Assessment of drug-drug interactions among renal failure patients of nephrology ward in a south Indian tertiary care hospital

Abstract

Polypharmacy is common in drug prescriptions of chronic kidney disease patients. A study of the prescription patterns of drugs with potential interactions would be of interest to prevent drug related adverse events. A prospective observational study of six months (Dec 2009-May 2010) was carried out among the chronic kidney disease patients admitted to the nephrology ward of a South Indian tertiary care hospital. The pattern and rates of drug-drug interactions seen in the prescriptions of these patients was studied. Among the 205 prescriptions included, a total of 474 interactions were reported, making 2.7 interactions per prescription with incidence rates of 76.09%. Around 19.62% of interactions were of major severity. Most common interactions were found between ascorbic acid and cyanocobalamine (12.45%), clonidine and metoprolol (3.80%) respectively. Hypo or hypertension (31.65%), decreased drug efficacy (29.11%) and hypo or hyperglycemia (14.14%), were the most commonly reported clinical outcomes of the drug interactions. Cardiovascular drugs (calcium channel blockers and beta blockers; 52%) constitute the major class of drugs involved in interactions. As most of the interactions had a delayed onset, long term follow-up is essential to predict the clinically significant outcomes of these interactions. Hence, drug interactions are commonly seen in the prescriptions of chronic kidney disease patients which can lead to serious adverse events if not detected early. Need for collaboration with a clinical pharmacist and electronic surveillance, which are absent in developing countries like India, is emphatic.

Assessment of prescribed medications and pattern of distribution for potential drug–drug interactions among chronic kidney disease patients attending the Nephrology Clinic of Lagos University Teaching Hospital in Sub-Saharan West Africa

“…Most of the DDIs had delayed onset and would require long-time follow-up in order to actually determine the clinically significant outcome of these interactions. The average number of DDIs per prescription in this study was 1.5, which is similar to the report by Sgnaolin et al 15 (1.0) but lower than the number reported by Rama et al 16 (2.7) and Marquito et al 19 (2.5). This showed that there was likelihood of at least a potential DDI for each prescription issued out to a CKD patient in this study.…”

“…In this study, the mean prescribed medications per patient was 10.28±3.85. This is slightly higher than 7.87±2.44 reported by Al-Ramahi et al 17 However, Rama et al 16 reported a higher mean prescribed drugs per patient of 12.08±6.30 compared to the finding in this present study. Our study population involved both nondialyzed and dialyzed patients unlike the study by Al-Ramahi that involved only CKD patients on maintenance hemodialysis (MHD).…”

Prescribing patterns of medicines in chronic kidney disease patients on maintenance hemodialysis

“…This is comparable to earlier studies. [ 14 15 ] However, the median number of DDIs per prescription was also high and increased progressively with an increasing number of drugs per prescription. Polypharmacy is a likely contributor to the high number of potential DDIs per prescription.…”

Drug-related problems in patients with erectile dysfunctions and multiple comorbidities

“…In addition, the result of our study also showed that the occurrence of drug interaction was higher in ESRD patients compared with non-ESRD patients. Although the study by Rama et al had found a high occurrence of drug interaction in patients with ESRD, the interactions were not the result of ED medication 63. Therefore, further studies are required to validate this relationship.…”