2022; 105:368504211070183. [PMID: 35072561 PMCID: PMC10358706 DOI: 10.1177/00368504211070183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Both polypharmacy and potential drug-drug interactions (pDDIs), especially those at the pharmacokinetic level, are common in hospitalized patients and are associated with adverse effects and failure of therapy. OBJECTIVE The aim of the present study is to investigate retrospectively the prevalence of polypharmacy and the risk of potential pharmacokinetic drug-drug interaction among hospitalized patients. METHODS The medical documentation of hospitalized patients in the unit of internal diseases at the hospital "St Marina" in Varna, Bulgaria for a period of six months (January-July 2016) was retrospectively reviewed. Lexicomp® Drug Interaction software was used for the detection of pDDI. Descriptive statistic and logistic regression were used for data analysis. RESULTS In this study, 294 patients out of 510 (57%) were selected with polypharmacy. The number of detected potential pharmacokinetic DDIs (pPKDDIs) was only 216 (or 12,4%), but almost 40% of patients with polypharmacy were exposed to at least one pPKDDIs. The most common pPKDDIs occur at the biotransformation level - 78 (36,1%), and the most common enzyme form that is involved in these interactions is cytochrome 3A4 (44 or 20,4%). The number of prescribed medications (>7) was found to increase the possibility of having pDDIs (OR 25.535, 95% CI 12.529 to 52.042; p = <0.001) and pPKDDIs (OR 5.165, 95% CI 3.430 to 7.779; p = <0.001) as well. CONCLUSION AND RELEVANCE Caution should be taken in patients taking more than seven drugs and careful assessment of the pPKDDIs should be made. When such interactions are detected, they need to be properly evaluated and managed.
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Affiliation(s)
- Kaloyan D. Georgiev
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Nadezhda Hvarchanova
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Elitsa Stoychev
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Branimir Kanazirev
- Department of Internal Medicine, UMHAT “St Marina”, Faculty of Medicine, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
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15
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Perić A, Udilović A, Dobrić S, Vezmar Kovačević S. The impact of treatment choices on potential drug-drug interactions in hypertensive patients. Br J Clin Pharmacol 2021; 88:2340-2348. [PMID: 34862631 DOI: 10.1111/bcp.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Aneta Perić
- Sector for Pharmacy, Military Medical Academy, Belgrade, Serbia.,Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Ana Udilović
- Deutsche Rentenversicherung Bayern Süd Rehafachzentrum Bad Füssing-Passau Standort Passau, Pasau, Germany
| | - Silva Dobrić
- Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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16
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Biase TMMA, Silva MT, Galvao TF. Potential drug interactions in adults living in the Brazilian Amazon: A population-based case-control study, 2019. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100056. [PMID: 35480614 PMCID: PMC9030716 DOI: 10.1016/j.rcsop.2021.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Marcus Tolentino Silva
- Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao Paulo, Brazil
| | - Tais Freire Galvao
- School of Pharmaceutical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
- Corresponding author at: School of Pharmaceutical Sciences, State University of Campinas, R. Candido Portinari, 200 - Cidade Universitária Zeferino Vaz, CEP: 13083-871 Campinas, Sao Paulo, Brazil.
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Akbar Z, Rehman S, Khan A, Khan A, Atif M, Ahmad N. Potential drug-drug interactions in patients with cardiovascular diseases: findings from a prospective observational study. J Pharm Policy Pract 2021; 14:63. [PMID: 34311787 PMCID: PMC8311960 DOI: 10.1186/s40545-021-00348-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Patients with cardiovascular diseases (CVD) are at high risk of experiencing drug–drug interactions (DDIs). The objective of this study was to evaluate the frequency, level and risk factors associated with potential-DDIs (pDDIs) in hospitalized CVD patients at cardiology departments of two tertiary care hospitals in Quetta, Pakistan. Methods In the current prospective observational study, a total of 300 eligible CVD inpatients were evaluated for pDDIs using Lexicomp Interact®. The pDDIs were classified into class A (no known interaction); B (no action needed); C (monitor therapy: it is documented that the benefits of an interaction outweigh the risk, appropriately monitor therapy in order to avoid potential adverse outcomes); D (consider therapy modification: it is documented that proper actions must be taken to reduce the toxicity resulting from an interaction); X (avoid combination: the risk of an interaction outweighs the benefits and are usually contraindicated). Multivariate binary logistic regression analysis was used to find factors associated with the presence of Class-D and/or X pDDIs. A p-value < 0.05 was considered statistically significant. Results With a median of 8.50 pDDIs per patient, all patients (100%) had ≥ 1 pDDIs. Out of total 2787 pDDIs observed, 74.06% (n = 2064) were of moderate and (n = 483) 17.33% of major severity. Class C pDDIs were most common (n = 1971, 70.72%) followed by D (n = 582, 20.88%), B (n = 204, 7.32%) and X (n = 30, 1.08%). Suffering from cardiovascular diseases other than myocardial infarction (OR 0.053, p-value < 0.001) and receiving > 12 drugs (OR 4.187, p-value = 0.009) had statistical significant association with the presence of class D and/or X pDDIs. Conclusion In the current study, pDDIs were highly prevalent. The inclusion of DDI screening tools, availability of clinical pharmacists and paying special attention to the high-risk patients may reduce the frequency of pDDIs at the study sites.
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Affiliation(s)
- Zarka Akbar
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Sundas Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Asad Khan
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan.
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18
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Aleksić DZ, Milosavljević MN, Stefanović SM, Bukonjić A, Milosavljević JZ, Janković SM, Božović I, Perić S, Lavrnić D. Risk factors for potential drug-drug interactions in patients with myasthenia gravis. Neurol Res 2021; 43:1023-1030. [PMID: 34233604 DOI: 10.1080/01616412.2021.1948767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our aim was to determine risk factors for and frequency of potential drug-drug interactions (pDDIs) among hospitalized patients with myasthenia gravis (MG). METHODS This was a retrospective cross-sectional study of the-first time hospitalized MG patients or patients hospitalized because of the exacerbation of MG at the Neurology Clinic of the Clinical Center of Serbia, Belgrade. Medical records and discharge summaries of hospitalized MG patients over a 10-year period were reviewed. The pDDIs were identified by means of Micromedex, and multivariate regression methods were used to reveal potential predictors of number of pDDIs per patient. RESULTS The study included 687 patients with MG. In total, 2041 pDDIs were detected in 608 (88.5%) patients. Among the discovered pDDIs, 329 different pDDIs were observed. The most frequent pDDIs were pyridostigmine-prednisone (487patients/70.9%) and aspirin-prednisone (90 patients/13.1%) classified as moderate, and enalapril-potassium chloride (71patients/10.3%) classified as major pDDI. Five drugs (aspirin, insulin, prednisone, cyclosporine, metformin) were responsible for 22.6% of different pDDIs. Dyspnea, generalized form of MG, diabetes mellitus, hypertension, total number of drugs-used, use of antiplatelets were identified as the relevant risk factors for total number of pDDIs (R2 = 0.626,F = 73.797, p < 0.001), while age of patients and history of cancer were inversely correlated with such an outcome. CONCLUSION The frequency of the pDDIs in hospitalized MG patients is high, and adversely influenced by dyspnea, generalized MG, diabetes mellitus, hypertension, total number of drugs-used and use of antiplatelets.
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Affiliation(s)
- Dejan Z Aleksić
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Miloš N Milosavljević
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Srđan M Stefanović
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Andriana Bukonjić
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jovana Z Milosavljević
- Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slobodan M Janković
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ivo Božović
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Belgrade, Serbia
| | - Stojan Perić
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Belgrade, Serbia.,Department of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Lavrnić
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Belgrade, Serbia.,Department of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
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ÖZDAMAR EN, ÖZDAMAR İ. Evaluation of the potential drug-drug interactions at orthopedics and traumatology outpatient clinics of a tertiary care hospital. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.865824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Szilvay A, Somogyi O, Dobszay A, Meskó A, Zelkó R, Hankó B. Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them-A multicenter descriptive study according to medication reviews in Hungarian community pharmacies. PLoS One 2021; 16:e0253645. [PMID: 34157039 PMCID: PMC8219127 DOI: 10.1371/journal.pone.0253645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The study examined the Drug-Related Problems (DRPs) of patients with polypharmacy in 78 Hungarian community pharmacies, especially the interaction risks in terms of their clinical severity. Also, the objective was to analyze pharmacists’ interventions to solve the identified interaction risks. Methodology The research was carried out in the framework of the training of specialist pharmacists at Semmelweis University, with the participation of 78 graduated pharmacists with the collaboration of 98 GPs. A total of 755 patients participated in pharmaceutical counseling which meant a medication review process. DRPs were uniformly categorized and the interventions were recorded by pharmacists, while a detailed analysis of interaction risks was performed by authors. Results A total of 984 DRPs were registered. The most common category of DRPs was the "non-quantitative safety problems" (62.6%). Interaction risk was the most common cause of DRPs (54.0%). The highest proportion of interaction risks were between two prescription drugs (66.7%). In 30.7% of interaction risks’ cases, there was not known negative outcome. In contrast, it was recommended to modify the therapy in 14.9% of interaction risks. Acetylsalicylic acid (22.8%), acenocoumarol (17.7%), and diclofenac (13.9%) were the most common active substances which caused serious interaction risks. A total of 599 pharmacist interventions were used to solve the 531 interaction risks. Pharmacists notified the GPs about the problem in 28.4% of cases and they intervened without the GP in 63.1% of cases, most often with patient education (27.4%). Conclusion Medication review by community pharmacists is required for the safe medicine using of patients with polypharmacy, as a significant number of DRPs have been recorded. The incidence of interaction risks stood out. It is essential to develop a pharmaceutical guideline to properly classify the clinical relevance of interaction risks (e.g. according to high-risk active substances) and to increase the collaboration with GPs.
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Affiliation(s)
- András Szilvay
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Orsolya Somogyi
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Annamária Dobszay
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Attiláné Meskó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Romána Zelkó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Balázs Hankó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
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21
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Min HK, Sung SA, Chung W, Kim YH, Chae DW, Ahn C, Oh KH, Park SK, Lee SW. Polypharmacy and the Progression of Chronic Kidney Disease: Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease. Kidney Blood Press Res 2021; 46:460-468. [PMID: 34091449 DOI: 10.1159/000516029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The renal hazard of polypharmacy has never been evaluated in predialysis chronic kidney disease (CKD) patients. OBJECTIVE We aimed to analyze the renal hazard of polypharmacy in predialysis CKD patients with stage 1-5. METHOD The data of 2,238 patients from a large-scale multicenter prospective Korean study (2011-2016), excluding 325 patients with various missing data, were reviewed. Polypharmacy was defined as taking 6 or more medications at the time of enrollment; renal events were defined as a ≥50% decrease in kidney function from baseline values, doubling of the serum creatinine levels, or initiation of renal replacement treatment. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox proportional-hazard regression analysis. RESULTS Of the 1,913 patients, the mean estimated glomerular filtration rate was 53.6 mL/min/1.73 m2. The mean medication count was 4.1, and the prevalence of polypharmacy was 27.1%. During the average period of 3.6 years, 520 patients developed renal events (27.2%). Although increased medication counts were associated with increased renal hazard with HR (95% CI) of 1.056 (1.007-1.107, p = 0.025), even after adjusting for various confounders, adding comorbidity score and kidney function nullified the statistical significance. In mediation analysis, 55.6% (p = 0.016) of renal hazard in increased medication counts was mediated by the kidney function, and there was no direct effect of medication counts on renal event development. In subgroup analysis, the renal hazard of the medication counts was evident only in stage 1-3 of CKD patients (p for interaction = 0.014). CONCLUSIONS We cannot identify the direct renal hazard of multiple medications, and most of the potential renal hazard was derived from intimate relationship with disease burden and kidney function.
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Affiliation(s)
- Hyang Ki Min
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Su Ah Sung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Uijeongbu, Republic of Korea
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22
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Nusair MB, Al-Azzam S, Alhamad H, Momani MY. The prevalence and patterns of self-medication with antibiotics in Jordan: A community-based study. Int J Clin Pract 2021; 75:e13665. [PMID: 32772449 DOI: 10.1111/ijcp.13665] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Self-medication with antibiotics is one of the leading causes of antibiotic resistance and drug therapy problems, making antibiotic self-medication practices a global concern. Despite global efforts to limit these practices, self-medication with antibiotics remains prevalent in developing countries. This study aimed to investigate the prevalence and patterns of self-medication with antibiotics in Jordan and to compare the findings of self-medication practices with antibiotics with results from 2006. METHOD A cross-sectional community-based study used a convenient sampling technique and recruited a large sample from all over Jordan. Between February and April 2019 trained 5th-year pharmacy students recruited participants (eg, door to door) who had taken antibiotics in the preceding month. The questionnaire consisted of 14 questions that aimed to describe the patterns of self-medication with antibiotics. RESULTS A total of 1928 participants took part in this study. Of the 1928 respondents, 40.4% reported having used an antibiotic without a prescription in the previous month. Participants who had self-medicated with antibiotics had primarily used them for sore throat and influenza. Self-medicated participants had obtained antibiotics primarily from pharmacies (57.2%) and relied primarily on pharmacists (34.8%) and their own previous experience (35.2%) for information on the proper use of antibiotics. The rate of self-medication with antibiotics in Jordan in 2019 (40.4%) had not changed significantly since 2006 (39.5%, P = .295). However, self-medication practices (eg, source of antibiotic supply and information) have changed over the year. CONCLUSION The findings of this study revealed that the prevalence of self-medication with antibiotics in Jordan remains high. This is a significant concern that requires a quick response from the government authorities to develop a collaborative approach to stop the dispensing of antibiotics without a prescription.
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Affiliation(s)
- Mohammad B Nusair
- Pharmacy Practice Department, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Sayer Al-Azzam
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamza Alhamad
- Faculty of Pharmacy, Zarqa University, Zarqa, Jordan
| | - Mohammad Y Momani
- Pharmacy Practice Department, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
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23
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Ren W, Liu Y, Zhang J, Fang Z, Fang H, Gong Y, Lv X. Prevalence of potential drug-drug interactions in outpatients of a general hospital in China: a retrospective investigation. Int J Clin Pharm 2020; 42:1190-1196. [PMID: 32488437 PMCID: PMC7476976 DOI: 10.1007/s11096-020-01068-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022]
Abstract
Background Potential drug–drug interactions are important factors resulting in adverse drug reactions or therapeutic failure. Therefore, potential drug–drug interactions need to be identified to prevent the related risk and improve drug safety. Objective This study was designed to determine the prevalence of potential drug–drug interactions and investigate the association of potential drug–drug interactions with characteristics in outpatient prescriptions. Setting A large-scale general university hospital in Jinshan District of Shanghai, China. Method The retrospective study was conducted on data obtained from prescriptions containing two or more drugs, written for outpatients older than 18 years. They were screened for potential drug–drug interactions using Lexi-Interact in UpToDate, Stockley’s Drug Interactions and Medicine Specification in the order of priority. Main outcome measure Drug–drug interactions with C, D, X risk rating and clinical parameters recorded at the prescriptions. Results 16,120 prescriptions were screened for the presence of potential drug–drug interactions and 4882 (30.29%) prescriptions containing 6667 potential drug–drug interactions were identified. Among 6667 potential drug–drug interactions, 90.81% (6054/6667), 8.49% (566/6667), 0.70% (47/6667) potential drug–drug interactions belonged to the risk category of C, D and X, respectively. Male, old age and polypharmacy increased the likelihood of potential drug–drug interactions. The most frequently prescribed drugs responsible for potential drug–drug interactions included pioglitazone, dihydrocodeine, thalidomide, sotalol, amiodarone and amlodipine. The predominant potential adverse outcome of potential drug–drug interactions was the increased central nervous system suppression function with the mechanism of reinforced pharmacological effects. Conclusion This study showed that potentially significant drug–drug interactions in outpatients were prevalent in real-world practice. Considering the risk of potential clinical consequences related to potential drug–drug interactions, it is necessary to implement the computerized surveillance and warning systems with drug–drug interactions databases as well as develop the clinical guidelines regarding the widespread potential drug–drug interactions.
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Affiliation(s)
- Weifang Ren
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yujuan Liu
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jun Zhang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Zhonghong Fang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Huan Fang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yuan Gong
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiaoqun Lv
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China.
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