scholarly journals Potential drug-drug interactions of antiretrovirals and antimicrobials detected by three databases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pornpun Vivithanaporn ◽  
Teetat Kongratanapasert ◽  
Bovornpat Suriyapakorn ◽  
Pichayut Songkunlertchai ◽  
Patpicha Mongkonariyawong ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Drug Interactions ◽  
Standard Treatment ◽  
Opportunistic Infections ◽  
Essential Medicines ◽  
Potential Drug ◽  
Potential Ddis

AbstractStandard treatment for HIV infection involves a combination of antiretrovirals. Additionally, opportunistic infections in HIV infected patients require further antimicrobial medications that might cause drug-drug interactions (DDIs). The objective of this study was to to compare the recognition of DDIs between antiretrovirals and antimicrobials by three proprietary databases and evaluate their concordance. 114 items of antiretrovirals and antimicrobials from the National List of Essential Medicines of Thailand 2018 were used in the study. However, 21 items were not recognised by Micromedex, Drugs.com, and Liverpool HIV interactions. Only 93 items were available for the detection of potential DDIs by the three databases. Potential DDIs detected from the three databases included 292 pairs. Liverpool showed the highest number of DDIs with 285 pairs compared with 259 pairs by drugs.com and 133 pairs by Micromedex. Regarding the severity classifications, Liverpool reported 10% Contraindicated; Micromedex reported 14% contraindicated and 59% major; Drugs.com reported 21% major. The Fleiss’ kappa agreements were fair to poor among the three databases, higher agreement was observed for DDIs classified as severe. This study highlights the need to harmonize the evaluation and interpretation of DDI risk in order to produce standardized information to support prescribers.

scholarly journals ASSESSMENT OF POTENTIAL DRUG INTERACTIONS AMONG HOSPITALIZED PATIENTS IN NEUROLOGY DEPARTMENT IN TERTIARY CARE HOSPITALS

2019 ◽  
pp. 173-176
Author(s):  
DIJO DAIS ◽  
RANJEET AVIS CHERUVATHOOR ◽  
KAMESWARAN R ◽  
SHANMUGA SUNDARAM RAJAGOPAL
Keyword(s):  
Risk Factors ◽  
Drug Interactions ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Daily Basis ◽  
Potential Drug ◽  
Potential Ddis ◽  
Patient History ◽  
Therapeutic Advantage ◽  
Tertiary Care Hospitals

Objective: This research was instigated to determine and assess the prevalence, severity, type, and the total number of potential drug interactions in the neurology department of two hospitals in India. Methods: The data were collected from the prescriptions and by patient history interview on a daily basis. The drug-drug interactions (DDIs) were identified using Micromedex® database-2.7 and drugs.com. Results: The drug interactions were influenced by a plethora of risk factors: Gender, age, comorbidities, length of hospital stay, and the neurological condition. The study was comprised 320 patients, among 196 patients were identified with potential DDIs (PDDIs), and a total of 450 PDDIs were observed. The prevalence of PDDIs according to the severity was major (42.6%), moderate (45.11%), and minor (12.22%). Conclusion: To lessen PDDIs, the range of medications for the patients must be properly managed, and it is encouraged to remove all medicines without therapeutic advantage, intention, and an indication.

scholarly journals Comparing Potential Drug-Drug Interactions in Veterinary Medications Using Two Electronic Databases

2020 ◽  
Author(s):  
Anusak Kijtawornrat ◽  
Tussapon Boonyarattanasoonthorn ◽  
Phisit Khemawoot
Keyword(s):  
Health Care ◽  
Veterinary Medicine ◽  
Global Health ◽  
Drug Interactions ◽  
Drug Prescription ◽  
Lower Sensitivity ◽  
Potential Drug ◽  
Health Issues ◽  
Potential Ddis ◽  
Veterinary Medicines

Abstract Background: One of the most common global health issues in humans and animals is drug-drug interactions (DDIs). This issue increases the risks of health care in both human and veterinary medicine, as animals live long lives and receive many medicines to treat their illnesses. Currently, many electronic databases are using as a tool for potential DDI prediction, e.g., Micromedex and Drugs.com. The purpose of this study was to compare the ability of Micromedex and Drugs.com to detect potential DDIs in veterinary medicines.Results: There were 140 drugs, mainly used for the treatment of disease in animal hospitals, but the Micromedex and Drugs.com databases unidentified 44 items, therefore only 96 items were used in this study. The analysis detected 1,132 potential DDI pairs from the two databases. Micromedex identified 429 pairs of potential DDIs, while Drugs.com identified 842 pairs of potential DDIs. The same severity of the potential DDIs occurred between the two databases for 139 pairs (12.28%) and a different severity was found for 993 pairs (87.72%).Conclusion: Although Micromedex had a lower sensitivity to find out potential DDIs than Drugs.com, Micromedex provided more informative documentation. Veterinary pharmacists should evaluate potential DDIs from different databases and communicate with both the veterinarian and animal owners to ensure an appropriate drug prescription.

scholarly journals Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis

2021 ◽  
Vol 27 (1) ◽  
pp. 186-196
Author(s):  
Po-Yao Hsu ◽  
Yu-Ju Wei ◽  
Jia-Jung Lee ◽  
Sheng-Wen Niu ◽  
Jiun-Chi Huang ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Drug Interactions ◽  
Median Number ◽  
Lipid Lowering ◽  
Hcv Rna ◽  
Close Monitoring ◽  
Potential Drug ◽  
Direct Acting Antivirals ◽  
Potential Ddis ◽  
Direct Acting

Background/Aims: Direct‐acting antivirals (DAAs) have been approved for hepatitis C virus (HCV) treatment in patients with end-stage renal disease (ESRD) on hemodialysis. Nevertheless, the complicated comedications and their potential drug-drug interactions (DDIs) with DAAs might limit clinical practice in this special population.Methods: The number, class, and characteristics of comedications and their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan.Results: Of 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10).Conclusions: HCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs.

scholarly journals Current epidemiological and etiological characteristics and treatment of seizures or epilepsy in patients with HIV infection

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Changhao Yu ◽  
Dong Zhou ◽  
Weijia Jiang ◽  
Jie Mu
Keyword(s):  
General Population ◽  
Hiv Infection ◽  
Drug Interactions ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Opportunistic Infections ◽  
Research Progress ◽  
Future Research ◽  
Hiv Patients ◽  
Predisposing Factor

Abstract Seizures or epilepsy is one of the common serious complications in patients with advanced human immunodeficiency virus (HIV) infection or diagnosed with immune deficiency syndrome, with higher incidence and prevalence than in the general population. Generalized seizures are the most common type in the patients. Opportunistic infections are a stereotypical predisposing factor for seizures in HIV patients, but a variety of pathogenic factors can also be found in these patients, such as metabolic perturbation and drug-drug interactions. The diagnostic criteria for seizures in these patients are the same as those in the general population. As HIV patients with seizures need to take both antivirals and antiepileptic drugs, the risk of drug-drug interactions is greatly increased, and the side effects of drugs may also become more prominent. At present, most experience in antiepileptic drug usage has come from the general population, and there is still a lack of guidance of antiepileptic drug use in special groups such as the HIV-infected people. Unlike the old-generation drugs that involve metabolisms through CYP450, the first-line antiepileptic drugs usually bypass CYP450, thus having less drug-drug interactions. In this review, we summarize the recent research progress on the above-mentioned widely discussed topics and make a prospect on future research direction.

scholarly journals Potential drug interactions in patients given antiretroviral therapy

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Wendel Mombaque dos Santos ◽  
Silvia Regina Secoli ◽  
Stela Maris de Mello Padoin
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Drug Interactions ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Antiretroviral Drugs ◽  
P Value ◽  
Potential Drug ◽  
Cross Sectional ◽  
Treatment Data

ABSTRACT Objective: to investigate potential drug-drug interactions (PDDI) in patients with HIV infection on antiretroviral therapy. Methods: a cross-sectional study was conducted on 161 adults with HIV infection. Clinical, socio demographic, and antiretroviral treatment data were collected. To analyze the potential drug interactions, we used the software Micromedex(r). Statistical analysis was performed by binary logistic regression, with a p-value of ≤0.05 considered statistically significant. Results: of the participants, 52.2% were exposed to potential drug-drug interactions. In total, there were 218 potential drug-drug interactions, of which 79.8% occurred between drugs used for antiretroviral therapy. There was an association between the use of five or more medications and potential drug-drug interactions (p = 0.000) and between the time period of antiretroviral therapy being over six years and potential drug-drug interactions (p < 0.00). The clinical impact was prevalent sedation and cardiotoxicity. Conclusions: the PDDI identified in this study of moderate and higher severity are events that not only affect the therapeutic response leading to toxicity in the central nervous and cardiovascular systems, but also can interfere in tests used for detection of HIV resistance to antiretroviral drugs.

scholarly journals The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units

2020 ◽  
Vol 11 ◽  
pp. 204209862098064
Author(s):  
Mansoor Masjedi ◽  
Mahtabalsadat Mirjalili ◽  
Ehsan Mirzaei ◽  
Hadis Mirzaee ◽  
Afsaneh Vazin
Keyword(s):  
Intensive Care ◽  
Drug Interactions ◽  
Intensive Care Units ◽  
Trauma Center ◽  
Type A ◽  
P Value ◽  
Potential Drug ◽  
Potential Ddis ◽  
Once Daily ◽  
Staffing Patterns

Background: Drug–drug interactions (DDIs) have created alarming challenges for public health, especially in those admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and decreases the treatment costs. The effect of academic versus non-academic (therapeutic) intensivist as well as hours of coverage and attendance of intensivist on potential DDIs (pDDIs) was evaluated in six adult trauma ICUs of a level one trauma center. Methods: In this 6-month cross-sectional study, 200 patients were included. The DDIs were classified into five groups, including type A, B, C, D, and X. pDDIs were defined as interactions belonged to C, D and X categories. Patients in six adult ICUs with three different patterns of intensivist staffing models including type A (once-daily therapeutic intensivist visit followed by 24 h on-call), B (twice-daily academic intensivist visit, 8 h of attendance in ICU and 16 h on-call) and C (all criteria just like ICU type B, except for the presence of therapeutic instead of academic intensivist) were screened for pDDIs. Results: In total, 3735 drug orders and 3869 drugs (193 different types) were screened and 1826 pDDIs were identified. Type C, D and X interactions accounted for 60.6%, 35.5%, and 3.9% of all pDDIs, respectively. The mean of pDDI per patient was significantly higher ( p-value < 0.001) in the ICU type A than ICU types C and B. The frequency of pDDIs was the highest in the type A ICUs. A statistically significant relationship was observed between the number of prescribed drugs and ICU length of stay ( p-value < 0.001 and p = 0.009, respectively). Conclusion: Different patterns of intensivist staffing affect pDDIs to varying degrees. In the studied ICUs academic versus therapeutic intensivist, twice versus once-daily visit, and 8 h attendance with16 h on-call versus 24 h on-call were associated with more reductions in pDDIs. Plain language summary The impact of different intensivist staffing patterns in ICUs on the rate of potential drug-drug interactions Drug-drug interactions (DDIs) have created alarming challenges for public health, especially in patients admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and limits the costs. Considering the high incidence of potential DDIs (pDDIs) occurring for critically ill patients and the importance of ADRs caused by pDDIs in ICUs, the effect of the presence of an academic versus therapeutic intensivist, as well as the hour of coverage of intensivist on prevalence of pDDIs was evaluated in six adult trauma ICUs of a level one trauma center in Shiraz, Iran. We also determined the prevalence of pDDIs and their associated risk factors. To the best of our knowledge, this is the first study that has assessed the effect of various ICU physician staffing models on the incidence and pattern of pDDIs.

Sensitivity and specificity of drug interaction databases to detect interactions with recently approved oral antineoplastics

2021 ◽  
pp. 107815522098424
Author(s):  
John B Bossaer ◽  
Danielle Eskens ◽  
Austin Gardner
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Potential Drug ◽  
Considerable Variability ◽  
Potential Ddis ◽  
Chi Square ◽  
Small Pilot Study ◽  
Significant Variability ◽  
Chi Square Test ◽  
Prescribing Information

Rationale: Drug-drug interactions (DDIs) with oral antineoplastics (OAs) are of increasing concern given the rapid increase in OA approvals and use in cancer patients. A small pilot study of 20 DDIs with OAs showed significant variability in commonly used DDI screening databases in sensitivity of detecting potentially clinically relevant DDIs. This study builds upon that work by expanding the number of potential DDIs analyzed and including a specificity analysis. Methods Newly approved OAs from 2016 to May 2019 (n = 22) were included in this analysis. Prescribing information for each drug was reviewed. A list of explicit and theoretical drug interactions was created for each OA by the two investigators. A board-certified oncology pharmacist adjudicated all DDI pairs for potential clinical significance. In total, 229 DDI pairs were used to analyze sensitivity of 5 DDI databases (Lexicomp®, Micromedex®, Medscape, Eporactes®, & Drugs.com). Additionally, 64 “dummy” or false DDI pairs were created to analyze specificity. Sensitivity and specific were analyzed using Cochran’s Qtest, while accuracy was analyzed using chi-square test. Results There was significant variability among the databases with regards to sensitivity (p < 0.0001), specificity (p < 0.0001), and accuracy (p < 0.0001). In terms of accuracy (max score = 400), Lexicomp®(355), Epocrates® (344), and Drugs.com (352) scored higher than MicroMedex® (270) and Medscape (280). Conclusions Considerable variability exists among DDI screening databases with regards to OAs and potential drug interactions. Clinicians should be vigilant in both screening for DDIs with OAs and describing DDIs encountered in clinical practice.

scholarly journals Polypharmacy and severe potential drug-drug interactions among older adults with cardiovascular disease in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwan Sheikh-Taha ◽  
Myriam Asmar
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Health Outcomes ◽  
Drug Interactions ◽  
Tertiary Care ◽  
The United States ◽  
Potential Drug ◽  
Potential Ddis ◽  
Increased Risk ◽  
Negative Health Outcomes

Abstract Background Polypharmacy continues to be a topic of concern among older adults and puts patients at increased risk of potential drug-drug interactions (DDIs) and negative health outcomes. The objective of this study was to assess the prevalence of polypharmacy among older adults with cardiovascular disease (CVD) and to identify severe potential DDIs. Methods A retrospective chart review was conducted in a tertiary care center over a three-month period where we reviewed home medications of older adults upon hospital admission. Inclusion criteria were age ≥ 65 years, history of CVD, and admission to the cardiology service. Polypharmacy was defined as 5 or more medications taken concomitantly, hyper-polypharmacy was defined as 10 or more medications taken concomitantly, and severe potential DDIs were considered to be those belonging to category D or X using Lexicomp® Drug Information Handbook. Category D interaction states that modification of therapy should be considered while category X states that the combination should be absolutely avoided. Results A total of 404 patients with a mean age of 76.6 ± 7.4 years were included. Patients were taking an average of 11.6 ± 4.5 medications at home and 385 (95%) received polypharmacy, 278 (69%) received hyper-polypharmacy, and 313 (77.5%) had at least one severe potential DDI. Under category D, the most common potential DDIs were drugs with additive central nervous system (CNS) depressant effect and drugs that increase the risk of QT prolongation. Under category X, the most common potential DDIs were non-selective β-blockers that may diminish the bronchodilator effect of β2 agonists and drugs with anticholinergic properties that enhance the ulcerogenic effect of oral solid potassium. Conclusions Polypharmacy, hyper-polypharmacy, and severe potential DDIs are very common in older adults with CVD. Clinicians should vigilantly review patients’ drug records and adjust therapy accordingly to prevent adverse drug reactions and negative health outcomes.

scholarly journals Potential drug–drug interactions with direct oral anticoagulants in elderly hospitalized patients

2017 ◽  
Vol 8 (10) ◽  
pp. 319-328 ◽  
Author(s):  
Heather L. Forbes ◽  
Thomas M. Polasek
Keyword(s):  
Drug Interactions ◽  
Product Information ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Plasma Concentrations ◽  
Hospitalized Patients ◽  
Local Health ◽  
Potential Drug ◽  
Potential Ddis ◽  
Elderly Hospitalized Patients

Background: To determine the prevalence and nature of potential drug–drug interactions (DDIs) with direct oral anticoagulants (DOACs) in elderly hospitalized patients. Methods: This was a retrospective observational study. Inclusion criteria were: aged over 65 years; taking apixaban, rivaroxaban or dabigatran; and admitted to the Repatriation General Hospital between April 2014 and July 2015. A list of clinically relevant ‘perpetrator’ drugs was compiled from product information, the Australian Medicines Handbook, the Australian National Prescribing Service resources, and local health network guidelines. The prevalence and nature of potential DDIs with DOACs was determined by comparing inpatient drug charts with the list of perpetrator drugs. Results: There were 122 patients in the study with a mean age of 82 years. Most patients had nonvalvular atrial fibrillation and were taking DOACs to prevent thrombotic stroke (83%). Overall, 45 patients (37%) had a total of 54 potential DDIs. Thirty-five patients had potential pharmacodynamic DDIs with antidepressants, nonsteroidal anti-inflammatory drugs and antiplatelets (35/122, 29%). Nineteen patients had potential pharmacokinetic DDIs (19/122, 16%). Of these, 68% (13/19) were taking drugs that increase DOAC plasma concentrations (amiodarone, erythromycin, diltiazem or verapamil) and 32% (6/19) were taking drugs that decrease DOAC plasma concentrations (carbamazepine, primidone or phenytoin). There were no cases of patients taking contraindicated interacting drugs. Discussion: Potential DDIs with DOACs in elderly hospital inpatients are relatively common, particularly interactions that may increase the risk of bleeding. The risk–benefit ratio of DOACs in elderly patients on polypharmacy should always be carefully considered.

scholarly journals Potential Drug-Drug Interactionsamong Adult Patients Admitted to MedicalWards at a Tertiary Teaching Hospital inEthiopia

2018 ◽  
Vol 8 (5-s) ◽  
pp. 348-354 ◽  
Author(s):  
Samson Kibrom ◽  
Zelalem Tilahun ◽  
Solomon Assefa Huluka
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Teaching Hospital ◽  
Adult Patients ◽  
Potential Drug ◽  
Potential Ddis ◽  
Pharmacodynamic Interaction ◽  
Cross Sectional ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

  Abstract Introduction: A Drug-drug interaction (DDI) is a decrease or increase in the pharmacological or clinical response to the administration of two or more drugs that are different from the anticipated response they initiate when individually administered. Objectives: To assess the prevalence and factors associated with potential DDIs among adult inpatients admitted to the medical wards of a tertiary teaching Hospital in Ethiopia. Methods: A retrospective cross-sectional study design was employed on adult patients who were admitted to the medical ward in one year period. A total of 384patients’ medical records were checked for a possible DDI using Micromedex DrugReax® drug interaction database and analyzed consecutively using SPSS version 20.0. Results: Among 384 adult patients enrolled in the study, 209 (54.4%) of them had medications with at least one potential DDI in their prescriptions. Of the 209 potential DDI, 26.3% were with a minimum of one major potential DDI. The median number of potential DDI per patient was 2.2. Overall, 296 potential DDI were identified in the current study. Among 296 identified potential drug-drug interactions, most of the interaction (49.7%) had good documentation. The number of medication prescribed per patient showed a significant (p< 0.001) association with the occurrence of potential DDIs. Conclusion: More than half of the patients’ prescription contains potentially interacting medications. This study, additionally, revealed that there is a significant association between potential DDIs and number of medications prescribed per patient. Key words: Drug-drug interactions, pharmacokinetic interaction, pharmacodynamic interaction, internal medicine

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