scholarly journals Interactions in cancer treatment considering cancer therapy, concomitant medications, food, herbal medicine and other supplements

2021 ◽  
Author(s):  
Clemens P. J. G. Wolf ◽  
Tobias Rachow ◽  
Thomas Ernst ◽  
Andreas Hochhaus ◽  
Bijan Zomorodbakhsch ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Herbal Medicine ◽  
Drug Interactions ◽  
University Hospital ◽  
Patient Records ◽  
Literature Research ◽  
Different Types ◽  
Concomitant Medications ◽  
Potential Interactions ◽  
Major Drug

Abstract Purpose The aim of our study was to analyse the frequency and severity of different types of potential interactions in oncological outpatients’ therapy. Therefore, medications, food and substances in terms of complementary and alternative medicine (CAM) like dietary supplements, herbs and other processed ingredients were considered. Methods We obtained data from questionnaires and from analysing the patient records of 115 cancer outpatients treated at a German university hospital. Drug–drug interactions were identified using a drug interaction checking software. Potential CAM-drug interactions and food–drug interactions were identified based on literature research. Results 92.2% of all patients were at risk of one or more interaction of any kind and 61.7% of at least one major drug–drug interaction. On average, physicians prescribed 10.4 drugs to each patient and 6.9 interactions were found, 2.5 of which were classified as major. The most prevalent types of drug–drug interactions were a combination of QT prolonging drugs (32.3%) and drugs with a potential for myelotoxicity (13.4%) or hepatotoxicity (10.1%). In 37.2% of all patients using CAM supplements the likelihood of interactions with medications was rated as likely. Food-drug interactions were likely in 28.7% of all patients. Conclusion The high amount of interactions could not be found in literature so far. We recommend running interaction checks when prescribing any new drug and capturing CAM supplements in medication lists too. If not advised explicitly in another way drugs should be taken separately from meals and by using nonmineralized water to minimize the risk for food–drug interactions.

scholarly journals Drug interactions of oral anticoagulants

2020 ◽  
Vol 10 (1) ◽  
pp. 70
Author(s):  
Gayathri Anil ◽  
Pradhyumna Muraleedharan ◽  
Atiya Rehman Faruqui
Keyword(s):  
Drug Interactions ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Median Number ◽  
Potential Drug ◽  
Concomitant Medications ◽  
Potential Interactions ◽  
Major Drug

Background: Oral anticoagulants (OACs) are the drugs of choice where long-term anticoagulation is needed due to convenience of dosing. But their use has potential for several drug interactions. Monitoring for potential interactions with timely management will decrease the risk of complications of anticoagulation.Methods: We aimed to assess the presence of potential drug-drug interactions in patients on oral anticoagulants for various indications. Prescriptions of a cohort of patients on oral anticoagulants were analyzed. Potential drug interactions were identified using free software available at www.drugs.com and classified into major, moderate and minor types.Results: Of the 135 patients in the study, 83 were males and mean age was 52.9±17.3 years. Most commonly used OACs were vitamin K antagonists (VKAs) (80.0%) followed by direct oral anticoagulants (DOACs) (20.0%). Median number of concomitant medications per patient was 4 (IQR 3-6). A total of 307 potential interactions were identified in 121 patients with a median of 2 interactions per patient. Of the 56 patients who had potential for major drug interactions, 45 (41.6%) were on VKAs and 11 (40.7%) on DOACs had potential to develop major interactions. Using logistic regression model, significant predictors of major drug interactions were age>60 years (OR 2.50; 95% CI 1.05-5.95; p=0.04) and presence of venous thromboembolism VTE (OR 0.09; 95% CI 0.02-0.55; p=0.01).Conclusions: This hospital-based study showed potential drug interactions with OACs. Age more than 60 years and presence of VTE were significant predictors of major interactions. Awareness of potential interactions and monitoring doses of OACs help to prevent complications of therapy.

The prevalence of potentially beneficial and harmful drug-drug interactions in intensive care units

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Hossein Ali Mehralian ◽  
Jafar Moghaddasi ◽  
Hossein Rafiei
Keyword(s):  
Intensive Care ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Intensive Care Units ◽  
Medical Records ◽  
Potential Ddis ◽  
Cross Sectional ◽  
Text Book ◽  
The Mean ◽  
Potential Interactions

Abstract Background The present study was conducted with the aim of investigating the prevalence of potentially beneficial and harmful drug-drug interactions (DDIs) in intensive care units (ICUs). Methods The present cross-sectional prospective study was conducted in two ICUs in Shahr-e Kord city, Iran. The study sample was consisted of 300 patients. The Drug Interaction Facts reference text book [Tatro DS. Drug interaction facts. St Louis, MO: Walters Kluwer Health, 2010.] was used to determine the type and the frequency of the DDIs. Results The participants consisted of 189 patients men and 111 women. The mean age of patients was 44.2 ± 24.6 years. Totally, 60.5% of patients had at least one drug-drug interaction in their profile. The total number of DDIs found was 663 (the mean of the total number of drug-drug interactions was 2.4 interactions per patient). Of all the 663 interactions, 574 were harmful and others were beneficial. In terms of starting time, 98 of the potential interactions were rapid and 565 of them were delayed. In terms of severity, 511 of the potential interactions were moderate. Some of the drugs in the patients’ medical records including phenytoin, dopamine, ranitidine, corticosteroid, dopamine, heparin, midazolam, aspirin, magnesium, calcium gluconate, and antibiotics, the type of ventilation, the type of nutrition and the duration of hospital stay were among the factors that were associated with high risk of potential DDIs (p < 0.05). Conclusions The prevalence of potentially beneficial and harmful DDIs, especially harmful drug-drug interactions, is high in ICUs and it is necessary to reduce these interactions by implementing appropriate programs and interventions.

scholarly journals A Minimal Information Model for Potential Drug-Drug Interactions

2021 ◽  
Vol 11 ◽  
Author(s):  
Harry Hochheiser ◽  
Xia Jing ◽  
Elizabeth A. Garcia ◽  
Serkan Ayvaz ◽  
Ratnesh Sahay ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Best Practice ◽  
Task Force ◽  
Information Model ◽  
Potential Drug ◽  
Community Group ◽  
Drug Drug Interaction ◽  
Potential Interactions ◽  
Minimal Information

Despite the significant health impacts of adverse events associated with drug-drug interactions, no standard models exist for managing and sharing evidence describing potential interactions between medications. Minimal information models have been used in other communities to establish community consensus around simple models capable of communicating useful information. This paper reports on a new minimal information model for describing potential drug-drug interactions. A task force of the Semantic Web in Health Care and Life Sciences Community Group of the World-Wide Web consortium engaged informaticians and drug-drug interaction experts in in-depth examination of recent literature and specific potential interactions. A consensus set of information items was identified, along with example descriptions of selected potential drug-drug interactions (PDDIs). User profiles and use cases were developed to demonstrate the applicability of the model. Ten core information items were identified: drugs involved, clinical consequences, seriousness, operational classification statement, recommended action, mechanism of interaction, contextual information/modifying factors, evidence about a suspected drug-drug interaction, frequency of exposure, and frequency of harm to exposed persons. Eight best practice recommendations suggest how PDDI knowledge artifact creators can best use the 10 information items when synthesizing drug interaction evidence into artifacts intended to aid clinicians. This model has been included in a proposed implementation guide developed by the HL7 Clinical Decision Support Workgroup and in PDDIs published in the CDS Connect repository. The complete description of the model can be found at https://w3id.org/hclscg/pddi.

scholarly journals High rate of major drug–drug interactions of lopinavir–ritonavir for COVID-19 treatment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Juan Macías ◽  
Ana Pinilla ◽  
Francisco A. Lao-Dominguez ◽  
Anaïs Corma ◽  
Enrique Contreras-Macias ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Drug Interactions ◽  
High Frequency ◽  
Cross Sectional Study ◽  
Charlson Index ◽  
High Rate ◽  
Cross Sectional ◽  
Concomitant Medications ◽  
The Impact ◽  
Major Drug

AbstractThe impact of drug–drug interactions (DDI) between ritonavir-boosted lopinavir (LPV-r) to treat patients with coronavirus disease 2019 (COVID-19) and commonly used drugs in clinical practice is not well-known. Thus, we evaluated the rate and severity of DDI between LPV-r for COVID-19 treatment and concomitant medications. This was a cross-sectional study including all individuals diagnosed of SARS-CoV-2 infection treated with LPV-r and attended at a single center in Southern Spain (March 1st to April 30th, 2020). The frequency [95% confidence interval (95% CI)] of potential and major DDI were calculated. Overall, 469 patients were diagnosed of COVID-19, 125 (27%) of them were prescribed LPV-r. LPV-r had potential DDI with concomitant medications in 97 (78%, 95% CI 69–85%) patients, and in 33 (26%, 95% CI 19–35%) individuals showed major DDI. Twelve (36%) patients with major DDI and 14 (15%) individuals without major DDI died (p = 0.010). After adjustment, only the Charlson index was independently associated with death [adjusted OR (95% CI) for Charlson index ≥ 5: 85 (10–731), p < 0.001]. LPV-r was discontinued due to side effects in 31 (25%) patients. Management by the Infectious Diseases Unit was associated with a lower likelihood of major DDI [adjusted odds ratio (95% CI): 0.14 (0.04–0.53), p = 0.003). In conclusion, a high frequency of DDI between LPV-r for treating COVID-19 and concomitant medications was found, including major DDI. Patients with major DDI showed worse outcomes, but this association was explained by the older age and comorbidities. Patients managed by the Infectious Diseases Unit had lower risk of major DDI.

Drug–drug interactions in patients receiving tyrosine kinase inhibitors

2016 ◽  
Vol 24 (2) ◽  
pp. 110-115 ◽  
Author(s):  
Kristine L Keller ◽  
Miguel J Franquiz ◽  
Alison P Duffy ◽  
James A Trovato
Keyword(s):  
Tyrosine Kinase ◽  
Drug Interactions ◽  
Tyrosine Kinase Inhibitor ◽  
Tyrosine Kinase Inhibitors ◽  
Kinase Inhibitors ◽  
Kinase Inhibitor ◽  
Cancer Drug ◽  
Inhibitor Concentration ◽  
Concomitant Medications ◽  
Potential Interactions

Rationale Tyrosine kinase inhibitors are increasingly used in the treatment of cancer. Drug interactions involving tyrosine kinase inhibitors are commonly encountered in clinical practice. The objective of this study was to describe the frequency of tyrosine kinase inhibitor-associated drug interactions among a cohort of oncology patients. Methods Adult patients were included who presented to either of two outpatient oncology practices and were prescribed a tyrosine kinase inhibitor during 2 January 2013 to 1 January 2015. Demographic and medication data were abstracted from electronic medical records. Lexicomp®, Micromedex Solutions®, and medication labeling were utilized to identify potential interactions between tyrosine kinase inhibitors and concomitant medications. Interactions were then assessed by the investigators for clinical significance. The primary outcome was the frequency of significant drug interactions involving tyrosine kinase inhibitors and concomitant medications. Secondary outcomes included describing the nature and clinical impact of interactions, and describing interactions by medication class. Results A total of 356 patients were identified for analysis, in whom 244 potential interactions were identified, and 109 (44.7%) of which were considered severe. Decreased tyrosine kinase inhibitor absorption due to acid suppressive therapy and CYP3A4 interactions were the most frequent mechanisms of potential subtherapeutic and supratherapeutic concentrations, respectively. Potential clinical consequences included QTc prolongation ( n = 53, 48.6%), decreased tyrosine kinase inhibitor concentration ( n = 53, 48.6%), and increased tyrosine kinase inhibitor concentration ( n = 3, 2.8%). Conclusions Safer alternative therapy and/or more frequent clinical monitoring should be considered if an interaction poses a significant risk of increased tyrosine kinase inhibitor toxicity or decreased tyrosine kinase inhibitor efficacy. Oncology pharmacists can play a role in screening for tyrosine kinase inhibitor-associated interactions, recommending alternative therapies or dosing strategies, and monitoring tyrosine kinase inhibitor efficacy and toxicity.

scholarly journals High rate of major drug-drug interactions of lopinavir-ritonavir for COVID-19 treatment

2020 ◽  
Author(s):  
Juan Macias ◽  
Ana Pinilla ◽  
Francisco A Lao-Dominguez ◽  
Anais Corma ◽  
Enrique Contreras-Macias ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Drug Interactions ◽  
High Frequency ◽  
Cross Sectional Study ◽  
Charlson Index ◽  
High Rate ◽  
Cross Sectional ◽  
Concomitant Medications ◽  
The Impact ◽  
Major Drug

The impact of drug-drug interactions (DDI) between ritonavir-boosted lopinavir (LPV-r) to treat patients with coronavirus disease 2019 (COVID-19) and commonly used drugs in clinical practice is not well-known. Thus, we evaluated the rate and severity of DDI between LPV-r for COVID-19 treatment and concomitant medications. This was a cross-sectional study including all individuals diagnosed of SARS-CoV-2 infection treated with LPV-r and attended at a single center in Southern Spain (March 1st to April 30th, 2020). The frequency [95% confidence interval (95% CI)] of potential and major DDI were calculated. Overall, 469 patients were diagnosed of COVID-19, 125 (27%) of them were prescribed LPV-r. LPV-r had potential DDI with concomitant medications in 97 (78%, 95% CI: 69%-85%) patients, and in 33 (26%, 95% CI: 19%-35%) individuals showed major DDI. Twelve (36%) patients with major DDI and 14 (15%) individuals without major DDI died (p=0.010). After adjustment, only the Charlson index was independently associated with death [adjusted OR (95% CI) for Charlson index ≥5: 85 (10-731), p <0.001]. LPV-r was discontinued due to side effects in 31 (25%) patients. Management by the Infectious Diseases Unit was associated with a lower likelihood of major DDI [adjusted odds ratio (95% CI): 0.14 (0.04-0.53), p=0.003). In conclusion, a high frequency of DDI between LPV-r for treating COVID-19 and concomitant medications was found, including major DDI. Patients with major DDI showed worse outcomes, but this association was explained by the older age and comorbidities. Patients managed by the Infectious Diseases Unit had lower risk of major DDI.

scholarly journals Occurrence of possible drug related interactions in medical patients in out-patient departments of Pakistan

2020 ◽  
Vol 9 (10) ◽  
pp. 1503
Author(s):  
Hammad A. Butt ◽  
Ammara Khan ◽  
Naveed Suleman
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Related Problem ◽  
Potential Drug ◽  
Medical Patients ◽  
Interaction Detection ◽  
Drug Related Problem ◽  
Detection Program ◽  
Background Data ◽  
Potential Interactions

Background: Data regarding occurrence of drug-drug interactions in Pakistan is rare. In the current study, we have tried to find out the clinical adversity and frequency witnessed in prescriptions of a medical outpatient department.Methods: Patient prescriptions were analyzed for potential drug-drug interactions.  A sample of 364 patients, visited outpatient department who were being prescribed at least two drugs simultaneously using a drug interaction program website.Results: The 364 patients (72.8% male, mean age 57.9±15.2 years) were prescribed a median of six drugs (range 2-13) at OPD visit. Three hundred forty nine patients (95.8%) had at least one potentially interacting drug combination. 2636 potential interactions were seen in the visiting patients. Out of these 124 (4.7%) were of major severity, 1730 (65.6%) moderate and 515 (19.5%). Out of 124 patients with a potential DDI with major severity, no patient was re-hospitalized within 2 months after discharge due to a probable drug-related problem associated with the potential DDI.Conclusions: A large percentage of patients were detected having one or more potential drug-drug interactions, using drug interaction detection program. However, the percentage of patients having clinically adverse consequences due to drug-drug interactions appears to be very low.

scholarly journals Nurses' Awareness and Perception of Drug-Drug and Drug Food Interactions

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Hend A. E. Elshenawi ◽  
Yasmin F. M. Abed Elazeem
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Drug Safety ◽  
Structured Interview ◽  
University Hospital ◽  
Surgical Department ◽  
Low Level ◽  
Drug Drug Interaction ◽  
Plan Management ◽  
Assessment Questionnaire

Context: The issue of drug interactions is a global concern. Studies reported a high prevalence of drug interactions worldwide. The drug-drug interaction (DDIs) and drug-food interactions (DFIs) are often predictable and preventable. Nurses play essential roles in inpatient drug safety. Aim: This study aimed to assess nurses' awareness and perception of drug-drug and drug-food interactions. Methods: A cross-sectional descriptive design was used to achieve the aim of this study on a convenient sample of 150 nurses working at emergency departments(medical, surgical), cardiac care unit, renal department, general surgery department, and the chest and heart surgical department at the Main University Hospital of Alexandria, Egypt. Four study tools used. They were a structured interview questionnaire designed to assess the nurses’ sociodemographic characteristic, nurses’ working experiences to drug-drug and drug-food interactions, and nurses’ history in encountering drug-drug and drug-food interactions; nurses’ awareness of drug/drug interaction assessment questionnaire, nurses’ awareness of drug/food interaction assessment questionnaire, and drug safety nurses’ perception assessment questionnaire. Results: The findings of the current study reveal that 64% of the studied nurses did not receive training on DDIs or DFIs other than that in their basic education. 56% of the nurses came across patients who experienced either DDIs or DFIs. Regarding awareness, around half of them did not make aware of the drug-drug interactions of the studied drug pairs that are frequently used in the clinical practice. Concerning DFIs, 74% of the studied nurses had a low level of total awareness. Regarding nurses’ perception to drug safety, 49.3% of the studied nurses agreed that the risk of drug-drug interaction is high, 55.3% agreed with the importance for prescribers to learn about DDIs and DFIs, and 53.3% of them agreed with the information regarding the DDIs and DFIs useful to the nurse in plan management. The current study revealed a statistically significant association between training received and nurses’ awareness regarding DDIs and DFIs. Conclusion: The study concluded a low level of awareness among the studied nurses regarding DDIs and DFIs with an average perception of the risk of DDIs/DFIs, and the importance of related information in plan management. The study recommended different strategies to be applied to assist prescribers and nurses in identifying potential DDIs, providing educational interventions, facilitating access to DDI information sources, applying computerized alerting systems, and delivering performance feedback among the most commonly recommended strategies.

scholarly journals Evaluation of the systemic and therapeutic repercussions caused by drug interactions in oncology patients

2019 ◽  
Vol 65 (5) ◽  
pp. 611-617
Author(s):  
Camila Ribeiro de Arruda Monteiro ◽  
Jean Henri Maselli Schoueri ◽  
Debora Terra Cardial ◽  
Lívia de Castro Linhares ◽  
Karine Corcione Turke ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Cancer Patients ◽  
Study Drug ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Close Monitoring ◽  
Sectional Study ◽  
Cross Sectional ◽  
Potential Interactions

SUMMARY INTRODUCTION: Drug interaction is an important cause of global morbidity. It is of particular importance in cancer patients since they are often in use of polypharmacy, related to interactions between the drugs and the chemotherapeutics used. OBJECTIVE: To evaluate the drug interaction between chemotherapy and other drugs in cancer patients. METHODS: a cross-sectional study carried out in the outpatient oncology department of a public tertiary hospital. Two hundred thirty-five patients were included, and the drugs they were using were identified. Using the MedScape and Epocrates database, we evaluated the interactions between medications and chemotherapy by defining their frequency and dividing their severity from interaction into mild, close monitoring necessity and severe. RESULTS: 161 patients had some drug interaction. We identified 9 types of mild interactions, 23 types of interactions with close monitoring necessity, and 2 types of serious interactions. The most frequent interactions were between fluorouracil and leucovorin (32 cases) and cyclophosphamide and doxorubicin (19 cases). Serious interactions were between aspirin and pemetrexed; and leucovorin and Bactrim. CONCLUSION: In the present study, drug interactions were frequent, including serious interactions with a potential increase in morbidity and mortality. Thus, it is necessary for oncologists to draw up a therapeutic plan considering potential interactions between prescribed chemotherapy and current medications in use by patients.

Knowledge of Herbal Medicines and Herb-drug Interaction Among Medical and Pharmacy Students of the University of Lagos, Nigeria

2020 ◽  
Vol 16 (1) ◽  
pp. 61-70
Author(s):  
O.U. Amaeze ◽  
O.A. Olugbake ◽  
M. Lawal
Keyword(s):  
Drug Interaction ◽  
Herbal Medicine ◽  
Drug Interactions ◽  
Health Care Providers ◽  
Statistical Significance ◽  
Herbal Medicines ◽  
Pharmacy Students ◽  
Care Providers ◽  
Medical Undergraduate ◽  
The University

Background: Concurrent use of herbal and orthodox medicines can result in herb-drug interaction, which could remain unidentified due to the limited knowledge of health care providers on herbal medicines effects and safety.Objectives: This study aimed to assess the knowledge of medical and pharmacy students of the University of Lagos on herbal medicines and herb-drug interactions.Method: The study was a cross-sectional survey of final year pharmacy and medical undergraduate students (422) of the University of Lagos. Data was collected using a validated, previously developed, and standardized self-administered questionnaire. Descriptive statistics was used to evaluate the students’ demographics, knowledge of herbal medicines and herb-drug interactions, types and uses of herbal medicines, while inferential statistics was employed to assess the association between the students’ demographics and their knowledge of herb-drug interactions. Statistical significance was set at P<0.05.Results: The response rate was 97%. The students (98.0%) knew that herbs can be used as medicines; common uses of herbal medicines reported by the students include malaria (11.4%), pain (24.6%), and fever (36.2%). There was no association between the students’ demographics and their knowledge about herbal medicine. Age was significantly associated with knowledge of herb-drug interaction (P<0.05). The students (96.8%) knew that herbs can interact with conventional drugs when administered concurrently. The sources of the students’ knowledge about herbal medicine and herb-drug interaction include lectures (52.2%), literature (14%) and personal experience (13.9%).Conclusion: The students had good knowledge of herbal medicines; however, the subject of herbal medicines and their effects should be given more attention in the medical and pharmacy program curriculum, in order to enhance the students’ knowledge base of herbal medicines and interactions, and equip the future physicians and pharmacists adequately for better patient care. Keywords: Herbal medicines, Herb-drug interaction, Pharmacy students, Medical students

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