Polypharmacy and the occurrence of potential drug–drug interactions among geriatric patients at the outpatient pharmacy department of a regional hospital in Durban, South Africa

Abstract Background Polypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice. Little is known about this practice in South Africa. This study aimed to determine the level of polypharmacy and potential drug–drug interactions amongst the geriatric patient population in a facility in South Africa. Method A cross-sectional retrospective prescription chart review for 250 geriatric patients was conducted at the outpatient pharmacy department of a regional hospital. Variables extracted included demographic information, diagnosis, type of prescriber contact, and polypharmacy. Potential drug–drug interactions were determined with web-based multi-drug interaction checkers. Results The average (SD) number of diagnosed clinical problems was 3.54 ± 1.26, with hypertension, diabetes mellitus, and heart disease occurring most frequently. The level of polypharmacy was high with patients receiving an average (SD) of 12.13 ± 4.25 prescribed medicines from 3032 prescribed medicines. The level of polypharmacy was highest within the age categories, 60–64, and 70–74 years of age, respectively. The level of potential drug–drug interactions was also high with an average (SD) of 10.30 ± 7.48 from 2570 potential drug interactions. The majority of these interactions were moderate (72.5%) and pharmacodynamic (73.2%) by nature of the clinical severity of action and mechanism of action, respectively. Polypharmacy and type of prescriber contact were statistically significant contributors to the occurrence of potential drug–drug interactions, (F (2, 249) = 68.057, p < 0.05). However, in a multivariate analysis of variables to determine the strength of the association, polypharmacy was determined to be the strongest contributor to the occurrence of potential drug–drug interactions (p < 0.05) when compared with the type of prescriber contact (p value = 0.467). Therefore, irrespective of the type of prescriber contact, polypharmacy increases the potential for drug interactions among the sampled patient population. Conclusion A comprehensive consideration of disease management guidelines, patient factors, and rational medicine review could be measurable strategies towards improving medicine use. This would also limit the occurrence of significant drug interactions among the geriatric patient population. A national study is required to determine if differences occur across hospitals and regions.

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Identification of potential drug–drug interactions between antiretroviral drugs from prescriptions in the private health-care sector in South Africa

International Journal of STD & AIDS ◽

10.1258/ijsa.2009.009343 ◽

2012 ◽

Vol 23 (3) ◽

pp. 166-172 ◽

Cited By ~ 2

Author(s):

N L Katende-Kyenda ◽

M S Lubbe ◽

J H P Serfontein ◽

I Truter

Keyword(s):

South Africa ◽

Health Care ◽

Drug Interactions ◽

Antiretroviral Drugs ◽

Health Care Sector ◽

Potential Drug ◽

Private Health Care

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Potential drug-drug interactions among patients with chronic kidney disease admitted at National Hospital: a retrospective study in Tanzania

10.21203/rs.2.21799/v1 ◽

2020 ◽

Author(s):

Wigilya Mikomangwa ◽

Jephter E. Malifa ◽

Hamu Mlyuka ◽

Ritah Mutagonda ◽

Manase Kilonzi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Drug Interactions ◽

P Value ◽

Potential Drug ◽

National Hospital ◽

Prescribed Medicines ◽

Prolonged Hospital ◽

Social Demographic

Abstract Background: Drug related problems such as drug-drug interactions (DDI) are likely to occur in chronic kidney disease (CKD) patients due to polypharmacy practice. The DDI increases the risk of morbidity, mortality, prolonged hospital and cost of treatment. In most cases, the potential drug-drug interactions (pDDI) are not checked during prescribing or dispensing of polypharmacy for CKD patients in developing countries like Tanzania. Therefore, we documented the pattern and potential drug-drug interactions (DDIs) among CKD patients admitted at Muhimbili National Hospital (MNH).Methods: The study retrospectively reviewed 198 files for CKD patients admitted at MNH between January 2017 and December 2018. The social-demographic characteristics and comorbidities were documented using a checklist. Prescriptions with polypharmacy were reviewed and prescribed medicines were documented. Medscape drug interaction checker was used for pDDIs. The SPSS version 23.0 was used to carry out statistical analysis. Results: The study involved a total of 306 prescriptions with polypharmacy with a mean(±SD) of 6.21(±1.22) medicines per prescription. Majority of patients (77.2%) were in stage 5 of chronic kidney disease. Frequently prescribed medicines were pantoprazole 135(44.1%), furosemide 133(43.5%), ferrotone 101(33.0%), calcium carbonate 91(29.7%), amlodipine 121(39.5%), nifedipine 83(27.1%), bisoprolol 46(15.0%) and clonidine 38(12.4). The prevalence of pDDIs was 94.1%. The total of 1743 potential drug-drug interactions was observed with a mean of 6.03(±2.12) interactions per prescription. Majority of the pDDIs were moderate (67.5%) whereas, 29.5%, 2.6% and 0.3 were minor, serious and contraindicated respectively. The occurrence of pDDIs was associated with stroke (P-value=0.038), diabetes mellitus (p-value=0.049) and hypertension with diabetes mellitus (p-value=0.047).Conclusion: The prevalence of pDDIs was high among the CKD patients. The determinants of pDDIs among CKD patients were hypertension, diabetes mellitus and stroke. Interaction checkers should be incorporated in health system to guide the prescribing and dispensing of medicine for CKD patients.

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Polypharmacy and potential drug-drug interactions among geriatric patients

National Journal of Physiology Pharmacy and Pharmacology ◽

10.5455/njppp.2020.10.02055202017032020 ◽

2020 ◽

pp. 1

Author(s):

Bhavisha Vegada ◽

Amit Shah ◽

Deep Shah ◽

Karishma Mogal ◽

Hirva Santoki ◽

...

Keyword(s):

Drug Interactions ◽

Geriatric Patients ◽

Potential Drug

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Lithium Side Effects in the Medically Ill

The International Journal of Psychiatry in Medicine ◽

10.2190/vdll-d9lh-eve9-d1k2 ◽

1993 ◽

Vol 23 (4) ◽

pp. 357-382 ◽

Cited By ~ 8

Author(s):

W. Alexander Morton ◽

Susan C. Sonne ◽

R. Bruce Lydiard

Keyword(s):

Side Effects ◽

Literature Review ◽

Drug Interactions ◽

Drug Monitoring ◽

Geriatric Patient ◽

Potential Drug ◽

Medical Problems ◽

Medically Ill ◽

Organ Systems ◽

General Pharmacology

Objective: This review will include the general pharmacology of lithium and discuss its effects on various organ systems, with emphasis on the medically ill patient as well as the geriatric patient with multiple medical problems. Methods: A full literature review on the side effects of lithium was performed. Attention is focused on the medically ill and possible drug interactions. Results: This review points to the numerous problems which can result in toxicity in the medically ill or the geriatric patient. Conclusion: Serious side effects can be avoided with proper drug monitoring and knowledge of potential drug interactions.

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Determining potential drug-drug interactions between lopinavir/ritonavir and other antiretrovirals and prescribed daily doses in a section of the private health care sector in South Africa

African Journal of Pharmacy and Pharmacology ◽

10.5897/ajpp11.776 ◽

2013 ◽

Vol 7 (41) ◽

pp. 2727-2733

Author(s):

L. Katende-Kyenda

Keyword(s):

South Africa ◽

Health Care ◽

Drug Interactions ◽

Health Care Sector ◽

Potential Drug ◽

Private Health Care

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The Risk of Drug-Drug Interactions with Paracetamol in a Population of Hospitalized Geriatric Patients

Journal of Pharmaceutics ◽

10.1155/2020/1354209 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Lykke Ida Kaas Oldenburg ◽

Kim Peder Dalhoff ◽

Luana Østerdal Sandoval ◽

Charlotte Vermehren

Keyword(s):

At Risk ◽

Drug Interactions ◽

Geriatric Patients ◽

Geriatric Medicine ◽

Potential Drug ◽

Clinical Probability ◽

Patients At Risk ◽

Concomitant Medications ◽

Hospitalized Geriatric Patients

Aims. This study investigates the consumption of paracetamol and the risk of potential drug-drug interactions and assesses the clinical impact hereof in patients admitted to a department of geriatric medicine. Methods. A retrospective and longitudinal study was conducted in patients who had been receiving paracetamol upon or during hospitalization. The hospital files of the included patients were reviewed, including documentation of concomitant medications, diagnoses, biochemical values, and adverse incidents during admission. These parameters were used as a clinical follow-up when assessing a clinical probability impact of the identified drug-drug interactions. Results. In total, 104 patients were admitted during the study period. 91 (87.5%) of these (mean age 86 years) received a prescription or were treated with paracetamol. Of these, 10% were evaluated as being at risk of potential drug-drug interactions with paracetamol. Seven of the potential drug-drug interactions were related to treatments with warfarin, one with valsartan and one with phenytoin. Of the nine patients at risk, six did experience either abnormal biochemical values or potential related clinical incidents. Four patients experienced increased INR (range 3.2–4.6), of which one patient suffered from anaemia and one with hematemesis. Two patients experienced increased ALAT/ASAT (55/42 U/I and 87/51 U/I, both females). One experienced hypertension. Conclusion. A large majority of the patients in this study received treatment with paracetamol. Six patients were evaluated as having abnormal biochemical values or were experiencing clinical incidents during their hospitalization potentially related to the identified potential drug-drug interactions.

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Study of potential drug interactions between prescribed drugs in geriatric patients attending outpatient department in a government tertiary care hospital in Maharashtra

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20162474 ◽

2016 ◽

pp. 1569-1573 ◽

Cited By ~ 1

Author(s):

Tushar Nishandar ◽

Anand Kale ◽

Harshal Pise

Keyword(s):

Drug Interactions ◽

Geriatric Patients ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Outpatient Department ◽

Care Hospital ◽

Potential Drug

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Drug-Drug Interactions in Hepatitis Patients: Do these Interactions Matter in Clinical Perspectives?

Annals of Hepatology ◽

10.5604/01.3001.0012.2238 ◽

2018 ◽

Vol 17 (5) ◽

pp. 0-10

Author(s):

Sidra Noor ◽

Mohammad Ismail ◽

Iqbal Haider ◽

Faiza Khadim

Keyword(s):

Drug Interactions ◽

Clinical Relevance ◽

Retrospective Cohort ◽

Adverse Outcomes ◽

Potential Drug ◽

Moderate Severity ◽

Risk Patients ◽

Clinical Profiles ◽

Prescribed Medicines ◽

Pedal Edema

Introduction and aim. Hepatitis patients usually present with comorbidities and polypharmacy which increases risk of potential drug-drug interactions (pDDIs). We explored frequency, levels, predictors, and clinical relevance of pDDIs in hospitalized hepatitis patients. Methods. Retrospective cohort study was used. Clinical profiles of 413 hepatitis patients were reviewed for pDDIs using Micromedex-DrugReax. Frequency, levels and clinical relevance of pDDIs were reported. Logistic regression analysis was used to calculate odds-ratios for predictors. Results. Of total 413 patients, pDDIs were reported in 55.2%. Major-pDDIs were found in 35% patients. Total 660 pDDIs were identified, of which, 304 (46%) were of major-severity and 299 (45%) of moderate-severity. Patient’s profiles of top-10 major-pDDIs were presented with signs/symptoms such as fever, hepatomegaly, anorexia, jaundice, hypertension, tachycardia, bradycardia, & pedal edema; and abnormalities in labs such as electrolytes-level, alanine aminotransferase, blood urea nitrogen, bilirubin-level, & serum creatinine. Significant association was observed for the presence of pDDIs with >9 prescribed medicines (p < 0.001), hospitalization of >5 days (p = 0.03), and stroke as comorbidity (p = 0.05). Moreover, odds of exposure to major-pDDIs were significantly higher in patients taking >9 prescribed medicines (p < 0.001), hospitalization of >5 days (p = 0.002), and stroke as comorbidity (p = 0.002). Conclusion. We observed hepatitis patients present with a considerable number of clinically relevant pDDIs. Attention should be given to widespread major-pDDIs and their potential adverse outcomes. Clinically relevant parameters, such as labs and signs/symptoms should be monitored particularly in high risk patients having polypharmacy, prolong hospitalization, and stroke as comorbidity.

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