scholarly journals POSSIBLE TOXIC EFFECTS OF BENZODIAZEPINES;

2013 ◽  
Vol 20 (02) ◽  
pp. 284-289
Author(s):  
SYED TALAT IQBAL ◽  
ZAINAB BATOOL ◽  
SAJID MEHMOOD
Keyword(s):  
Drug Interactions ◽  
Seizure Control ◽  
Toxic Effects ◽  
Potential Ddis ◽  
Aged Patients ◽  
Ensure Patient Safety ◽  
Medical Letter ◽  
Related Drug ◽  
Detection Software ◽  
Therapeutic Doses

Introduction: Benzodiazepines and its derivatives are used widely as anxiolytics, hypnotics, seizure control and as musclerelaxants. Design: The prescriptions of 270 patients were evaluated for moderate to severe drug interactions using drug interactiondetection software. Setting: Teaching hospital in Gujrat, Pakistan. Objective: This study is used to evaluate the possible toxic effects ofbenzodiazepine related drug-drug interactions in prescriptions of indoor patients. Material & Methods: The prescriptions wereprocessed through a software program named, The Medical Letter Adverse Drug Interaction program. The randomly collected patientchart profiles included both male and female patients ranging from age of few months old children to old aged patients. Result: Out of 270patients medication charts 210 medication charts were having at least one or more drug interactions ranging from moderate to severe.Out of 80 interacting drug combinations found, 15 were benzodiazepine related drug interactions. So, percentage of benzodiazepinesrelated drug interactions was 18.75%.Moreover, the data also showed that the percentage of DDIs increases as the prescription sizeincreases. Our results indicate that hospitalized patients in Pakistan are at risk of ADRs caused by potential DDIs. Moreover, there arechances that the safe therapeutic doses of benzodiazepines may become toxic or ineffective due to drug-drug interactions andpolypharmacy. Conclusions: So, the use of DDIs detection software programs in hospitals and pharmacies should be promoted in orderto minimize drugs especially benzodiazepines related injuries and to ensure patient safety.

scholarly journals Evaluation of drug-drug interactions in hospitalized patients on medications for OUD

2021 ◽  
Vol 11 (4) ◽  
pp. 231-237
Author(s):  
Olivia Berger ◽  
Katherine Rector ◽  
Jacqueline Meredith ◽  
Jamielynn Sebaaly
Keyword(s):  
Drug Interactions ◽  
Respiratory Depression ◽  
Qt Prolongation ◽  
Inpatient Setting ◽  
Close Monitoring ◽  
Potential Ddis ◽  
Prescribing Practices ◽  
Ensure Patient Safety ◽  
Increased Risk ◽  
Cns Effects

Abstract Introduction Medications used to treat OUD have common metabolic pathways and pharmacodynamic properties that can lead to drug-drug interactions (DDIs) that may go unnoticed in the inpatient setting. The purpose of this study was to identify the frequency of DDIs between medications prescribed for OUD and commonly used inpatient medications. Methods This was a retrospective review of orders for buprenorphine, buprenorphine-naloxone, and methadone to identify potential DDIs. Adult inpatients with an order for one of these medications for OUD were included. Medication regimens were evaluated throughout the inpatient stay and on day of discharge for DDIs. DDIs were classified by severity and type of interaction (increased risk of QT prolongation, additive CNS effects/respiratory depression, and opioid withdrawal). The primary endpoint was the number of potential DDIs. Other endpoints included number of each classification/severity of DDI, duration of therapy of interacting medications, and modifications made to OUD medications because of DDIs. Results A total of 102 patients were included, with 215 inpatient interactions and 83 interactions at discharge identified. While inpatient, 85% of patients were on an interacting medication, and 46% of patients were on an interacting medication at discharge. The most common classification of DDI was additive CNS effects/respiratory depression (68.8% inpatient, 50.6% discharge), followed by QT prolongation (24.2% inpatient, 45.8% discharge). The majority of DDIs were classified as requiring close monitoring rather than contraindicated. Discussion There are opportunities to optimize the prescribing practices surrounding OUD medications in both the inpatient setting and at discharge to ensure patient safety.

Review of Cimetidine Drug Interactions

1983 ◽  
Vol 17 (2) ◽  
pp. 110-120 ◽  
Author(s):  
Eugene M. Sorkin ◽  
Diane L. Darvey
Keyword(s):  
Blood Flow ◽  
Drug Interactions ◽  
Hepatic Blood Flow ◽  
Hepatic Clearance ◽  
Hepatic Metabolism ◽  
Rapid Onset ◽  
Related Drug ◽  
Cytochrome P 450 ◽  
Acid Labile ◽  
Hepatic Cytochrome

The literature on cimetidine drug interactions has been thoroughly reviewed. Several different mechanisms have been proposed for cimetidine-related drug interactions. These mechanisms include: (1) impaired hepatic drug metabolism due to inhibition of hepatic microsomal enzymes, (2) reduced hepatic blood flow, resulting in decreased clearance of drugs that are highly extracted by the liver, (3) increased potential for myelosuppression when administered concurrently with other drugs capable of causing myelosuppression, and (4) altered bioavailability of acid-labile drugs. Cimetidine binds reversibly to the hepatic cytochrome P-450 and P-448 systems, resulting in decreased metabolism of drugs that undergo Phase I reactions (e.g., dealkylation and hydroxylation). In contrast, glucuronidation pathways are unaffected. The rapid onset and reversal of cimetidine's inhibition of hepatic metabolism indicates an effect on hepatic enzyme systems. Cimetidine also has been reported to decrease hepatic blood flow. Drugs that are highly extracted by the liver, such as propranolol, lidocaine, and morphine, may be postulated to have a decreased hepatic clearance. Cimetidine, through its effect on gastric pH, may increase the absorption of acid-labile drugs or may decrease the absorption of drugs. There have been reports of increased potential for myelosuppression when cimetidine is administered concurrently with drugs capable of causing bone marrow suppression. An understanding of the mechanisms involved in cimetidine drug interactions allows the clinician to prevent and predict these interactions.

Potential Aspirin-Related Drug Interactions in the Elderly

DICP ◽  
1989 ◽  
Vol 23 (4) ◽  
pp. 340-340
Author(s):  
Arthur Schwartz ◽  
Sybil N.E. Seoka
Keyword(s):  
Drug Interactions ◽  
The Elderly ◽  
Related Drug

scholarly journals SURVEY OF PATTERN OF DRUG INTERACTIONS IN PATIENTS BEING PRESCRIBED ANTI-DIABETIC MEDICATIONS IN A TERTIARY CARE HOSPITAL: PROSPECTIVE CROSS SECTIONAL STUDY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Sujeet A. Divhare ◽  
Satyashil Ingale
Keyword(s):  
Diabetes Mellitus ◽  
Drug Interactions ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Potential Ddis ◽  
Cross Sectional

Background: Potential importance of drug –drug interactions (DDIs) is increasing as polypharmacy becomes more prevalent. Because additional data on the incidence and pattern of potential DDIs among diabetic patients are lacking in India, and supplemental pharmacodynamic or clinical outcome information is needed to address importance of a drug- drug interaction. Aim and objectives: To identify and analyze the pattern of DDIs in patients being prescribed anti-diabetic drugs in a tertiary care hospital. Material and Methods: This prospective cross-sectional study was carried out for a period of three months in 200 Type 2 diabetes mellitus (Type 2 DM) patients who were taking at least one antidiabetic agent during the period of past six months, of any age and either sex admitted in medicine ward of a tertiary care teaching hospital. Only one prescription was included for each patient on his/her 3rd day of hospitalization in the ward. Results: A total of 1217 drugs were prescribed in 200 prescriptions, resulting in an average of 6.1 drugs per prescription. A total of 637 potential DDIs were noted. The majority were seen in middle aged and elderly people. No overall difference was detected in the patients on insulin or metformin therapy taking or not taking additional drugs with the potential to interact. Worse control was found in the group of patients on sulphonylurea therapy taking interacting drugs (P <0.05). This difference was most marked in the group of patients over 60 years of age, who also had the highest intake of potentially interacting drugs (57%; <35 years-37%). Conclusion: Antidiabetic drugs have numerous interactions. A good practice is to use a drug­–drug interaction checker if any questions arise, several are available online. Quality care starts with the clinician obtaining a complete medication list for each patient at the start of each visit. Keywords: diabetes mellitus, drug interactions, hypoglycemic agents, drug therapy, co-morbidity, polypharmacy

scholarly journals Appraisal and discernment of prevalent drug-drug interactions in patients with psychiatric disorders

2021 ◽  
Vol 10 (8) ◽  
pp. 1005
Author(s):  
Axa Jacob ◽  
Cristin Simon Thomas ◽  
Anay Deore ◽  
Prasanna Deshpande
Keyword(s):  
Drug Interactions ◽  
Hospital Admissions ◽  
Psychiatric Patients ◽  
Medical Complications ◽  
Medical Illness ◽  
Inclusion Criteria ◽  
Potential Ddis ◽  
Careful Monitoring ◽  
Mechanistic Approach ◽  
High Prevalence

Background: Drug-drug interactions (DDIs) contribute majorly to hospital admissions, treatment failures, avoidable medical complications and subsequent healthcare costs. Thus, we employ a mechanistic approach to prospectively investigate the incidence of potential DDIs in the psychiatric patients in a clinical setting.Methods: In this prospective, observational, multi centred study conducted for a span of 6 months, psychiatric inpatients (≥18 years) prescribed with 2 or more medications daily for any medical illness were included. The secured prescriptions of the inpatients selected in accordance to the inclusion criteria were then assessed for DDIs using Micromedex(TM) as a standard.Results: Of the total 400 enrolled participants, 383 (95%) of them showed at least one pDDI regardless of the severity. An average of 7.33 interactions per patient was also deduced. A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient.  Most of the interactions were of major (56.52%) and moderate severity (39.07) followed by contraindicated (2.55) and minor (1.83). Cardiovascular system (41.77%) had the highest potential to be affected due to the pDDIs identified. Trihexyphenidyl, haloperidol, promethazine, amisulpride, risperidone, divalproex, trifluoperazine, olanzapine and clozapine where among the most commonly encountered drugs in these interactions.Conclusions: A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient.  A significant association of the pDDIs with variables such as age, gender, diagnosis and total number of drugs used was identified. More studies are required to explore the overall pattern of DDIs in psychiatric patients along with their levels and correlation with different risk factors. Careful monitoring and documentation are necessary to prevent further complications thereby improving the therapeutic outcome.

Toxic Effects of Anticonvulsants: General Principles

PEDIATRICS ◽  
1974 ◽  
Vol 53 (4) ◽  
pp. 551-557
Author(s):  
H. Hooshmand
Keyword(s):  
Drug Interaction ◽  
Side Effects ◽  
Toxic Effects ◽  
Multiple Drug ◽  
Severe Ataxia ◽  
Multiple Drug Therapy ◽  
Toxic Potential ◽  
Therapeutic Doses ◽  
Relationship Of ◽  
The Relationship

Any drug, regardless of how benign and well tolerated, is potentially toxic. The toxicity may be due to (1) dosage; (2) the size of the patient; (3) drug interaction; (4) drug specificity for the disease; (5) the nature of the disease for which the drug is used; and (6) the mode and frequency of medication. DOSE OF ANTICONVULSANT Dose of anficonvulsant is very important (Table I). Any anticonvulsant in higher than therapeutic doses has toxic potential. It is well known that anticonvulsants in large enough doses can act as convulsants. This is especially true for diphenylhydantoin, benzodiazepines, and lidocaine. THE SIZE OF THE PATIENT The size of the patient should be considered in dosage. It is safer and more accurate to adjust dosage to body surface than to weight (Table I). As the child grows, there may be a need to gradually increase the dose of anticonvulsants if seizure control is poor, or if the serum level of the anticonvulsant starts to decline. DRUG INTERACTION The relationship. of multiple drug therapy and its toxic effects on the brain is quite complicated, and many forms of toxicity can result. Toxicity may be the result of a combination of pharmacologically similar drugs. Such a combination may enhance the side effects of drowsiness and ataxia. The patient may suffer from these side effects without attaining therapeutic levels of individual anticonvulsants in the blood. In other words, a combination of drugs such as phenobarbital and primidone may result in severe ataxia and drowsiness.

scholarly journals ASSESSMENT OF POTENTIAL DRUG INTERACTIONS AMONG HOSPITALIZED PATIENTS IN NEUROLOGY DEPARTMENT IN TERTIARY CARE HOSPITALS

2019 ◽  
pp. 173-176
Author(s):  
DIJO DAIS ◽  
RANJEET AVIS CHERUVATHOOR ◽  
KAMESWARAN R ◽  
SHANMUGA SUNDARAM RAJAGOPAL
Keyword(s):  
Risk Factors ◽  
Drug Interactions ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Daily Basis ◽  
Potential Drug ◽  
Potential Ddis ◽  
Patient History ◽  
Therapeutic Advantage ◽  
Tertiary Care Hospitals

Objective: This research was instigated to determine and assess the prevalence, severity, type, and the total number of potential drug interactions in the neurology department of two hospitals in India. Methods: The data were collected from the prescriptions and by patient history interview on a daily basis. The drug-drug interactions (DDIs) were identified using Micromedex® database-2.7 and drugs.com. Results: The drug interactions were influenced by a plethora of risk factors: Gender, age, comorbidities, length of hospital stay, and the neurological condition. The study was comprised 320 patients, among 196 patients were identified with potential DDIs (PDDIs), and a total of 450 PDDIs were observed. The prevalence of PDDIs according to the severity was major (42.6%), moderate (45.11%), and minor (12.22%). Conclusion: To lessen PDDIs, the range of medications for the patients must be properly managed, and it is encouraged to remove all medicines without therapeutic advantage, intention, and an indication.

Pharmacokinetic drug–drug interactions: an insight into recent US FDA-approved drugs for prostate cancer

Bioanalysis ◽  
2020 ◽  
Vol 12 (22) ◽  
pp. 1647-1664
Author(s):  
Siva Nageswara Rao Gajula ◽  
Gangireddy Navitha Reddy ◽  
Dannarm Srinivas Reddy ◽  
Rajesh Sonti
Keyword(s):  
Drug Interactions ◽  
Therapeutic Index ◽  
Aged Patients ◽  
Metabolizing Enzymes ◽  
Considerable Concentration ◽  
Concentration Changes ◽  
Us Fda ◽  
Approved Drugs ◽  
Fda Approved Drugs ◽  
Pharmacokinetic Drug

Pharmacokinetic drug–drug interaction is a significant safety and efficiency concern as it results in considerable concentration changes. Drug–drug interactions are a substantial concern in anticancer drugs that possess a narrow therapeutic index. These interactions remain as the principal regulatory obstacle that can lead to termination in the preclinical stage, restrictions in the prescription, dosage adjustments or withdrawal of the drugs from the market. Drug metabolizing enzymes or transporters mediate the majority of clinically relevant drug interactions. Cancer diagnosed aged patients use multiple medications and are more prone to significant drug–drug interactions. This review provides detailed information on clinically relevant drug–drug interactions resulting from drug metabolism by enzymes and transporters with a particular emphasis on recent FDA approved antiprostate cancer drugs.

The prevalence of potentially beneficial and harmful drug-drug interactions in intensive care units

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Hossein Ali Mehralian ◽  
Jafar Moghaddasi ◽  
Hossein Rafiei
Keyword(s):  
Intensive Care ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Intensive Care Units ◽  
Medical Records ◽  
Potential Ddis ◽  
Cross Sectional ◽  
Text Book ◽  
The Mean ◽  
Potential Interactions

Abstract Background The present study was conducted with the aim of investigating the prevalence of potentially beneficial and harmful drug-drug interactions (DDIs) in intensive care units (ICUs). Methods The present cross-sectional prospective study was conducted in two ICUs in Shahr-e Kord city, Iran. The study sample was consisted of 300 patients. The Drug Interaction Facts reference text book [Tatro DS. Drug interaction facts. St Louis, MO: Walters Kluwer Health, 2010.] was used to determine the type and the frequency of the DDIs. Results The participants consisted of 189 patients men and 111 women. The mean age of patients was 44.2 ± 24.6 years. Totally, 60.5% of patients had at least one drug-drug interaction in their profile. The total number of DDIs found was 663 (the mean of the total number of drug-drug interactions was 2.4 interactions per patient). Of all the 663 interactions, 574 were harmful and others were beneficial. In terms of starting time, 98 of the potential interactions were rapid and 565 of them were delayed. In terms of severity, 511 of the potential interactions were moderate. Some of the drugs in the patients’ medical records including phenytoin, dopamine, ranitidine, corticosteroid, dopamine, heparin, midazolam, aspirin, magnesium, calcium gluconate, and antibiotics, the type of ventilation, the type of nutrition and the duration of hospital stay were among the factors that were associated with high risk of potential DDIs (p < 0.05). Conclusions The prevalence of potentially beneficial and harmful DDIs, especially harmful drug-drug interactions, is high in ICUs and it is necessary to reduce these interactions by implementing appropriate programs and interventions.

Safety and Efficacy of Supratherapeutic Doses of Clobazam

2019 ◽  
Vol 34 (12) ◽  
pp. 735-738
Author(s):  
Sravya Gedela ◽  
Daniel A Freedman ◽  
Satyanarayana Gedela ◽  
Peter Glynn ◽  
Ann Salvator ◽  
...  
Keyword(s):  
Seizure Control ◽  
Care Utilization ◽  
Retrospective Data ◽  
Limited Data ◽  
Inclusion Criteria ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
The Us ◽  
Long Acting ◽  
Therapeutic Doses

Clobazam is a commonly used long-acting benzodiazepine approved by the US Food and Drug Administration (FDA) to treat seizures associated with Lennox Gastaut syndrome. The FDA approved maximum dosage of clobazam is 1 mg/kg/d or a total of 40 mg a day. Many providers exceed this dosage but there is limited data on the safety, tolerability, and efficacy of supratherapeutic doses. We reviewed retrospective data at our institution and compared patients on supratherapeutic doses to patients on therapeutic doses. A total of 133 patients met inclusion criteria (65 supratherapeutic, 67 therapeutic). There was no statistically significant difference in terms of seizure control, health care utilization, or side effects between patients on supratherapeutic doses and those on therapeutic doses. This study lends further support to the safety and tolerability of supratherapuetic doses of clobazam.

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