scholarly journals Reduction of drug-drug interaction and inappropriate prescription in polymedicated elderly who consult in the ambulatory

2021 ◽  
Vol 6 (4) ◽  
pp. 86-88
Author(s):  
Fajreldines A
Keyword(s):  
Drug Interaction ◽  
Adverse Events ◽  
Drug Interactions ◽  
The Elderly ◽  
Total Sample ◽  
Outpatient Setting ◽  
Inappropriate Drug ◽  
Inappropriate Prescription ◽  
Post Intervention ◽  
Drug Drug Interaction

Introduction: Older adults or elderly people over 64 years of age are patients more vulnerable to suffering adverse events related to medication, and this can generate states of both physical and psychological discomfort, loss of autonomy, mental disorders, etc. Objectives: To analyze the drug-drug interaction and inappropriate prescription of drugs in the outpatient setting in the elderly and implement barriers to reduce this problem. Materials and methods: Quasi-experimental study, of the before after type. The Beers 2019 criteria were used to assess inappropriate drug prescribing. The Uptodate definition of drug-drug interactions and their classification were used. Results: 203 polypathological, sarcopenic elderly patients were studied. These patients attended the outpatient consultation during the 2016-2018 period. 99 patients participated in the pre-intervention and 104 in the post-intervention. The distribution by sex was: 110 (54.2%) women and 93 (45.8%) men. The mean age was 77.3 + 13.3 years. In the total sample analyzed before the intervention, 33 (33.3%) showed inappropriate prescription of drugs criteria. Drug interactions in the pre-intervention were present in 51 patients (51.5%). After the intervention that consisted of training doctors with the Beers criteria and editing a list with clinically relevant interactions in the elderly, which can cause adverse events, inappropriate prescription was reduced to 26 patients (25%), p = 0.05, and clinically relevant interactions were reduced from 51 (51.51%) to 12 (11.53%), p = 0.003. The association between inappropriate prescription and clinically relevant interactions is OR: 3.23 (95% CI 1.91-3.88). Conclusions: The proportion of patients with inappropriate prescription is within the ranges published by various authors as well as drug interactions, the intervention was good to reduce the two problems in this sample of patients.

scholarly journals The Prevalence of Drug-Drug Interaction and Inappropriate Drug Prescription Among the Elderly in Kashan

2019 ◽  
pp. 183-192
Author(s):  
Mansour Dianati ◽  
Neda Mirbagher Ajorpaz ◽  
Mohammad Sajjad Lotfi ◽  
Maryam Najarzadeh
Keyword(s):  
Drug Interaction ◽  
Drug Prescription ◽  
The Elderly ◽  
Inappropriate Drug ◽  
Drug Drug Interaction

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

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.

Clinical Data Combined With Modeling and Simulation Indicate Unchanged Drug‐Drug Interaction Magnitudes in the Elderly

2020 ◽  
Author(s):  
Felix Stader ◽  
Perrine Courlet ◽  
Hannah Kinvig ◽  
Melissa A. Penny ◽  
Laurent A. Decosterd ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Modeling And Simulation ◽  
Clinical Data ◽  
The Elderly ◽  
Unchanged Drug ◽  
Drug Drug Interaction

Comparison of eight screening tools to detect interactions between herbal supplements and oncology agents

2020 ◽  
Vol 26 (8) ◽  
pp. 1843-1849
Author(s):  
Faisal Shakeel ◽  
Fang Fang ◽  
Kelley M Kidwell ◽  
Lauren A Marcath ◽  
Daniel L Hertz
Keyword(s):  
Drug Interaction ◽  
Positive Predictive Value ◽  
Drug Interactions ◽  
Predictive Value ◽  
Screening Tools ◽  
Herbal Supplements ◽  
Interaction Detection ◽  
Natural Medicine ◽  
Interaction Screening ◽  
Drug Drug Interaction

Introduction Patients with cancer are increasingly using herbal supplements, unaware that supplements can interact with oncology treatment. Herb–drug interaction management is critical to ensure optimal treatment outcomes. Several screening tools exist to detect drug–drug interactions, but their performance to detect herb–drug interactions is not known. This study compared the performance of eight drug–drug interaction screening tools to detect herb–drug interaction with anti-cancer agents. Methods The herb–drug interaction detection performance of four subscription (Micromedex, Lexicomp, PEPID, Facts & Comparisons) and free (Drugs.com, Medscape, WebMD, RxList) drug–drug interaction tools was assessed. Clinical relevance of each herb–drug interaction was determined using Natural Medicine and each drug–drug interaction tool. Descriptive statistics were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Linear regression was used to compare performance between subscription and free tools. Results All tools had poor sensitivity (<0.20) for detecting herb–drug interaction. Lexicomp had the highest positive predictive value (0.98) and best overall performance score (0.54), while Medscape was the best performing free tool (0.52). The worst subscription tools were as good as or better than the best free tools, and as a group subscription tools outperformed free tools on all metrics. Using an average subscription tool would detect one additional herb–drug interaction for every 10 herb–drug interactions screened by a free tool. Conclusion Lexicomp is the best available tool for screening herb–drug interaction, and Medscape is the best free alternative; however, the sensitivity and performance for detecting herb–drug interaction was far lower than for drug–drug interactions, and overall quite poor. Further research is needed to improve herb–drug interaction screening performance.

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

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 339-347 ◽  
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.

Inappropriate Drug Use in the Elderly: a Nationwide Register-Based Study

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1243-1248 ◽  
Author(s):  
Kristina Johnell ◽  
Johan Fastbom ◽  
Måns Rosén ◽  
Andrejs Leimanis
Keyword(s):  
Drug Use ◽  
Drug Interactions ◽  
Psychotropic Drugs ◽  
The Elderly ◽  
Inappropriate Drug ◽  
Anticholinergic Drugs ◽  
Elderly Persons ◽  
Inappropriate Drug Use ◽  
Drug Register ◽  
Long Acting

Background: Potentially inappropriate drug use (IDU) is an important and preventable safety concern in the care of elderly patients and has been associated with adverse drug reactions, hospitalization, and mortality. Objective: To estimate the prevalence of potentially IDU among the elderly in Sweden and investigate whether age. sex, and number of dispensed drugs are associated with IDU. Methods: We analyzed data on age, sex, and dispensed drugs for people aged 75 years and older who were listed in the Swedish Prescribed Drug Register from October–December 2005 (N = 732 226). The main outcome measures of IDU were prescription of anticholinergics, prescription of long-acting benzodiazepines, concurrent use of 3 or more psychotropic drugs, and an indication of potentially serious drug-drug interactions. Results: Prevalence for IDU was 17%; for anticholinergic drugs 6%, long-acting benzodiazepines 5%, 3 or more psychotropic drugs 5%, and potentially serious drug–drug interactions 4%. After adjustment for age and sex, number of dispensed drugs was strongly associated with all 4 measures of IDU. After adjustment for sex and number of dispensed drugs, increasing age was moderately associated with a higher probability of IDU, long-acting benzodiazepines, and 3 or more psychotropic drugs, After adjustment for age and number of dispensed drugs, women had a slightly increased probability of IDU, anticholinergic drugs, long-acting benzodiazepines, and 3 or more psychotropic drugs. Conclusions: IDU was fairly common among the elderly in Sweden in 2005 and was strongly connected to the number of dispensed drugs they were taking. Older age and female sex were related to inappropriate use of psychotropic drugs, whereas the opposite relationship prevailed for potentially serious drug–drug interactions. Future research is needed to determine whether IDU will become more common due to increasing use of drugs among elderly persons. The challenge is to balance the problems related to IDU without denying older people potentially valuable drug therapy.

Potential Drug Interactions— Fact or Fallacy?

1975 ◽  
Vol 9 (11) ◽  
pp. 586-590 ◽  
Author(s):  
Curtis D. Black ◽  
Nicholas G. Popovich
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Patient Care ◽  
Clinical Studies ◽  
Literature Search ◽  
Potential Drug ◽  
Careful Evaluation ◽  
Current Drug ◽  
Drug Drug Interaction

At present, the pharmacist is faced with a perplexing number of potential drug interactions as they relate to patient care. The purpose of the investigation was to evaluate current drug-drug interaction literature, specifically gastrointestinal drug interactions. Literature search and review evaluated the authoritative basis on which conclusions were made. From this, a review was written to illustrate fallacies and misconceptions that could be derived from the literature with the intent it would serve as a guide in interpreting and evaluating drug-drug interactions. The overall study illustrates the vast need for careful evaluation of drug interaction literature before erroneous recommendations are made on conceivably inconclusive clinical studies.

scholarly journals DRUG-DRUG INTERACTION;

2017 ◽  
Vol 24 (03) ◽  
pp. 357-365
Author(s):  
Hina Hasnain ◽  
Huma Ali ◽  
Farya Zafar ◽  
Ali Akbar Sial ◽  
Kamran Hameed ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Adverse Event ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Multidisciplinary Approach ◽  
Drug Information ◽  
Drug Effects ◽  
Information Provision ◽  
Drug Drug Interaction ◽  
Drug Order

Drug-drug interaction (DDI) is a specific type of adverse event, which developsdue to multiple regimen therapy, and that may lead to significant hospitalization and death.Clinical and economic impact of drug interactions are increasingly accredited as a chiefconcern in critical care. Potentiating effects of DDIs in intensive care units are far more criticaldue to complex medications regimen, high risk severely ill population and associated metabolicand physiological disturbances which can impede drug effects. Pharmacist contribution isclassified as clarification of drug order, appropriate drug information provision, and advice forsubstitute treatment. A multidisciplinary approach is very necessary in developing a pharmacotherapeuticregimen designed to optimize patient outcome and minimize any potential dugdrug interactions. This review encompasses the prevalence, categorization, significance interm of patient safety and prescription efficacy, clinical and economic burdens, national andinternational data comparisons related to drug-drug interactions.

scholarly journals Safe Non-opioid and Non-barbiturate containing Acute Medication Combinations in Headache: An Exhaustive Approach Based on DrugBank Database

2020 ◽  
Author(s):  
Victor Kaytser ◽  
Pengfei Zhang
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Drug Combinations ◽  
Exhaustive Search ◽  
Common Elements ◽  
Acute Medication ◽  
Drug Drug Interaction ◽  
Drugbank Database ◽  
Exhaustive List

Structured AbstractBackgroundRational polypharmacy in abortive medications use is often inevitable for patients with refractory headaches.ObjectiveWe seek to enumerate an exhaustive list of headaches abortive medications that are without drug-drug interactions.MethodsWe updated a list of acute medications based on the widely used Jefferson Headache Manual with novel abortive medications including ubrogepant, lasmiditan, and rimegepant. Opioids and barbiturate containing products are excluded. We then conducted an exhaustive search of all pair-wise interactions for this list of medication via DrugBank API. Using this interaction list, we filtered all possible two, three, and four drug combinations of abortive medications. The resultant list of medication was then reapplied to DrugBank to verify the lack of known drug-drug interaction.ResultsThere are 192 medication combinations that do not contain any drug-drug interactions. Most common elements in these combinations are ubrogepant, prochlorperazine, followed by tizanidine. There are 67 three-drug combinations that do not contain interaction. Only 2 of the four-drug combinations do not yield some form of drug-drug interactions.ConclusionThis list of headaches abortive medications without drug-drug interactions is a useful tool for clinicians seeking to more effectively manage refractory headaches.

scholarly journals Universal Patient Identifier and Interoperability for Detection of Serious Drug Interactions: Retrospective Study

10.2196/23353 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e23353
Author(s):  
Howard Michael Sragow ◽  
Eileen Bidell ◽  
Douglas Mager ◽  
Shaun Grannis
Keyword(s):  
United States ◽  
Drug Interaction ◽  
Drug Interactions ◽  
The United States ◽  
Security And Privacy ◽  
Patient Identification ◽  
Pharmacy Benefit Manager ◽  
Pharmacy Benefit ◽  
Privacy Concerns ◽  
Drug Drug Interaction

Background The United States, unlike other high-income countries, currently has no national unique patient identifier to facilitate health information exchange. Because of security and privacy concerns, Congress, in 1998, prevented the government from promulgating a unique patient identifier. The Health and Human Services funding bill that was enacted in 2019 requires that Health and Human Services report their recommendations on patient identification to Congress. While there are anecdotes of incomplete health care data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a unique patient identifier might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of potential improvements. Objective We sought to determine the frequency of serious drug-drug interaction alerts discovered because a pharmacy benefits manager uses a universal patient identifier and estimate undiscovered serious drug-drug interactions because pharmacy benefit managers do not yet fully share patient records. Methods We conducted a retrospective study of serious drug-drug interaction alerts provided from September 1, 2016 to August 31, 2019 to retail pharmacies by a national pharmacy benefit manager that uses a unique patient identifier. We compared each alert to the contributing prescription and determined whether the unique patient identifier was necessary in order to identify the crossover alert. We classified each alert’s disposition as override, abandonment, or replacement. Using the crossover alert rate and sample population size, we inferred a rate of missing serious drug-drug interaction alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes. Results Among a population of 49.7 million patients, 242,646 serious drug-drug interaction alerts occurred in 3 years. Of these, 2388 (1.0%) crossed insurance and were discovered because the pharmacy benefit manager used a unique patient identifier. We estimate that up to 10% of serious drug-drug alerts in the United States go undetected by pharmacy benefit managers because of unexchanged information or pharmacy benefit managers that do not use a unique patient identifier. These information gaps may contribute, annually, to up to 6000 patients in the United States receiving a contraindicated medication. Conclusions Comprehensive patient identification across disparate data sources can help protect patients from serious drug-drug interactions. To better safeguard patients, providers should (1) adopt a comprehensive patient identification strategy and (2) share patient prescription history to improve clinical decision support.

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