Evaluation of drug information resources for interactions between therapeutic drugs and drugs of abuse

Synergistic cardiotoxic effects of captagon and azithromycin in rat via oxidative stress, apoptosis and upregulation of the PI3K/AKT/NF-kB pathway

Fenethylline (Captagon) is a blend of amphetamine and theophylline that functions as a stimulant, while azithromycin (AZ) is a commonly prescribed macrolide antibiotic. The co-usage of illicit substances and therapeutic drugs can result in substantial health risk especially cardiotoxicity. This study aimed to assess cardiotoxicity effects of Captagon (Capta) and Azithromycin/Captagon interaction in adult male rats. Forty-two animals were assigned into 6 groups: Group I (Control) and group II (AZ (30 mg/kg/day) starting from the 14th day of the experiment and for 2 weeks. Group III (Capta10 mg/kg/day), group IV (Capta20 mg/kg/day), group V (AZ+Capta10) and group VI (AZ+Capta20) daily 28 days. Electrocardiogram (ECG), cardiac enzymes, oxidative stress markers, inflammatory genes expression, histopathological and immunohistochemical changes were assessed. Administration of AZ and Capta alone or in combination cause cardiotoxicity. This was indicated by elevated LDH and CTNI levels, ECG changes as increased HR, prolonged QT interval and elevated ST segment accompanied by cardiac histopathological changes. There was a significant reduction in antioxidants SOD, GSH, TAC, and catalase, alongside a significant rise in oxidative stress MDA and NO. Significant rise of ERK, TNF-α, NF-ҡB, PI3K/AKT, Il-1β and IL-6, in both the Capta20 and AZ+Capta groups in dose dependent manner. The Coadministration of AZ and Capta20 produced intense immunoexpression of caspase-3 and BAX and wide areas of negative reactivity for Bcl-2. Coadministration of AZ and Capta induced cardiotoxicity through oxidative stress, inflammation, and apoptosis pathways. It is important to educate healthcare providers and patients about the potential harmful interactions.

Tertiary drug information sources for treatment and prevention of COVID-19

Objective

To evaluate tertiary drug information databases in terms of scope, consistency of content, and completeness of COVID-19 drug information.

Methods

Five electronic drug information databases: Clinical Pharmacology, Lexi-Drugs, AHFS DI (American Hospital Formulary Service Drug Information), eFacts and Comparisons, and Micromedex In-Depth Answers, were evaluated in this cross-sectional evaluation study, with data gathered from October 2021 through February 2022. Two study investigators independently extracted data (parallel extraction) from each resource. Descriptive statistics were primarily used to evaluate scope (i.e., whether the resource addresses use of the medication for treatment or prevention of COVID-19) and completeness of content (i.e., whether full information is provided related to the use of the medication for treatment or prevention of COVID-19) based on a 10-point scale. To analyze consistency among resources for scope, the Fleiss multi-rater kappa was used. To analyze consistency among resources for type of recommendation (i.e., in favor, insufficient evidence, against), a two-way mixed effects intraclass coefficient was calculated.

Results

A total of 46 drug monographs, including 3 vaccination monographs, were evaluated. Use of the agents for treatment of COVID-19 was most frequently addressed in Lexi-Drugs (73.9%), followed by eFacts and Comparisons (71.7%), and Micromedex (54.3%). The highest overall median completeness score was held by AHFS DI followed by Micromedex, and Clinical Pharmacology. There was moderate consistency in terms of scope (kappa 0.490, 95% CI 0.399-0.581, p<0.001) and recommendations (intraclass correlation coefficient 0.518, 95% CI 0.385-0.651, p<0.001).

Conclusion

Scope and completeness results varied by resource, with moderate consistency of content among resources.

Drug interaction alerts in older primary care patients, and related medically justified actions

PURPOSE

To describe presented interaction alerts in older patients, and the extent to which these require further medical action for the specific patient or are already being addressed.

METHODS

Interaction alerts presented at a physician consultation, for 274 consecutive primary care patients treated with two or more drugs (median age: 75 years; 59% female), were extracted. These alerts are based on Janusmed, a decision support integrated in the medical records that provides recommendations for managing the interactions. One general practitioner (GP) and one GP/clinical pharmacologist determined in retrospect, first independently and then in consensus, whether the alerts justified further medical action, considering each patient's health condition.

RESULTS

In all, 405 drug interaction alerts in 151 (55%) patients were triggered. Medical action in response was deemed medically justified for 35 (9%) alerts in 26 (17%) patients. These actions most often involved a switch to a less interacting drug from the same drug class (n = 10), a separate intake (n = 9), or the ordering of a laboratory test (n = 8). Out of 531 actions suggested by the alert system, only 38 (7%) were applicable to the specific patient, as, for instance, laboratory parameters were already being satisfactorily monitored or a separate intake implemented.

CONCLUSIONS

More than every other older patient receives drug treatment that triggers drug interaction alerts. Nine in ten alerts were already being addressed or were not relevant in the clinical setting, whereas, for the remaining tenth, some medical action, that for unknown reasons had not been taken, was reasonable. These findings show that interaction alerts are questionable as indicators of problematic prescribing.

Potential Psychotropic and COVID-19 Drug Interactions: A Comparison of Integrated Evidence From Six Database Programs

Background

Drug interactions are a significant issue in mental illnesses and coronavirus disease 2019 (COVID-19) infections. Inconsistency in drug interaction resources makes prescribing challenging for healthcare professionals. To assess the scope, completeness, and consistency of drug-drug interactions (DDIs) between psychotropic and COVID-19 medications in six specific drug information (DI) databases.

Methodology

For the comparison, six DI resources were used: Portable Electronic Physician Information Database, Micromedex®, Medscape.com, UpToDate®, Drugs.com drug interaction checker, and WebMD.com drug interaction checker. Using the Statistical Package for the Social Sciences (SPSS) software version 27 (IBM Corp., Armonk, NY), the gathered data were examined for scope, completeness, and consistency.

Results

Scope scores were higher for PEPID© than all the other resources (p < 0.001) for each comparison. PEPID© had better overall completeness scores (median 5, Interquartile range [IQR] 5 to 5; p<0.05 for each comparison), except for Drugs.com (p < 0.05 for each comparison), and were more remarkable for Micromedex® (median 5, IQR 5 to 5). The Fleiss kappa scores among the six different DI sources were poor (k < 0.20, p < 0.05) for the category of information related to clinical effects and level of documentation, moderate agreement (k = 0.4 - 0.6, p < 0.05) for the severity and course of action of DDIs, and fair agreement (k = 0.4 - 0.6, p < 0.05) for mechanism.

Conclusion

A comprehensive, accurate information among DI resources is essential for healthcare professionals that will significantly impact patient care in the clinical practice. Banking on high-quality resources will help healthcare professionals to make an informed decision while prescribing to avoid inappropriate combinations that can adversely affect patient outcomes.