Probable Interaction Between Warfarin and the Combination of Remdesivir With Dexamethasone for Coronavirus Disease 2019 (COVID-19) Treatment: A 2 Case Report

Purpose: To describe a potential drug interaction between warfarin and the combination of remdesivir with dexamethasone. Summary: Two male patients, a 71-year-old and 62-year-old presented to the emergency department for symptoms of coronavirus disease 2019 (COVID-19). Both patients were on long-term warfarin therapy with their most recent international normalized ratio (INR) prior to admission within their patient specific goal as managed by their outpatient Pharmacist. In both instances, the patients denied any changes in diet, lifestyle, or missed doses of medications upon admission interview. During admission, both patients experienced a marked elevation in INR within 24 to 48 hours of the initiation of remdesivir with dexamethasone for COVID-19 pneumonia directed therapy. The patients were both eventually stable and were instructed to continue warfarin monitoring and management under the direction of their outpatient Pharmacist upon discharge. Conclusion: The underrecognized but probable interaction between warfarin in conjunction with remdesivir and dexamethasone warrants further analysis.

Decrease in Efficacy of Warfarin as a Result of Drug-Drug Interaction (Case Report)

The one of the main aims in modern clinical pharmacology is to provide safe and effective therapy considering a frequent administration of several drugs having different drug-drug interactions. Warfarin belongs to the number of popular anticoagulants which along with its efficiency not infrequently alters anticoagulant characteristics when administered with other drugs and food products. A case of a decrease in the efficacy of warfarin in a patient with mitral stenosis while taking a combined choleretic drug is presented in the article. The components of this choleretic drug (dry animal bile, dry garlic extract, dry nettle extract, activated charcoal) could impair the absorption of warfarin, increase intestinal absorption of vitamin K, and have a negative effect on the anticoagulant effect of warfarin. Management of patients receiving anticoagulants should be performed in accordance with clinical recommendations. Prescription of drugs, including multicomponent ones, without proven efficacy, for such patients should be considering the potential drug interaction.

Sitagliptin and Simvastatin Interaction Causing Rhabdomyolysis and AKI

We report a case of rhabdomyolysis and severe acute kidney injury (AKI) requiring dialysis in a 69-year-old male who was recently started on sitagliptin while on chronic simvastatin therapy. This potential interaction is not included in the package insert for sitagliptin. A comprehensive literature review revealed six previous reports of rhabdomyolysis due to drug interaction between sitagliptin and statins including simvastatin, lovastatin, and atorvastatin. Of these six cases, only two had developed rhabdomyolysis-associated AKI, none of which were severe enough to require dialysis. As patients are commonly prescribed statins and sitagliptin for treatment of dyslipidemia and diabetes, health care professionals should be aware of this potential drug interaction and closely monitor their patients for signs and symptoms of rhabdomyolysis and AKI. This case highlights the importance of conducting further studies on the risk of muscular toxicity of sitagliptin especially when administered concurrently with statins.

Valproate Interaction With Carbapenems: Review and Recommendations

Introduction: Valproic acid is a commonly used antiepileptic drug. Combining valproate derivatives with carbapenem antibiotics is associated with a potential drug interaction that decreases serum concentration of valproate and may expose the patient to uncontrolled seizure risk from valproate subtherapeutic concentration. Raising awareness of this drug interaction among health care providers including emergency department physicians, neurologists, and pharmacists is highly needed. The aim of this article was to review the current literature about the potential drug interaction resulting from combining valproate derivatives with carbapenem antibiotics and to establish therapeutic recommendations regarding their use together. Methods: A review of the literature was conducted using Medline (through PubMed), Ovid, Embase, Cochrane library using the following keywords: valproate, valproic acid, carbapenem, ertapenem, doripenem, meropenem, imipenem, and valproate drug interaction. In addition, a manual search through major journals for articles referenced in PubMed was performed. Related publications from January 1998 till November 2018 were included in the initial search. Relevant publications were reviewed, and data regarding patients, type of carbapenem used, valproic acid dosing and level, interaction severity, and clinical outcome were summarized. Results and Discussion: Few clinical trials and multiple case reports have shown that carbapenem antibiotics including meropenem, ertapenem, imipenem, and doripenem can decrease the serum concentration of valproate derivatives leading to a subtherapeutic serum concentration and seizures in some patients. Valproic acid serum concentration may be significantly decreased with addition of a carbapenem antibiotic but generally return toward normal shortly after discontinuation of the carbapenem antibiotic. Conclusions: Generally, the concurrent use of carbapenem antibiotics with valproate derivatives should be avoided due to the potential of drug-drug interaction that results in subtherapeutic valproate serum concentration. Other antimicrobial agents should be considered as alternatives to carbapenems but if a concurrent carbapenem is necessary, using an additional antiepileptic agent is recommended. Therapeutic drug monitoring of valproate serum concentrations is warranted when a carbapenem-valproic acid combination therapy is unavoidable.

Potensi Interaksi Obat Antituberkulosis dan Anti Diabetes terhadap Efek Samping Obat pada Pasien Tuberkulosis-Diabetes Melitus di RSUD Al-Ihsan Bandung

Pengobatan tuberkulosis (TB) dengan diabetes melitus (DM) pada pasien TB-DM membutuhkan waktu yang cukup lama dan beragam sehingga memiliki risiko tinggi menyebabkan potensi interaksi obat dan menimbulkan efek samping obat. Penelitian ini bertujuan mengetahui hubungan potensi interaksi obat antituberkulosis dengan obat antidiabetes pada pasien TB dengan DM di Poli DOTS RSUD Al-Ihsan pada periode April–Mei 2018. Penelitian ini dilakukan dengan metode analitik observasional menggunakan pendekatan cross-sectional, pengambilan data obat yang terdapat pada rekam medik dan kuesioner yang telah dilakukan uji validitas dan uji reliabilitas. Data potensi interaksi obat diolah dengan memasukkan data obat yang dikonsumsi pasien menggunakan software pada Lexi-Interact. Subjek berjumlah 30 responden dipilih secara total sampling. Hasil penelitian menunjukkan frekuensi tertinggi potensi interaksi obat antituberkulosis-obat antidiabetes pada derajat berat sejumlah 12 dari 30 pasien. Efek samping yang terjadi pada pasien dengan frekuensi tertinggi adalah derajat ringan sejumlah 10 dari 30 pasien. Analisis dengan uji chi-square tidak memiliki nilai kemaknaan antara potensi interaksi obat dan efek samping obat (p=0,146). Simpulan, tidak terdapat hubungan potensi interaksi obat dengan efek samping yang timbul pada pasien TB dengan DM di Poli DOTS RSUD Al-Ihsan periode April–Mei 2018. POTENTIAL INTERACTIONS BETWEEN ANTI TUBERCULOSIS DRUG AND ANTI DIABETES DRUG WITH SIDE EFFECTS ON TUBERCULOSIS-DIABETES MELLITUS PATIENTS IN RSUD AL-IHSAN BANDUNGThe medication of tuberculosis (TB) with diabetes mellitus (DM) on TB-DM patients requires quiet a long and diverse time, so it has a high risk to potentially causing a medicine interaction and produce side effects. The research aimed to know the relation of potential interactions between anti tuberculosis medicine and anti diabetes drug with side effects on TB-DM patients in Directly Observed Treatment Short-course (DOTS) outpatient clinic of RSUD Al-Ihsan Bandung in April–May 2018. This research was done by cross sectional approach method by taking the drug data in the medical records and questionnaires which have been tested for validity and reliability. Data of potential drug interactions is processed by entering data of drug consumed by patient using software on Lexi-Interact. The subjects were 30 respondents, selected by total sampling. The results showed the highest frequency of potential anti-tuberculosis drug anti-diabetic drug interactions on severe degree 12 of 30 patients. The results also showed that the side effects occurring in patients with highest frequency were mild degrees of 10 of 30 patients. The analysis obtained by chi square test between potential drug interaction with side effect of drug is not having any meaning value with (p=0.146). In conclusion, there is no relation between potential drug interaction and side effect on TB-DM patients in Directly Observed Treatment Short-course (DOTS) outpatient clinic of RSUD Al-Ihsan Bandung in April–May 2018.

Drug Interaction Potency on Type 2 Diabetes Mellitus Patient in Hospital X in South Tangerang

Drug interaction is an interaction among a drug with other ingredients that prevents the drug from giving certain or expected effect. Such interaction might happen between a drug and other drugs, drugs with food, as well as drugs and disease. Potential drug interaction in patients with type 2 diabetes mellitus in some hospitals had been reported by several previous publications. This study aimed to identify the potential of drug interactions in patients with type 2 diabetes mellitus at Hospital X, South Tangerang. This paper is a descriptive research with retrospective retrieval data. Data were obtained in the form of patient medical records from July 2014 to June 2015. Data analysis was done by descriptive statistic analysis using SPSS version 16. The results showed that there were 90 medical records that fulfilled the inclusion criteria. Of these, 57.7% was found to be potential drug interaction. There are 55 drug interactions that potentially cause hypoglycemia, and there are 21 times that potentially cause hyperglycemia. The severity of interaction in moderate category was 89.39% (total of 66), and the rest was in minor category. Major categories were not found. The potential for drug interactions in type 2 diabetes mellitus patients is quite common and these findings complement the findings of previous published studies. Physicians and pharmacists as health workers who are directly related to the treatment of patients need to increase awareness of the potency of interactions of these drugs.