scholarly journals Drug–drug interactions between treatment specific pharmacotherapy and concomitant medication in patients with COVID-19 in the first wave in Spain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. D. Cantudo-Cuenca ◽  
Antonio Gutiérrez-Pizarraya ◽  
Ana Pinilla-Fernández ◽  
Enrique Contreras-Macías ◽  
M. Fernández‑Fuertes ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Concomitant Medication ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Hospital ◽  
Anatomical Therapeutic Chemical Classification ◽  
Factors Associated ◽  
Mechanism Of Interaction ◽  
Concomitant Medications ◽  
The University ◽  
Potential Interactions

AbstractPrimary aim was to assess prevalence and severity of potential and real drug–drug interactions (DDIs) among therapies for COVID-19 and concomitant medications in hospitalized patients with confirmed SARS-CoV-2 infection. The secondary aim was to analyze factors associated with rDDIs. An observational single center cohort study conducted at a tertiary hospital in Spain from March 1st to April 30th. rDDIs refer to interaction with concomitant drugs prescribed during hospital stay whereas potential DDIs (pDDIs) refer to those with domiciliary medication. DDIs checked with The University of Liverpool resource. Concomitant medications were categorized according to the Anatomical Therapeutic Chemical classification system. Binomial logistic regression was carried out to identify factors associated with rDDIs. A total of 174 patients were analyzed. DDIs were detected in 152 patients (87.4%) with a total of 417 rDDIs between COVID19-related drugs and involved hospital concomitant medication (60 different drugs) while pDDIs were detected in 105 patients (72.9%) with a total of 553 pDDIs. From all 417 rDDIs, 43.2% (n = 180) were associated with lopinavir/ritonavir and 52.9% (n = 221) with hydroxychloroquine, both of them the most prescribed (106 and 165 patients, respectively). The main mechanism of interaction observed was QTc prolongation. Clinically relevant rDDIs were identified among 81.1% (n = 338) (‘potential interactions’) and 14.6% (n = 61) (contraindicated) of the patients. Charlson index (OR 1.34, 95% IC 1.02–1.76) and number of drugs prescribed during admission (OR 1.42, 95% IC 1.12–1.81) were independently associated with rDDIs. Prevalence of patients with real and pDDIs was high, especially those clinically relevant. Both comorbidities and polypharmacy were found as risk factors independently associated with DDIs development.

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 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.

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.

scholarly journals POS0486 FACTORS ASSOCIATED WITH CHRONOTROPIC RESPONSE IN PEOPLE WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 475.2-476
Author(s):  
A. Osailan
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiorespiratory Fitness ◽  
Inflammatory Markers ◽  
Exercise Intolerance ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Chronotropic Response ◽  
Factors Associated ◽  
The University

Background:People with rheumatoid arthritis (RA) are at high risk for cardiovascular diseases (CVD) and CVD mortality. Reduced Chronotropic response (CR), which produces exercise intolerance, is known as a contributing factor to CVD and mortality. Studies have shown that people with RA have reduced CR. However, knowledge about the factors associated with CR in people with RA is limited.Objectives:To explore the factors associated with CR including CVD risk factors, inflammatory markers and cardiorespiratory fitness (VO2 peak).Methods:106 people with RA completed a treadmill exercise tolerance test while heart rate (HR) was monitored via 12 leads ECG. CR was defined as the percentage of [(achieved peak HR minus resting HR) divided by (age-predicted maximum HR minus resting HR)]. Serological CVD risk factors and inflammatory markers including lipids profile, markers of insulin resistance and sensitivity (HOMA, QUICKi), high sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), fibrinogen and white blood cells (WBC) were examined via a fasted blood sample. VO2 peak was assessed via breath-by-breath gas analysis.Results:34% had reduced CR based on the cut-off value (≤ 80%) and the average CR was 86.2 ± 21%. Body mass index (r=-0.33, p=.001), HOMA (r=-0.26, p=.009), hsCRP (r=-0.23, p=.02), ESR (r=-0.21, p=.04), fibrinogen (r=-0.2, p=.05), WBC (r=-0.21, p=.04) were inversely associated with CR, whereas, high density lipoprotein (HDL) (r=0.43, p<.001), QUICKi (r=0.31, p=.002), and VO2 peak (r=0.4, p<.001) were positively associated with CR. When all the variables were entered into a stepwise linear regression, HDL (p<.001) and VO2 peak (p=.009) were independently associated with CR.Conclusion:The current findings suggest that CR in RA was associated with many CVD risk factors, inflammatory markers, and cardiorespiratory fitness. Among all the varibales, HDL and cardiorespiratory fitness were moderately and independently associated with CR. Future studies should investigate the effect of improving these associated variables on CR in people with RA via exercise training programes.Acknowledgements:Thanks to physical activity in Rheumatoid arthritis research team and Research department in Dudley Hospital. Sincere appreciation and gratitude to Dr Jet Veldhuizen van Zanten, Prof. Joan Duda, and Prof. George Kitas from the University of Birmingham and Prof. George Metsios from the University of Wolverhampton.Disclosure of Interests:None declared

Enhancing the professional dignity of midwives: A phenomenological study

2017 ◽  
Vol 26 (4) ◽  
pp. 1062-1074 ◽  
Author(s):  
Christelle Froneman ◽  
Neltjie C van Wyk ◽  
Ramadimetja S Mogale
Keyword(s):  
Research Design ◽  
Phenomenological Study ◽  
Tertiary Hospital ◽  
Ethical Considerations ◽  
Optimal Care ◽  
Team Members ◽  
University Of Pretoria ◽  
Phenomenological Research Design ◽  
The University ◽  
Depth Interviews

Background: When midwives are not treated with respect and their professional competencies are not recognised, their professional dignity is violated. Objective: This study explored and described how the professional dignity of midwives in the selected hospital can be enhanced based on their experiences. Research design: A descriptive phenomenological research design was used with in-depth interviews conducted with 15 purposely selected midwives. Ethical considerations: The Faculty of Health Sciences Research Ethics Committee of the University of Pretoria approved the study. The research was conducted in an academic tertiary hospital with voluntary participants. Findings: To dignify midwives it is essential to enhance the following: ‘to acknowledge the capabilities of midwives’, ‘to appreciate interventions of midwives’, ‘to perceive midwives as equal health team members’, ‘to invest in midwives’, ‘to enhance collegiality’, ‘to be cared for by management’ and ‘to create conducive environments’. Conclusion: The professional dignity of midwives is determined by their own perspectives of the contribution that they make to the optimal care of patients, the respect that they get from others and the support that hospital management gives them. With support and care, midwives’ professional dignity is enhanced. Midwives will strive to render excellent services as well as increasing their commitment.

scholarly journals Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

2016 ◽  
Vol 17 (5) ◽  
pp. 618-624 ◽  
Author(s):  
Thomas J. Wilson ◽  
Kate W. C. Chang ◽  
Suneet P. Chauhan ◽  
Lynda J. S. Yang
Keyword(s):  
Brachial Plexus ◽  
Prediction Algorithm ◽  
University Of Michigan ◽  
Brachial Plexus Palsy ◽  
Factors Associated ◽  
Neonatal Brachial Plexus Palsy ◽  
Active Range Of Motion ◽  
Wide Range ◽  
Nerve Surgery ◽  
The University

OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.

scholarly journals Hierarchy of evidence in interpretation of clinical significance of drug interactions

2012 ◽  
Vol 65 (1-2) ◽  
pp. 45-49
Author(s):  
Bozana Nikolic ◽  
Miroslav Savic
Keyword(s):  
Drug Metabolism ◽  
Drug Interactions ◽  
Clinical Significance ◽  
Health Professionals ◽  
Molecular Entity ◽  
Population Pharmacokinetic ◽  
Pharmacokinetic Studies ◽  
Potential Interactions

Introduction. Since drug interactions may result in serious adverse effects or failure of therapy, it is of huge importance that health professionals base their decisions about drug prescription, dispensing and administration on reliable research evidence, taking into account the hierarchy of data sources for evaluation. Clinical Significance of Potential Interactions - Information Sources. The sources of data regarding drug interactions are numerous, beginning with various drug reference books. However, they are far from uniformity in the way of choosing and presenting putative clinically relevant interactions. Clinical Significance of Potential Interactions - Interpretation of Information. The difficulties in interpretation of drug interactions are illustrated through the analysis of a published example involving assessment made by two different groups of health professionals. Systematic Evaluation of Drug-Drug Interaction. The potential for interactions is mainly investigated before marketing a drug. Generally, the in vitro, followed by in vivo studies are to be performed. The major metabolic pathways involved in the metabolism of a new molecular entity, as well as the potential of induction of human enzymes involved in drug metabolism are to be examined. In the field of interaction research it is possible to make use of the population pharmacokinetic studies as well as of the pharmacodynamic assessment, and also the postregistration monitoring of the reported adverse reactions and other literature data. Conclusion. In vitro and in vivo drug metabolism and transport studies should be conducted to elucidate the mechanisms and potential for drug-drug interactions. The assessment of their clinical significance should be based on well-defined and validated exposure-response data.

Influence of Concomitant Polypharmacy on Docetaxel-induced Febrile Neutropenia

2021 ◽  
Vol 1 (3) ◽  
pp. 135-141
Author(s):  
KATSUYA MAKIHARA ◽  
YUKA SHIMEDA ◽  
TOMOKAZU MATSUMURA
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Febrile Neutropenia ◽  
Confidence Interval ◽  
Cytochromes P450 ◽  
Cyp3a4 Activity ◽  
Factors Associated ◽  
Cyp3a4 Inhibitors ◽  
Concomitant Medications ◽  
Main Factor

Background/Aim: Docetaxel (DTX) is metabolized by liver cytochromes P450 (CYP) 3A4 (CYP3A4) and 3A5 (CYP3A5) CYP3A4 activity is considered the main factor affecting the effectiveness in DTX clearance. We, therefore, explored the association between DTX-induced febrile neutropenia (FN) and concomitant polypharmacy involving CYP3A4 inhibitors in cancer patients. Patients and Methods: Among patients who received docetaxel, we compared the number of concomitant medications between patients with and without FN, and risk factors associated with FN were identified. Results: The total number of concomitant CYP3A4 inhibitors and substrates used was significantly higher in patients with FN [mean: 2.1 (95% confidence interval (CI)=1.5-2.9)] than in those without FN [mean: 1.4 (95% CI=1.0-1.8)] (p=0.01). The only risk factor for FN was the use of ≥2 concomitant CYP3A4 inhibitors and substrates in total (OR=4.82, 95% CI=1.77-14.1; p=0.002). Conclusion: Polypharmacy involving CYP3A4 inhibitors and substrates increases the risk of DTX-induced FN.

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