scholarly journals Legemiddel­interaksjoner hos sykehuspasienter – forekomst og klinisk betydning

2009 ◽  
Vol 18 (2) ◽  
Author(s):  
Hege Salvesen Blix ◽  
Kirsten K. Viktil ◽  
Åsmund Reikvam
Keyword(s):  
Drug Interactions ◽  
Clinical Importance ◽  
Patient Characteristics ◽  
Total Sample ◽  
Computer Programme ◽  
Potential Drug ◽  
New Drug ◽  
Hospitalised Patients ◽  
Medication Reviews ◽  
Clinically Significant

Introduction: Little is known about the occurrence of drug interactions of hospitalised patients. We aimed to identify the frequency of potential drug interactions among hospitalised patients and, furthermore, to evaluate how many of these were problematic and clinically significant. Methods: We investigated drug interactions by two methods: by applying a computerised drug-drug interaction programme and by prospective clinical evaluation. The study was carried out at departments of internal medicine and rheumatology in five Norwegian hospitals in 2002. Patient characteristics and information on drug use were recorded for 827 patients consecutively included. Medication reviews were carried out by clinical pharmacists and drug-related problems (DRPs), among which drug interactions is one category, were identified and discussed in the hospital multidisciplinary team, chaired by a physician. Retrospectively, the patients’ drug regimens were screened by using a computer programme for drug-drug interactions, DRUID. This programme is universally used in Norway and classifies DDIs into four categories according to assumed severity: A, avoid; B, avoid/take precautions; C, take precautions; D, no action needed. Results: A total of 1513 DDIs were found in 544 patients (66% of the total sample of 827 patients) by computer screening. Many of these were related to drugs started in the hospital, that is they were new drug interactions. By bedside evaluation, 99 DDIs were found in 73 patients (9%). Of these, 89 were also identified by computer screening. Thus, only 6% of the computer identified drug interactions were assessed to be clinically problematic. Interactions of all degrees of severity, according to the computer programme, were identified as problematic by bedside screening. Drugs most often causing new drug interactions were warfarin, acetylsalicylic acid, digitoxin and combinations of codeine and paracetamol. Conclusions: The majority of hospitalised patients have potential drug interactions, however, less than one in ten have interactions of clinical importance. Computer graded severity has limitations when intended to be used as an indicator for clinical importance. Another way of picking up new, possibly serious drug interactions would be to select indicator drugs, which are drugs frequently known to be involved in interactions, and then undertake the main interaction search on these drugs.

scholarly journals A multicentered pharmacoepidemiological approach to evaluate clinically significant potential drug–drug interactions in medical intensive care settings in Pakistan

2018 ◽  
Vol 25 (4) ◽  
pp. 190-195 ◽  
Author(s):  
Faisal Shakeel ◽  
Jamshaid Ali Khan ◽  
Muhammad Aamir ◽  
Syed Muhammad Asim ◽  
Irfan Ullah
Keyword(s):  
Intensive Care ◽  
Drug Interactions ◽  
Intensive Care Units ◽  
Potential Drug ◽  
Significant Potential ◽  
Significant Difference ◽  
Tertiary Hospitals ◽  
Medical Intensive Care ◽  
Clinically Significant ◽  
Multiple Drugs

Background: Iatrogenic injuries due to drug–drug interactions are particularly significant in critical care units because of the severely compromised state of the patient. The risk further increases with the use of multiple drugs, increasing age, and stay of the patient. Objective: The aim was to assess potential drug–drug interactions, evaluate clinically significant potential drug–drug interactions and their predictors in medical intensive care units of tertiary hospitals in Pakistan. Methods: Analysis of patient data collected from medical intensive care units of tertiary hospitals in Pakistan were carried out using Micromedex DrugReax. Various statistical tools were applied to identify the significance of associated predictors. Results: In a total of 830 patients, prevalence of potential drug–drug interactions was found to be 39%. These attributed to 190 drug combinations, of which 15.4% were clinically significant. A significant association of potential drug–drug interactions was present with number of prescribed drugs, age, and gender. In terms of clinically significant potential drug–drug interactions, the association was significant with increasing age. Moreover, one-way analysis of variance revealed a significant difference in the means of potential drug–drug interactions among the four hospitals. Conclusion: A prevalence of 39% potential drug–drug interactions was observed in patients of medical intensive care unit, with 22.8% being clinically significant. These attributed to nine drug pairs and could easily be avoided to reduce the risk of adverse effects from potential drug–drug interactions.

New Drug Review-Ezogabine (Potiga): Seizing the seizure

2011 ◽  
Vol 1 (6) ◽  
pp. 135-136
Author(s):  
Misty L. Gonzalez
Keyword(s):  
Clinical Trial ◽  
Adverse Effects ◽  
Drug Interactions ◽  
Drug Administration ◽  
Mechanism Of Action ◽  
New Drug ◽  
Clinical Trial Evidence ◽  
Clinically Significant ◽  
Trial Evidence ◽  
Drug Review

Ezogabine was approved by the Food and Drug Administration (FDA) in June of 2011. This article reviews clinically significant aspects of this new drug including: the FDA-approved indications, mechanism of action, administration, drug interactions, adverse effects, clinical trial evidence, innovative properties and place in therapy.

scholarly journals Clinically Relevant Drug-Drug Interactions and Management Strategies: A Hospital based Study

2020 ◽  
Vol 2 (2) ◽  
pp. 109-114
Author(s):  
Arun Sharma ◽  
Sitaram Khadka ◽  
Bimal Kunwar ◽  
Kapil Amgain ◽  
Rinku Joshi ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Management Strategies ◽  
Clinical Importance ◽  
Cross Sectional Study ◽  
Automated System ◽  
Clinical Settings ◽  
Evaluation Tool ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Clinically Significant

Background: Drug-drug interactions (DDIs) are one of the significant drug related problems encountered in clinical settings. Better understanding of the mechanisms, severity, and likely consequences of clinically significant DDIs are essential for proper medication therapy management (MTM). This study is conducted with the aim to aware clinical practitioners about clinically significant DDIs that occur in clinical settings and to help them manage such events with the accurate knowledge and technique. Methods: A descriptive cross-sectional study was conducted in Shree Birendra Hospital, Kathmandu on the prescription of medical out-patient department from June to November 2020. Total 483 prescriptions were selected randomly. A panel of physicians, pharmacologists and clinical pharmacists under the supervision of a consultant physician using MICROMEDEX DRUG-REAX, Evaluation of Drug Interactions, Drug Interaction Facts, Drug Interactions: Analysis and Management was conducted. Main outcome measure was obtained by the supervisor’s endorsement on panelists' opinion about clinical importance of DDIs. Results: A total of 2006 medicines were prescribed in 483 prescription samples. The number of drugs per prescription was in a range from 2 to 11 with 4.15 on average. DDIs were found in 21.53% prescriptions (n=104). 168 DDIs were identified with major, moderate, and minor types in 32 (19%), 85 (51%), and 51 (30%) respectively. As per occurrence, the panel determined that 13 interactions were clinically important. Conclusion: The drug interactions identified by a panel of expert using standard evaluation tool are considered to be clinically important and likely to occur in the clinical settings. Clinically significant DDIs can be preventable and can also be used for the beneficial effects in MTM. Adequate knowledge regarding nature of DDIs, inclusion of automated system in prescribing and dispensing area, and inter-professional collaboration of a clinical team is liable to prevent and manage such events and help in rational drug therapy.

Revisiting CYP2C9-Mediated drug-drug Interactions: A Review

2021 ◽  
pp. 6166-6172
Author(s):  
Nurliana Abd Mutalib ◽  
Mohd Amirul Ariffin Mohd Rafi ◽  
Normala Abd Latip
Keyword(s):  
Natural Products ◽  
Reference Material ◽  
Drug Interactions ◽  
Phase 1 ◽  
Potential Drug ◽  
Health Practitioners ◽  
Clinical Drugs ◽  
Clinically Significant

Drug-drug interactions (DDI) are the most common cases that occur in our healthcare in which are very alarming as it may lead to severe complications. Consumption of natural products concomitantly with conventional drugs or treatment using polypharmacy have become the norm that promoting the potential of pharmacokinetic or pharmacodynamic drug interactions as the combination may mimic, increase or reduce the effects of the drug or the herb which could result in clinically significant interactions. CYP2C9 is the second major isoform from CYP450 family of enzyme, which responsible in phase 1 metabolism of 15-20% clinical drugs. Up to date, many substrates of CYP2C9 have been discovered and these discoveries may open more doors for potential drug-drug interactions in patients. Many studies have been done to evaluate the effect of drugs on the activity of CYP2C9 and how it influenced the effectiveness of therapy in patients. Various data regarding CYP2C9 related DDI from in vitro, in vivo and clinical studies were critically discussed in this review to provide insights on how these drugs and natural products may exhibit drug interactions clinically. This review could be beneficial reference material for health practitioners and researchers.

Potential drug-drug interactions in hospitalized pediatric patients with respiratory disorders: a retrospective review of clinically important interactions

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Maryam Hassanzad ◽  
Sabereh Tashayoie Nejad ◽  
Amir Ali Mahboobipour ◽  
Farzaneh Salem ◽  
Shadi Baniasadi
Keyword(s):  
Risk Factors ◽  
Drug Interactions ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Respiratory Disorder ◽  
Potential Drug ◽  
Respiratory Disorders ◽  
Drug Classes ◽  
Increased Risk ◽  
Clinically Significant

Abstract Background Hospitalized pediatric patients are at an increased risk of experiencing potential drug-drug interactions (pDDIs) due to polypharmacy and the unlicensed and off-label administration of drugs. The aim of this study is to characterize clinically significant pDDIs in pediatric patients hospitalized in a tertiary respiratory center. Methods A retrospective analysis of medications prescribed to pediatric patients admitted to the pediatric ward (PW) and pediatric intensive care unit (PICU) of a respiratory referral center was carried out over a six-month period. The pDDIs were identified using the Lexi-Interact database and considered as clinically relevant according to the severity rating as defined in the database. Frequency, drug classes, mechanisms, clinical managements, and risk factors were recorded for these potential interactions. Results Eight hundred and forty-five pDDIs were identified from the analysis of 176 prescriptions. Of the total pDDIs, 10.2% in PW and 14.6% in PICU were classified as clinically significant. Anti-infective agents and central nervous system drugs were the main drug classes involved in clinically significant pDDIs as object and/or precipitant drugs. A higher number of medications [odds ratio (OR): 4.8; 95% confidence interval (CI): 2.0–11.4; p < 0.001] and the existence of a nonrespiratory disease, which led to a respiratory disorder (OR: 3.8; 95% CI: 1.40–10.4; p < 0.05), were the main risk factors associated with an increased incidence of pDDIs. Conclusions A high and similar risk of pDDIs exists in pediatric patients with respiratory disorders hospitalized in PW and PICU. The patients prescribed a higher number of medications and presenting respiratory symptoms induced by a nonrespiratory disease require extra care and monitoring. Pediatricians should be educated about clinically significant DDIs for highly prescribed medications in their settings in order to take preventive measures and safeguard patient safety.

scholarly journals Risk Factors for the Occurrence of Potential Drug-drug Interactions in Surgical Patients

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Miloš N. Milosavljevic ◽  
Aleksandar G. Kočovic ◽  
Slobodan M. Jankovic ◽  
Dragče M. Radovanovic ◽  
Slobodan S. Milisavljevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Drug Interactions ◽  
Cohort Analysis ◽  
Personal Digital Assistant ◽  
Antiarrhythmic Therapy ◽  
Surgical Patients ◽  
Potential Drug ◽  
Clinical Center ◽  
Clinically Significant

Abstract Background: Drug-drug interactions are defined as modifications of the drug action that result from the simultaneous administration of another individual drug or several drugs. Nowadays, potential drug-drug interactions (DDIs) are most frequently detected and analyzed using personal digital assistant software programs (online interaction checker tools). Objective: To determine the risk factors for the emergence of all drug-drug interactions in surgical patients with particular emphasis on clinically significant interactions. Patients and methods: This was a retrospective cohort analysis of patients treated at the Surgical Clinic of the Clinical Center Kragujevac. Three interaction checkers were used to reveal drug-drug interactions: Medscape, Epocrates and Micromedex. Results: The study included total of 200 patients, aged 58.54±17.08 years. Average number of drug-drug interactions per patient was between 10.50±9.10 (Micromedex) and 18.75±17.14 (Epocrates). Number of prescribed drugs, antidepressive therapy, antiarrhythmic therapy, number of pharmacological/therapeutic subgroups (2nd level of ATC classification) prescribed, delirium or dementia, diabetes, heart failure, and number of physicians who prescribed drugs to single patient were identified as risk factors for drug-drug interactions while length of hospitalization in days and age of patient in years emerged as protective factors. Conclusion: Drug-drug interactions are relatively common in surgical patients and predisposed by factors such as number of prescribed drugs or drug group per patient, number of physicians who prescribed drugs, antidepressive therapy, antiarrhythmic therapy, presence of delirium or dementia, diabetes and heart failure. On the other hand, prolonged hospitalization and higher age are factors that reduce the risk of interactions in surgical patients.

Low Antituberculosis Drug Concentrations in Patients with AIDS

1996 ◽  
Vol 30 (9) ◽  
pp. 919-925 ◽  
Author(s):  
Charles A Peloquin ◽  
Annette T Nitta ◽  
William J Burman ◽  
Karen F Brudney ◽  
Jorge R Miranda-Massari ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Patient Characteristics ◽  
Antituberculosis Drug ◽  
Potential Drug ◽  
Serum Concentrations ◽  
Serum Samples ◽  
Antituberculosis Drugs ◽  
Cell Counts ◽  
Normal Ranges ◽  
Drug Concentrations

OBJECTIVE: To determine the frequency and magnitude of below normal apparent peak serum concentrations for antituberculosis drugs in patients with AIDS and CD4 cell counts less than 200 cells/mm3. We also explored the data for potential relationships between response variables and patient characteristics. DESIGN: Prospective study of consecutive patients seen in tuberculosis clinics. SETTING: Five urban tuberculosis clinics in four major metropolitan areas. PARTICIPANTS: Twenty-six patients diagnosed with HIV infection and receiving treatment for active tuberculosis were eligible. MAIN OUTCOME MEASURES: After 2 weeks or more of therapy, blood was collected 2 hours after observed doses of the antituberculosis drugs. Serum samples were frozen, shipped to National Jewish Center in Denver, and analyzed by HPLC or GC. Serum concentrations were compared with the proposed normal ranges. Data were analyzed to determine correlations between antituberculosis drug serum concentrations and patient characteristics. RESULTS: Low 2-hour serum concentrations were common for antituberculosis drugs, particularly rifampin and ethambutol. Absorption of isoniazid was generally high. Potential drug—drug interactions were found between rifampin and fluconazole (fluconazole appears to increase rifampin concentrations) and between pyrazinamide and zidovudine (zidovudine may lower pyrazinamide concentrations). Patients receiving pyrazinamide had lower rifampin concentrations than those not receiving pyrazinamide. CONCLUSIONS: Low antituberculosis drug serum concentrations occur frequently during the treatment of tuberculosis in patients with AIDS. Additional research is required for patients with drug-resistant tuberculosis, and to clarify the nature of the potential drug—drug interactions.

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