Impact of Patient-Specific Drug Interaction Information on Physician Prescribing Patterns

Patient exposure to potential anticoagulant drug interactions was identified by computerized drug-therapy surveillance, as part of a peer-review program. To evaluate the response of clinicians provided with data on the potential drug interactions, 119 “exposed” patients were randomly divided and assigned to study or control groups. Physicians prescribing for the 60 study patients were informed of the potential problem by letter and were furnished with information on the drug interaction, while the 59 control patients were only monitored. Physicians provided with the information made statistically more changes in drug therapy than those not informed ( p < 0.05). Over 75 percent of study-patient physicians responding to a questionnaire accompanying the drug interaction data indicated that the service was useful and should be expanded to other drugs. Application of methods similar to that used in this study should offer drug utilization review committees an effective approach to improving drug therapy.

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Drug-drug interactions in an era of multiple anticoagulants: a focus on clinically relevant drug interactions

Hematology ◽

10.1182/asheducation-2018.1.339 ◽

2018 ◽

Vol 2018 (1) ◽

pp. 339-347 ◽

Cited By ~ 6

Author(s):

Sara R. Vazquez

Keyword(s):

Drug Interaction ◽

Adverse Events ◽

Drug Interactions ◽

Selective Serotonin Reuptake Inhibitors ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Management Strategies ◽

Antiplatelet Agents ◽

Anticoagulant Drug ◽

Interaction Management

Abstract Oral anticoagulants are commonly prescribed but high risk to cause adverse events. Skilled drug interaction management is essential to ensure safe and effective use of these therapies. Clinically relevant interactions with warfarin include drugs that modify cytochrome 2C9, 3A4, or both. Drugs that modify p-glycoprotein may interact with all direct oral anticoagulants, and modifiers of cytochrome 3A4 may interact with rivaroxaban and apixaban. Antiplatelet agents, nonsteroidal anti-inflammatory drugs, and serotonergic agents, such as selective serotonin reuptake inhibitors, can increase risk of bleeding when combined with any oral anticoagulant, and concomitant use should be routinely assessed. New data on anticoagulant drug interactions are available almost daily, and therefore, it is vital that clinicians regularly search interaction databases and the literature for updated management strategies. Skilled drug interaction management will improve outcomes and prevent adverse events in patients taking oral anticoagulants.

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Analisis Hubungan Polifarmasi Dan Interaksi Obat Pada Pasien Rawat Jalan Yang Mendapat Obat Hipertensi Di Rsp. Dr. Ario Wirawan Periode Januari-Maret 2019

Indonesian Journal of Pharmacy and Natural Product ◽

10.35473/ijpnp.v2i2.280 ◽

2019 ◽

Vol 2 (2) ◽

Author(s):

Lamtiar Parulian Parulian ◽

Ening Listyanti ◽

Anita Kumala Hati ◽

Istianatus Sunnah

Keyword(s):

Drug Interaction ◽

Drug Therapy ◽

Drug Interactions ◽

Trends in Prescribing Patterns and Drug Related Problems of Kidney Disease Patients

Journal of the Pakistan Medical Association ◽

10.47391/jpma.01816 ◽

2021 ◽

Vol 71 (11) ◽

pp. 2629-2636

Author(s):

Muhammad Arfat Yameen ◽

Mubashra Tafseer ◽

Warda Khan ◽

Sanaa Anjum ◽

Raza-E-Mustafa ◽

...

Keyword(s):

Drug Interaction ◽

Kidney Disease ◽

Drug Interactions ◽

Professional Staff ◽

Prescribing Patterns ◽

Dose Error ◽

Drug Related Problems ◽

Prescribing Trends ◽

Nephrotoxic Drugs ◽

Drug Drug Interaction

Objective: The aim of the study was the evaluation of drug-related problems, including drug-drug interactions, dose error, use of nephrotoxic drugs and polypharmacy with special emphasis on kidney disease patients. Methods: Descriptive cross-sectional study from January to April 2019 was carried out in nephrology ward of Ayub teaching hospital, Abbottabad, Pakistan to review patient’s medication orders for evaluation of drug-related problems. Doses of medicine and drug-drug interactions were evaluated by comparing it with standard protocols given in BNF and Lexicomp software. Prescriptions were also evaluated for polypharmacy and use of nephrotoxic drugs. Results: Out of 131 patients, majority were males 72 (55%). Drug-drug interactions were found in 69 (52.7%) patients among which the highest percentage was of the moderate drug-drug interaction (48.1%) followed by major and minor drug-drug interaction (29.8% and 20.6% respectively). Incidence of polypharmacy (51.9%) and use of nephrotoxic drug (77%) was high while dose error was low up to 10.7%. All the drug-related problems were present with a high percentage in patients with CKD as compare to other kidney diseases. There was significant association of CKD stages with DDIs, polypharmacy, dose error and prescribing drugs. There was significant positive correlation among DDIs-polypharmacy and prescribing drugs was noted in the study. Conclusion: The higher incidence of drug-related problems in our study setting reflects irrational prescribing trends and deficiency of professional staff dealing kidney disease patients. Key Words: kidney disease, drug-drug interactions, polypharmacy, nephrotoxic drugs, dose error. Continuous...

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Identifying and Communicating Clinically Meaningful Drug–Drug Interactions

Journal of Pharmacy Practice ◽

10.1177/0897190014544793 ◽

2014 ◽

Vol 29 (2) ◽

pp. 110-115 ◽

Cited By ~ 1

Author(s):

Scott D. Nelson ◽

Joanne LaFleur ◽

Emily Hunter ◽

Melissa Archer ◽

Carin Steinvoort ◽

...

Keyword(s):

Drug Therapy ◽

Drug Interactions ◽

Sleep Disorders ◽

Systematic Approach ◽

Pharmacy Practice ◽

Drug Regimen ◽

Patient Specific ◽

Multiple Drug ◽

Medical Problems ◽

Multiple Drug Therapy

Objective: Providing care to patients with comorbid medical problems may result in complicated, multiple drug therapy regimens, increasing the risk of clinically meaningful drug–drug interactions (DDIs). The purpose of this article is to describe the prevalence of DDIs and provide examples on how to identify and intervene on DDIs. Methods: We described DDI data from the Utah Drug Regimen Review Center, where adult Medicaid patients were reviewed by pharmacists from 2005 to 2009. Patients were selected by the number of prescriptions filled per month (>7) or having a high RxRisk score. Summary: A total of 8860 patients were reviewed, and 16.6% had at least 1 clinically meaningful DDI. Patients with DDIs were slightly younger (mean age 45.2 vs 48.2), more likely to be female (75.0% vs 68.9%), and had more prescriptions per month (13.4 vs 12.5) compared to patients without ( P < .001). Pharmacodynamic DDIs were more prevalent (80.2%) than pharmacokinetic. Pharmacodynamic DDIs mainly occurred with drugs used to treat psychiatric/seizure/sleep disorders (69.4%) and pain/migraine (56.6%). Pharmacokinetic DDIs mainly occurred with drugs used to treat psychiatric/seizure/sleep disorders (53.2%), cardiovascular diseases (46.3%), and infectious diseases (29.6%). Conclusions: Clinically meaningful DDIs are common in patients with complex medication regimens. A systematic approach for identifying DDIs, determining clinical significance, formulating patient-specific recommendations, and communicating recommendations is important in pharmacy practice.

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Drug-drug interactions in an era of multiple anticoagulants: a focus on clinically relevant drug interactions

Blood ◽

10.1182/blood-2018-06-848747 ◽

2018 ◽

Vol 132 (21) ◽

pp. 2230-2239 ◽

Cited By ~ 17

Author(s):

Sara R. Vazquez

Keyword(s):

Drug Interaction ◽

Adverse Events ◽

Drug Interactions ◽

Selective Serotonin Reuptake Inhibitors ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Management Strategies ◽

Antiplatelet Agents ◽

Anticoagulant Drug ◽

Interaction Management

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Drug Compatibility in Treatment of Chronic Infectious Diseases

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2021-11-5-344-358 ◽

2021 ◽

Vol 11 (5) ◽

pp. 344-358

Author(s):

E. S. Bazrova ◽

G. D. Kaminskiy ◽

L. Yu. Ilchenko ◽

A. Маtin ◽

I. G. Nikitin

Keyword(s):

Drug Interaction ◽

Drug Therapy ◽

Adverse Effects ◽

Drug Metabolism ◽

Infectious Diseases ◽

Drug Interactions ◽

Therapeutic Effect ◽

Patient Adherence ◽

Drug Compatibility

The article considers the features of pharmacotherapy of patients with chronic infectious diseases and co-morbidities in conditions of polypharmacy, the principles of drug metabolism, variants of adverse effects and drug-drug interactions, the possibilities of effective drug combinations. The purpose is to substantiate the possibility and emphasize the relevance of the additional search of the creation of the most optimal combinations of drugs for long-term and massive pharmacotherapy, that could be due to a beneficial drug-drug interaction, optimization of the regimen, route of drug administration and multitarget of the therapeutic effect, reduce the pharmacological load while maintaining the effectiveness of the treatment, increase patient adherence to drug therapy.

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Kajian Interaksi Obat Metformin pada Pasien Diabetes Mellitus

Jurnal Farmasetis ◽

10.32583/farmasetis.v8i2.592 ◽

2019 ◽

Vol 8 (2) ◽

pp. 55-58

Author(s):

Havizur Rahman ◽

Teresia Anggi Octavia

Keyword(s):

Diabetes Mellitus ◽

Drug Interaction ◽

Data Collection ◽

Drug Interactions ◽

Degenerative Disease ◽

Moderate Severity ◽

Purposive Sampling ◽

Chronic Degenerative Disease ◽

Over Time ◽

Diabetes Melitus

Diabetes melitus merupakan penyakit degeneratif kronis yang apabila tidak ditangani dengan tepat, lama kelamaan bisa timbul berbagai komplikasi, ini cenderung menyebabkan pasien mendapatkan banyak obat dalam satu resep yang dapat menimbulkan interaksi antar obat. Tujuan dari penelitian ini adalah mengetahui persentase terjadinya interaksi obat metformin secara teori serta mengkaji efek yang mungkin timbul dan solusinya. Teknik pengambilan data dengan purpossive sampling, yaitu resep pasien rujuk balik yang menderita diabetes mellitus yang menggunakan metformin. Data yang diperoleh ditemukan bahwa obat yang berinteraksi dengan metformin dengan tingkat keparahan minor ialah sebesar 60%. Kemudian untuk tingkat keparahan moderat ialah sebesar 20%. Sedangkan untuk tingkat keparahan mayor tidak ditemukan. Dari tabel diatas juga dapat diketahui bahwa terdapat 4 obat yang saling berinteraksi dengan metformin, sedangkan untuk obat yang tidak saling berinteraksi dengan metformin terdapat 9 obat. Jumlah obat yang berinteraksi secara teori sebesar 6,85% dan yang tidak berinteraksi 93,15%. Terdapat interaksi obat metformin dengan beberapa obat yaitu furosemid, lisinopril, acarbose dan ramipril. Kata kunci: interaksi obat, metformin, diabetes mellitus STUDY OF METFORMIN INTERACTION IN MELLITUS DIABETES PATIENTS ABSTRACT Mellitus is a chronic degenerative disease which if not handled properly, over time can arise various complications, this tends to cause patients to get many drugs in one recipe that can cause interactions between drugs. The purpose of this study is to determine percentage of metformin drug interactions in theory and examine the effects that may arise and solutions. Data collection techniques using purposive sampling, which is a recipe for reconciliation patients who suffer from diabetes mellitus using metformin. The data obtained it was found that drugs that interact with metformin with minor severity were 60%. Then for moderate severity is 20%. Whereas the major severity was not found. From the table above it can also be seen that there are 4 drugs that interact with metformin, while for drugs that do not interact with metformin there are 9 drugs. The number of drugs that interacted theoretically was 6.85% and 93.15% did not interact. An interaction of the drug metformin with several drugs namely furosemide, lisinopril, acarbose and ramipril. Keywords: drug interaction, metformin, diabetes mellitus

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Pharmacokinetic Drug-drug Interaction of Antibiotics Used in Sepsis Care in China

Current Drug Metabolism ◽

10.2174/1389200221666200929115117 ◽

2020 ◽

Vol 21 ◽

Author(s):

Xuan Yu ◽

Zixuan Chu ◽

Jian Li ◽

Rongrong He ◽

Yaya Wang ◽

...

Keyword(s):

Drug Interaction ◽

Drug Interactions ◽

Penicillin G ◽

Literature Mining ◽

Human Pharmacokinetics ◽

P450 Enzyme ◽

Drug Drug Interaction ◽

Pharmacokinetic Drug ◽

Sepsis Care

Background: Many antibiotics have a high potential for having an interaction with drugs, as perpetrator and/or victim, in critically ill patients, and particularly in sepsis patients. Methods: The aim of this review is to summarize the pharmacokinetic drug-drug interaction (DDI) of 45 antibiotics commonly used in sepsis care in China. Literature mining was conducted to obtain human pharmacokinetics/dispositions of the antibiotics, their interactions with drug metabolizing enzymes or transporters, and their associated clinical drug interactions. Potential DDI is indicated by a DDI index > 0.1 for inhibition or a treated-cell/untreated-cell ratio of enzyme activity being > 2 for induction. Results: The literature-mined information on human pharmacokinetics of the identified antibiotics and their potential drug interactions is summarized. Conclusion: Antibiotic-perpetrated drug interactions, involving P450 enzyme inhibition, have been reported for four lipophilic antibacterials (ciprofloxacin, erythromycin, trimethoprim, and trimethoprim-sulfamethoxazole) and three lipophilic antifungals (fluconazole, itraconazole, and voriconazole). In addition, seven hydrophilic antibacterials (ceftriaxone, cefamandole, piperacillin, penicillin G, amikacin, metronidazole, and linezolid) inhibit drug transporters in vitro. Despite no reported clinical PK drug interactions with the transporters, caution is advised in the use of these antibacterials. Eight hydrophilic antibacterials (all β-lactams; meropenem, cefotaxime, cefazolin, piperacillin, ticarcillin, penicillin G, ampicillin, and flucloxacillin), are potential victims of drug interactions due to transporter inhibition. Rifampin is reported to perpetrate drug interactions by inducing CYP3A or inhibiting OATP1B; it is also reported to be a victim of drug interactions, due to the dual inhibition of CYP3A4 and OATP1B by indinavir. In addition, three antifungals (caspofungin, itraconazole, and voriconazole) are reported to be victims of drug interactions because of P450 enzyme induction. Reports for other antibiotics acting as victims in drug interactions are scarce.

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Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽

10.3390/medicines8080044 ◽

2021 ◽

Vol 8 (8) ◽

pp. 44

Author(s):

Mary Beth Babos ◽

Michelle Heinan ◽

Linda Redmond ◽

Fareeha Moiz ◽

Joao Victor Souza-Peres ◽

...

Keyword(s):

Drug Interaction ◽

Case Report ◽

Drug Interactions ◽

Clinical Studies ◽

Drug Information ◽

Case Reports ◽

Full Information ◽

Information Need ◽

Herbal Products ◽

Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

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