Comparing Potential Drug–Drug Interactions in Companion Animal Medications Using Two Electronic Databases

Multiple-drug prescriptions can cause drug–drug interactions (DDIs), which increase risks associated with healthcare in veterinary medicine. Moreover, many human medicines are used in canine patients under the responsibility of veterinarians and may cause severe problems due to off-label use. Currently, many electronic databases are being used as tools for potential DDI prediction, for example, Micromedex and Drugs.com, which may benefit the prediction of potential DDIs for drugs used in canine. The purpose of this study was to examine different abilities for the identification of potential DDIs in companion animal medicine, especially in canine patients, by Micromedex and Drugs.com. Micromedex showed 429 pairs of potential DDIs, while Drugs.com showed 842 pairs of potential DDIs. The analysis comparing results between the two databases showed 139 pairs (12.28%) with the same severity and 993 pairs (87.72%) with different severities. The major mechanisms of contraindicated and major potential DDIs were cytochrome P450 induction–inhibition and QT interval prolongation. Veterinarians should interpret potential DDIs from several databases with caution and keep in mind that the results might not be reliable due to differences in sensitivity to drugs, drug-metabolizing enzymes, and elimination pathway between animals and humans.

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Comparing potential drug-drug interactions in veterinary medications using two electronic databases

10.21203/rs.3.rs-23037/v2 ◽

2020 ◽

Author(s):

Tussapon Boonyarattanasoonthorn ◽

Phisit Khemawoot ◽

Anusak Kijtawornrat

Keyword(s):

Drug Interactions ◽

Drug Prescription ◽

Lower Sensitivity ◽

Health Issues ◽

Potential Ddis ◽

Interval Prolongation ◽

Veterinary Medicines ◽

Qt Interval Prolongation ◽

Drug List ◽

Cytochrome P450 Induction

Abstract Background: One of the most common global health issues in humans and animals is drug-drug interactions (DDIs). This issue increases the risks associated with healthcare in both human and veterinary medicine, as animals live long lives and receive many medicines to treat their illnesses. Currently, many electronic databases are being used as tools for potential DDI prediction, for example, Micromedex and Drugs.com. The purpose of this study was to examine the different abilities for the identification of potential DDIs in veterinary medicines by Micromedex and Drugs.com. Results: A list of 140 drugs, mainly used for the treatment of disease in animal hospitals, was complied, but the Micromedex and Drugs.com databases could recognise only 96 of these drugs. After inputting the recognised drug list into the databases, Micromedex showed 429 pairs of potential DDIs, whilst Drugs.com showed 842 pairs of potential DDIs. The analysis comparing results between the two databases showed 139 pairs (12.28%) with the same severity and 993 pairs (87.72%) with different severities. Major mechanisms of contraindicated and major potential DDIs were cytochrome P450 induction-inhibition and QT interval prolongation.Conclusion: Although Micromedex had a lower sensitivity to identify potential DDIs than Drugs.com, Micromedex provided more informative documentation. Veterinary pharmacists should evaluate potential DDIs from several databases and communicate with both the veterinarian and animal owner to ensure an appropriate drug prescription.

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Safety of pharmacotherapy in a psychiatric inpatient setting and the QT interval

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1401 ◽

2021 ◽

Vol 76 (2) ◽

pp. 169-176

Author(s):

Oleg O. Kirilochev

Keyword(s):

Drug Interactions ◽

Qt Interval ◽

Psychiatric Inpatient ◽

Psychiatric Inpatients ◽

Torsades De Pointes ◽

Medical Decision ◽

Inpatient Setting ◽

Interval Prolongation ◽

Risk Of Death ◽

Qt Interval Prolongation

Background; Events associated with a risk of death are the most serious complications of pharmacotherapy; One of these complications is prolongation of the QT interval leading to Torsades de Pointes, a life-threatening condition that can result in asystole and sudden death. Factors contributing to the development of the long QT syndrome include heredity, structural abnormalities of the heart, electrolyte disorders, female gender, advanced age, use of drugs with certain electrophysiological properties, and drug-drug interactions. Consideration of all these factors can help achieve the most accurate and objective assessment of the risk of these rhythm disturbances. Aims to assess the risk of prolongation of the QT interval and the development of Torsades de Pointes in psychiatric inpatients. Methods. The study enrolled 500 patients who received medical care in a psychiatric inpatient setting. The risk of QT interval prolongation and development of Torsades de Pointes was assessed using the MedSafety Scan medical decision support system. Results. Of the 500 patients treated in the psychiatric inpatient setting, 224 had a risk of QT interval prolongation and developing Torsades de Pointes; the incidence was highest in the group of elderly patients. The mean risk score was 7.59 3.29 in general, 6.02 3.14 in patients aged under 65 years, and 9.16 2.62 in subjects over 65 years of age. An analysis of the frequencies of risk factors for prolongation of the QT interval and Torsades de Pointes revealed that patients aged over 65 years most commonly had atrial fibrillation, chronic heart failure, heart valve disorders, hypertension, and a history of myocardial infarction. Patients under 65 years of age more commonly received medicinal products prolonging the QT interval and drug combinations that can lead to potential drug-drug interactions of relevant clinical significance. Conclusion. The obtained results indicate the importance of assessing the risk of QT interval prolongation and development of Torsades de Pointes in psychiatric inpatients as an affordable preventive tool that can increase the safety of drug therapy.

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Detect Drug Interactions with Metronidazole

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i47a33049 ◽

2021 ◽

pp. 597-604

Author(s):

Ibrahim Dighriri ◽

Ahmed Mobarki ◽

Naif Althomali ◽

Khalid Alqurashi ◽

Othman Daghriri ◽

...

Keyword(s):

Drug Interactions ◽

Qt Interval ◽

Clinical Care ◽

Cost Effective ◽

Interval Prolongation ◽

Treatment Regimens ◽

Risk Of Bleeding ◽

Qt Interval Prolongation ◽

Concurrent Use ◽

Effective Medication

Introduction: Metronidazole has been prescribed to treat infections for over a century and continues to be helpful in the therapy of amoebiasis, trichomoniasis, and giardiasis. Metronidazole is a cost-effective medication because of its low price, few adverse effects, and favorable pharmacokinetic and pharmacodynamic properties; nevertheless, it interacts with a wide variety of other medications. Some interactions with other medicines diminish its effectiveness, while others increase it. Aims: The study aims to detect and evaluate metronidazole interactions with other medicines at King Abdulaziz Specialist Hospital. Methodology: This retrospective study encompasses the review of 360 computerized prescriptions inside the outpatient clinic at King Abdulaziz Specialist Hospital in Saudi Arabia between March and September 2020 to detect and evaluate interactions among metronidazole and different medications. Results: Metronidazole interactions are mostly major or moderate. Metronidazole had the most common interactions with domperidone (15.83 %), famotidine (13.89 %), and ciprofloxacin (11.67 %). Metronidazole contains a nitroimidazole ring, which suppresses the metabolism in the liver of numerous medications, including those that may be metabolized by the CYP3A4 and/or CYP450 2C9 isoenzymes. The combination of metronidazole with phenytoin or phenobarbital can cause metronidazole elimination to be accelerated and phenytoin clearance to be reduced. Metronidazole may improve warfarin's anticoagulant effects, leading to a longer prothrombin time and a higher risk of bleeding. Concurrent use of metronidazole with alfuzosin, escitalopram, and ondansetron may raise the risks of QT-interval prolongation and arrhythmias. Conclusion: Most metronidazole drug interactions can be avoided by following excellent clinical care and clinical pharmacology concepts, such as avoiding complex treatment regimens, educating patients. and identifying patient risk factors. Furthermore, before prescribing and dispensing medicines, physicians and pharmacists should utilize drug-drug interactions checkers such as Micromedex and Lexicomp or a book such as Stockley's Drug Interactions.

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Drug-drug interactions in patients with malaria: a multicenter retrospective study

10.21203/rs.2.20365/v1 ◽

2020 ◽

Author(s):

Sidra Noor ◽

Mohammad Ismail

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Regression Analysis ◽

Drug Interactions ◽

Hospital Stay ◽

Clinical Relevance ◽

Multiple Drug ◽

Laboratory Findings ◽

Qt Interval Prolongation ◽

Prescribed Medicines

Abstract Background: Hospitalized patients with malaria often present with comorbidities or associated complications for which a variety of drugs are prescribed. Multiple drug therapy often leads to drug-drug interactions (DDIs). Therefore, we investigated the prevalence, levels, risk factors, clinical relevance, and monitoring parameters/management guidelines of potential DDIs (pDDIs) among inpatients with malaria. Methods: A retrospective cohort study was carried out at multiple hospital settings. A total of 398 patients’ profiles were evaluated for pDDIs using the Micromedex Drug-Reax ®. Odds ratios were calculated to identify the strength of association between presence of DDIs and potential risk factors via logistic regression analysis. Further, the clinical relevance of frequent pDDIs was investigated. Results: Of 398 patients, pDDIs were observed in 37.2% patients, while major-pDDIs in 19.3% patients. Total 325 interaction were found, of which 45.5% were of major- and 34.5% moderate-severity. Patients with the most common pDDIs were found with signs/symptoms and abnormalities in laboratory findings representing nephrotoxicity, hepatotoxicity, QT interval prolongation, and reduced therapeutic efficacy . The adverse events were more common in patients prescribed with the higher doses of interacting drugs. Multivariate regression analysis showed statistically significant association of pDDIs with 5-6 prescribed medicines (p=0.01), >6 prescribed medicines (p<0.001), >5 days of hospital stay (p=0.03), and diabetes mellitus (p=0.04). Conclusions: PDDIs are commonly observed in patients with malaria. Healthcare professional’s knowledge about the most common pDDIs could help in preventing pDDIs and their associated negative effects. Pertinent clinical parameters, such as laboratory findings and signs/symptoms need to be checked, particularly in patients with polypharmacy, longer hospital stay, and diabetes mellitus.

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High prevalence of the risk factors for QT interval prolongation and associated drug–drug interactions in coronary care units

Postgraduate Medicine ◽

10.1080/00325481.2018.1516106 ◽

2018 ◽

Vol 130 (8) ◽

pp. 660-665 ◽

Cited By ~ 5

Author(s):

Qasim Khan ◽

Mohammad Ismail ◽

Iqbal Haider

Keyword(s):

Risk Factors ◽

Drug Interactions ◽

Qt Interval ◽

Interval Prolongation ◽

Qt Interval Prolongation ◽

High Prevalence ◽

Coronary Care ◽

Coronary Care Units

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Risk of QT Prolongation through Drug-drug Interactions between Hydroxychloroquine and Concomitant Drugs Prescribed in Real-world Practice

10.21203/rs.3.rs-79572/v1 ◽

2020 ◽

Author(s):

Byung Jin Choi ◽

Yeryung Koo ◽

Tae Young Kim ◽

Wou Young Chung ◽

Yun Jung Jung ◽

...

Keyword(s):

Drug Interactions ◽

Real World ◽

Qt Interval ◽

Qt Prolongation ◽

Qtc Interval ◽

Interval Prolongation ◽

Qt Interval Prolongation ◽

Life Threatening ◽

Alternative Drugs

Abstract Background: Hydroxychloroquine has recently received attention as a treatment for COVID-19. However, hydroxychloroquine may prolong the QTc interval, thus increasing the risk of life-threatening arrhythmia. Many patients with COVID-19 have comorbidities, necessitating the use of several drugs simultaneously with hydroxychloroquine. However, the risk of QT prolongation due to drug-drug interactions (DDIs) between hydroxychloroquine and these co-medications has not been identified. Therefore, it is necessary to investigate the risk of QT interval prolongation due to DDIs between hydroxychloroquine and frequently used concurrent drugs.Methods and Results: Using 447,632 patients and 1,040,752 electrocardiograms, we investigated the risk of QT prolongation due to DDIs between hydroxychloroquine and 118 concurrent drugs frequently used in real-world practice. In the analysis, we observed that 11 drugs (trimebutine, tacrolimus, tramadol, rosuvastatin, ciclosporin, sulfasalazine, rofecoxib, diltiazem, piperacillin/tazobactam, and isoniazid) show DDIs with hydroxychloroquine in the direction of QT prolongation.Conclusions: We found 11 drugs that show significant (p <0.05) DDIs with hydroxychloroquine, thereby increasing the risk of QT prolongation in patients. It is necessary to consider prescribing alternative drugs that have less DDI when these drugs are concurrently administered with hydroxychloroquine. Further investigation is needed to assess more profoundly the risk of QT prolongation due to DDI with hydroxychloroquine of each drug that we found in this analysis.

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Drug-drug interactions associated with adverse clinical outcomes and abnormal laboratory findings in patients with malaria

10.21203/rs.3.rs-28731/v1 ◽

2020 ◽

Author(s):

Sidra Noor ◽

Mohammad Ismail ◽

Faiza Khadim

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Regression Analysis ◽

Drug Interactions ◽

Hospital Stay ◽

Clinical Relevance ◽

Multiple Drug ◽

Laboratory Findings ◽

Qt Interval Prolongation ◽

Prescribed Medicines

Abstract Background: Hospitalized patients with malaria often present with comorbidities or associated complications for which a variety of drugs are prescribed. Multiple drug therapy often leads to drug-drug interactions (DDIs). Therefore, we investigated the prevalence, levels, risk factors, clinical relevance, and monitoring parameters/management guidelines of potential DDIs (pDDIs) among inpatients with malaria. Methods: A retrospective cohort study was carried out at multiple hospital settings. A total of 398 patients’ profiles were evaluated for pDDIs using the Micromedex Drug-Reax ® . Odds ratios were calculated to identify the strength of association between presence of DDIs and potential risk factors via logistic regression analysis. Further, the clinical relevance of frequent pDDIs was investigated. Results: Of 398 patients, pDDIs were observed in 37.2% patients, while major-pDDIs in 19.3% patients. Total 325 interaction were found, of which 45.5% were of major- and 34.5% moderate-severity. Patients with the most common pDDIs were found with signs/symptoms and abnormalities in laboratory findings representing nephrotoxicity, hepatotoxicity, QT interval prolongation, and reduced therapeutic efficacy . The adverse events were more common in patients prescribed with the higher doses of interacting drugs. Multivariate regression analysis showed statistically significant association of pDDIs with 5-6 prescribed medicines (p=0.01), >6 prescribed medicines (p<0.001), >5 days of hospital stay (p=0.03), and diabetes mellitus (p=0.04). Conclusions: PDDIs are commonly observed in patients with malaria. Healthcare professional’s knowledge about the most common pDDIs could help in preventing pDDIs and their associated negative effects. Pertinent clinical parameters, such as laboratory findings and signs/symptoms need to be checked, particularly in patients with polypharmacy, longer hospital stay, and diabetes mellitus.

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