scholarly journals THE CLINICAL SIGNIFICANCE OF POTENTIAL DRUG-DRUG INTERACTIONS AND THEIR TARGETS FOR MINIMIZATION AMONG HYPERTENSIVE DIABETIC OUTPATIENTS AT A KENYAN REFERRAL HOSPITAL

2020 ◽  
pp. 6-11
Author(s):  
MAKITE SIMON LATI ◽  
NYAMU GITONGA DAVID ◽  
ROSALINE NJOKI KINUTHIA
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Clinical Significance ◽  
Blood Pressure Monitoring ◽  
Adverse Outcomes ◽  
Potential Drug ◽  
National Hospital ◽  
Hypertensive Patients ◽  
Kenyatta National Hospital ◽  
Arterial Blood

Objective: To characterize the clinical significance of potential drug interactions and identify the targets for their minimization among adult diabetic hypertensive outpatients at Kenyatta National Hospital. Methods: This cross-sectional study collected and analyzed data from 104 diabetic hypertensive outpatients (aged ≥18 y) at the Department of Endocrinology Outpatient Clinic of Kenyatta National Hospital from 1st May 2019 to 31st August 2019. The main outcome measure was the clinical significance of potential drug interactions and the targets for minimization. Participants’ sociodemographic data, drugs prescribed and targets for prevention of potential drug-drug interactions were extracted from patient medical records into predesigned data collection forms. Potential drug interactions were identified using the Micromedex® drug interaction checker. Data was exported to STATA® software version 13 for analysis. Results: The study comprised predominantly females (70.2%) and the mean age was 61.6 (±10.8) years. Over 80% of patients were receiving renin inhibitors or metformin and the commonest potential drug interaction (25.0%) was antidiabetics-beta blockers. The most common potential clinical outcome of the drug-drug interaction was hyperkalemic lactic acidosis (14.4%), induced by combining enalapril with metformin, and hypoglycemia (9.6%) on concomitant use of antidiabetic and beta-blocker. Adverse clinical outcomes were mainly minimized through regular blood sugar checks (100%), blood pressure monitoring (98.1%), and minimal HbA1c (30.8%) checks as well as serum urea and electrolytes (17.3%) measurements. Conclusion: There are potential adverse outcomes of combination pharmacologic therapies among diabetic hypertensive patients in Kenyatta National Hospital. Apart from the clinical monitoring, clinicians should be aware that diabetic hypertensive patients are likely to have serious adverse effects of drug interactions and, therefore, institute or intensify other measures such as arterial blood gases and serum electrolyte tests.

scholarly journals THE PREDICTORS OF POTENTIAL DRUG-DRUG INTERACTIONS AMONG DIABETIC HYPERTENSIVE ADULT OUTPATIENTS IN A KENYAN REFERRAL HOSPITAL

2020 ◽  
pp. 63-67
Author(s):  
MAKITE SIMON LATI ◽  
NYAMU GITONGA DAVID ◽  
ROSALINE NJERI KINUTHIA
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Cross Sectional Study ◽  
Potential Drug ◽  
National Hospital ◽  
Cross Sectional ◽  
Kenyatta National Hospital ◽  
Stage 4 ◽  
Drug Drug Interaction ◽  
Study Participants

Objective: To characterize the predictors of potential drug-drug interactions among adult diabetic hypertensive outpatients at Kenyatta National Hospital. Methods: This cross-sectional study collected and analyzed data on potential drug interactions from 104 diabetic hypertensive outpatients (aged ≥18 y) at the Department of Endocrinology Outpatient Clinic of Kenyatta National Hospital from 1st May 2019 to 31st August 2019. The main outcome measure was the prevalence of potential drug-drug interactions and their predictors among the study population. Results: There was a female preponderance (70.2%). The mean age of the study participants was 61.6 y (SD±10.8). The prevalence of potential drug interactions was high at 57.7%. The average number of drug interactions was one interacting pair per patient, with a majority of the prescriptions (81.0%) having moderate drug-drug interactions. Patients receiving>2 drugs were almost three times more likely to have drug-drug interaction compared to those prescribed ≤ 2 drugs (AOR=2.79; 95% CI: 1.11-7.28); p=0.029). Participants who were at stage 4 of hypertension were 2.5 times more likely to have a drug-drug interaction compared to the other stages of hypertension (AOR=2.52; 95% CI 1.31-4.89; p=0.007). Conclusion: Polypharmacy and stage 4 hypertension are independently associated with drug-drug interactions among patients with both diabetes and hypertension. Future studies should characterize the specific type of drug interactions and possible targets of minimization of drug-drug interactions.

scholarly journals Drug interactions in hospital prescriptions in Denmark: Prevalence and associations with adverse outcomes

2021 ◽  
Author(s):  
Cristina Leal Rodriguez ◽  
Benjamin Skov Kaas-Hansen ◽  
Robert Eriksson ◽  
Jorge Hernansanz Biel ◽  
Kirstine G. Belling ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Drug Interaction ◽  
Length Of Stay ◽  
Drug Interactions ◽  
Hospital Admissions ◽  
Median Number ◽  
Adverse Outcomes ◽  
Potential Drug ◽  
Post Discharge ◽  
Strong Inhibitor

Importance: While the beneficial effects of medications are numerous, drug-drug interactions may lead to adverse drug reactions that are preventable causes of morbidity and mortality. Objective: To quantify the prevalence of potential drug-drug interactions in drug prescriptions at Danish hospitals, estimate the risk of adverse outcomes associated with discouraged drug combinations, and highlight the patient types (defined by the primary diagnosis of the admission) that appear to be more affected. Design: Cross-sectional (descriptive part) and cohort study (adverse outcomes part). Setting: Hospital electronic health records from two Danish regions (approx. 2.5 million people) from January 2008 through June 2016. Participants: Inpatients receiving two or more medications during their admission. Exposure: Concomitant prescriptions of potentially interacting drugs as per the Danish Drug Interaction Database. Main outcome and measure: Descriptive part: prevalence of potential drug-drug interactions in general and discouraged drug pairs in particular during admissions. Adverse outcomes part: post-discharge all-cause mortality rate, readmission rate and length-of-stay. Results: Among 2,886,227 hospital admissions (945,475 patients; median age 62 years [IQR: 41-74]; 54% female; median number of drugs 7 [IQR: 4-11]), patients in 1,836,170 admissions were exposed to at least one potential drug-drug interaction (659,525 patients; median age 65 years [IQR: 49-77]; 54% female; median number of drugs 9 [IQR: 6-13]), and in 27,605 admissions to a discouraged drug pair (18,192 patients; median age 68 years [IQR: 58-77]; female 46%; median number of drugs 16 [IQR: 11-22]). Meropenem-valproic acid (HR: 1.5, 95% CI: 1.1-1.9), domperidone-fluconazole (HR: 2.5, 95% CI: 2.1-3.1), imipramine-terbinafine (HR: 3.8, 95% CI: 1.2-12), agomelatine-ciprofloxacin (HR: 2.6, 95% CI: 1.3-5.5), clarithromycin-quetiapine (HR: 1.7, 95% CI: 1.1-2.7), and piroxicam-warfarin (HR: 3.4, 95% CI: 1-11.4) were associated with elevated mortality. Confidence interval bounds of pairs associated with readmission were close to 1; length-of-stay results were inconclusive. Conclusions and Relevance: Well-described potential drug-drug interactions are still missed and alerts at point of prescription may reduce the risk of harming patients; prescribing clinicians should be alert when using strong inhibitor/inducer drugs (i.e. clarithromycin, valproic acid, terbinafine) and prevalent anticoagulants (i.e. warfarin and NSAIDs) due to their great potential for dangerous interactions. The most prominent CYP isoenzyme involved in mortality and readmission rates was 3A4.

scholarly journals POTENTIAL DRUG INTERACTIONS IN HYPERTENSIVE PATIENTS IN LIWA DISTRICT HOSPITAL, LAMPUNG BARAT, INDONESIA

2017 ◽  
Vol 9 (6) ◽  
pp. 134
Author(s):  
Erna Yanti ◽  
Erna - Kristin ◽  
Alfi Yasmina
Keyword(s):  
Drug Interactions ◽  
District Hospital ◽  
Antihypertensive Agents ◽  
Potential Interaction ◽  
Multiple Drug ◽  
Potential Drug ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
Multiple Drugs ◽  
Potential Interactions

Objective: Patients with hypertension often suffer from other comorbidities, resulting in prescriptions of multiple drugs to treat the conditions. Multiple drug treatment is potentially associated with drug interactions. This aim of the study was to assess potential drug interactions in hypertensive patients in Liwa District Hospital.Methods: The design of the study was cross-sectional. The prescriptions for in-patients with essential hypertension in the Internal Medicine Unit in Liwa District Hospital during April-December 2012 were collected. Potential drug interactions were analyzed with the Drug Interaction Facts version 4.0, and classified into minor, significant, and serious.Results: A total of 60 hypertensive patients were included. They were prescribed 265 prescriptions, with a median total of 6 (range 1-21) drugs prescribed per prescription. There were 1616 potential drug interactions, with 6 (1-31) potential interactions per prescription. Most interactions (75.6%) were classified as significant. Serious potential interactions were most common in the combinations of diltiazem-amlodipine and spironolactone-potassium chloride, while significant potential interaction may occur most often with the combinations of calcium chloride-amlodipine and bisoprolol-amlodipine.Conclusion: Numerous potential drug interactions might occur in hypertensive patients, and most interactions were significant in severity. The largest proportion of the interactions occurred between antihypertensive agents and other drugs. 

scholarly journals Potential drug-drug interactions in the psychiatric hospital: Frequency analysis

2019 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Oleg O. Kirilochev ◽  
Inna P. Dorfman ◽  
Adelya R. Umerova ◽  
Svetlana E. Bataeva
Keyword(s):  
Drug Interactions ◽  
Clinical Significance ◽  
Psychiatric Hospital ◽  
Psychiatric Inpatient ◽  
Clinical Problem ◽  
Drug Combinations ◽  
Drug Prescriptions ◽  
Inpatient Setting ◽  
Potential Drug ◽  
Important Clinical Problem

Introduction: Drug-drug interactions are an important clinical problem in pharmacotherapy. This study is focused on different types of drugs used in a psychiatric hospital. Materials and methods: The pharmacoepidemiological study included the analysis of medical records of 500 psychiatric inpatients. The patients were divided into 2 groups: under 65 and over 65 years of age. All the drug prescriptions were analyzed to identify the combinations of drugs that can induce drug-drug interactions and determine their clinical significance. Results and discussion: Over 77% of hospitalized patients were administered drug combinations that could induce drug-drug interactions, most of which were of moderate clinical significance. A reliable association was found between the patient’s age, the clinical significance of drug-drug interactions, and the pharmacotherapy structure. The most common irrational drug combinations were identified. Conclusion: Timely analysis of drug prescriptions for potential drug-drug interactions can enhance the safety of pharmacotherapy and decrease the risk of adverse drug reactions in the psychiatric inpatient setting.

scholarly journals Review of Impact and Handling of Potential Antihypertensive Drug Interactions in Chronic Kidney Disease Patients

2021 ◽  
Vol 7 (1) ◽  
pp. 39-53
Author(s):  
Ni Made Susilawati ◽  
Eli Halimah ◽  
Siti Saidah
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Heart Function ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Potential Drug ◽  
Analysis Program ◽  
Drug Related Problems ◽  
Related Effect ◽  
Complete Knowledge

Drug interaction is a type of Drug-Related Problems (DRPs) that caneventually increase morbidity and mortality rates. CKD patients have asignificant risk of developing polypharmacy due to comorbid diseases andpharmacokinetics' alteration. The literature review was conducted byexploring all of the articles related to the drug interaction using druginteraction analysis program in CKD patients, which obtained from threedatabases, namely Google Scholar, PubMed, and Science Direct, usingseveral keywords combination. Based on the comprehensive reviewsconducted, it is known that the most common effects of antihypertensivedrug interactions in CKD patients are decreasing effects of antihypertensivedrugs, hypotension, and hyperkalemia. Handling management used for theemergence of potential drug interactions is based on the severity of the druginteractions and complete knowledge of the patients' clinical condition. Themanagement of drug interaction by monitoring blood pressure, diuresis, andpotassium levels; Monitor the related effect symptoms; Monitor the fluidand body weight; Monitor the kidney and heart function. On the conditionwhere the handling management of potential drug interactions is not carriedout, elevated morbidity and mortality rates are the risks of complicationsarising from the drug interactions.

scholarly journals Emerging and experimental treatments for COVID-19 and drug interactions with psychotropic agents

2020 ◽  
Vol 10 ◽  
pp. 204512532093530 ◽  
Author(s):  
Delia Bishara ◽  
Chris Kalafatis ◽  
David Taylor
Keyword(s):  
Drug Interaction ◽  
Adverse Effects ◽  
Drug Interactions ◽  
Clinical Trial Data ◽  
Potential Drug ◽  
Qtc Prolongation ◽  
Experimental Drugs ◽  
Psychotropic Agents ◽  
The Common ◽  
Experimental Treatments

As yet, no agents have been approved for the treatment of COVID-19, although several experimental drugs are being used off licence. These may have serious adverse effects and potential drug interactions with psychotropic agents. We reviewed the common agents being used across the world for the treatment of COVID-19 and investigated their drug interaction potential with psychotropic agents using several drug interaction databases and resources. A preliminary search identified the following drugs as being used to treat COVID-19 symptoms: atazanavir (ATV), azithromycin (AZI), chloroquine (CLQ)/hydroxychloroquine (HCLQ), dipyridamole, famotidine (FAM), favipiravir, lopinavir/ritonavir (LPV/r), nitazoxanide, remdesivir, ribavirin and tocilizumab. Many serious adverse effects and potential drug interactions with psychotropic agents were identified. The most problematic agents were found to be ATV, AZI, CLQ, HCLQ, FAM and LPV/r in terms of both pharmacokinetic as well as serious pharmacodynamic drug interactions, including QTc prolongation and neutropenia. Significant caution should be exercised if using any of the medications being trialled for the treatment of COVID-19 until robust clinical trial data are available. An even higher threshold of vigilance should be maintained for patients with pre-existing conditions and older adults due to added toxicity and drug interactions, especially with psychotropic agents.

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 Polypharmacy in the Management of Arterial Hypertension—Friend or Foe?

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1288
Author(s):  
Camelia Cristina Diaconu ◽  
Matei-Alexandru Cozma ◽  
Elena-Codruța Dobrică ◽  
Gina Gheorghe ◽  
Alexandra Jichitu ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Database Search ◽  
Potential Drug ◽  
Hypertensive Patients ◽  
Normotensive Subjects ◽  
The Mean ◽  
Review Study ◽  
Internal Medicine Clinic

Background and Objectives: Polypharmacy is associated with drug–drug or food–drug interactions that may pose treatment difficulties. The objective of the study was to investigate the use of polypharmacy in hypertensive patients hospitalized in the Internal Medicine Clinic of a European referral hospital. Materials and Methods: We conducted a retrospective chart review study on patients identified by a database search of discharge diagnoses to assess the use of polypharmacy and identify potential drug-drug and food-drug interactions. Results: In total, 166 hypertensive patients (68.46 ± 12.70 years, range 42–94 years) were compared to 83 normotensive subjects (67.82 ± 14.47 years, range 22–94 years) who were hospitalized in the clinic during the same period. Polypharmacy was more common in hypertensive versus normotensive subjects (p = 0.007). There were no differences in terms of age, as well as major (0.44 ± 0.77 versus 0.37 ± 0.73 interactions/patient, p = 0.52) and minor (1.25 ± 1.50 versus 1.08 ± 1.84 interactions/patient, p = 0.46) drug–drug interactions between patients with and without hypertension. The mean number of drug–drug interactions (6.55 ± 5.82 versus 4.93 ± 5.59 interactions/patient, p = 0.03), moderate drug–drug interactions (4.94 ± 4.75 versus 3.54 ± 4.17, p = 0.02) and food–drug interactions (2.64 ± 1.29 versus 2.02 ± 1.73, p = 0.00) was higher in patients with hypertension versus their counterparts. Conclusions: The present study reinforces that polypharmacy is a serious concern in hypertensive patients, as reflected by the high number of potentially harmful drug–drug or food–drug interactions. We recorded higher numbers of comorbidities, prescribed drugs, and moderate drug–drug/food–drug interactions in hypertensive versus normotensive patients. A strategy to evaluate the number of discharge medications and reduce drug–drug interactions is essential for the safety of hypertensive patients.

scholarly journals A Minimal Information Model for Potential Drug-Drug Interactions

2021 ◽  
Vol 11 ◽  
Author(s):  
Harry Hochheiser ◽  
Xia Jing ◽  
Elizabeth A. Garcia ◽  
Serkan Ayvaz ◽  
Ratnesh Sahay ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Drug Interactions ◽  
Best Practice ◽  
Task Force ◽  
Information Model ◽  
Potential Drug ◽  
Community Group ◽  
Drug Drug Interaction ◽  
Potential Interactions ◽  
Minimal Information

Despite the significant health impacts of adverse events associated with drug-drug interactions, no standard models exist for managing and sharing evidence describing potential interactions between medications. Minimal information models have been used in other communities to establish community consensus around simple models capable of communicating useful information. This paper reports on a new minimal information model for describing potential drug-drug interactions. A task force of the Semantic Web in Health Care and Life Sciences Community Group of the World-Wide Web consortium engaged informaticians and drug-drug interaction experts in in-depth examination of recent literature and specific potential interactions. A consensus set of information items was identified, along with example descriptions of selected potential drug-drug interactions (PDDIs). User profiles and use cases were developed to demonstrate the applicability of the model. Ten core information items were identified: drugs involved, clinical consequences, seriousness, operational classification statement, recommended action, mechanism of interaction, contextual information/modifying factors, evidence about a suspected drug-drug interaction, frequency of exposure, and frequency of harm to exposed persons. Eight best practice recommendations suggest how PDDI knowledge artifact creators can best use the 10 information items when synthesizing drug interaction evidence into artifacts intended to aid clinicians. This model has been included in a proposed implementation guide developed by the HL7 Clinical Decision Support Workgroup and in PDDIs published in the CDS Connect repository. The complete description of the model can be found at https://w3id.org/hclscg/pddi.

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