Drug-drug and drug-disease interactions in the ED: Analysis of a high-risk population

Goldberg, Richard M.; Mabee, John; Chan, Linda S.; Wong, Sandra F.

doi:10.1016/s0735-6757(96)90147-3

Cited by 277 publications

(187 citation statements)

References 8 publications

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“…It has been estimated that patients taking two drugs face a 13% risk of drug interactions, rising to 38% when taking four drugs, and to 82% if seven or more drugs are given simultaneously (Goldberg et al, 1996). Furthermore, prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, and inappropriate prescribing is associated with increased risk for adverse drug events (Gallagher, Barry, O'Mahony, 2007).…”

Section: Discussionmentioning

confidence: 99%

Potential interactions of central nervous system drugs used in the elderly population

Morrone

Schroeter

Petitembert

et al. 2009

Braz. J. Pharm. Sci.

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Objective: To describe the use of CNS drugs and to identify the most frequently observed potential drug interactions in the elderly living in Southern Brazil. Methods: A population-based, transversal and observational study was carried out during [2006][2007]. Four hundred and eighty elderly individuals of both genders were randomly recruited and interviewed. A validated pharmacotherapeutic questionnaire and the Micromedex ® Healthcare Series were utilized to analyze potential drug interactions. A severity rating scale employing the categories of "mild", "moderate" and "severe" was used to describe the interactions. Results: A population of elderly living in Southern Brazil was interviewed and 98 reported using CNS drugs, 74.5% female and 25.5% male. Out of these patients, 32.0% reported severe or moderate pharmacological interactions related to the use of other drugs. Alprazolam and imipramine were reported to potentially interact with tobacco. Twenty potential moderate drug/ethanol interactions were found. The potential drug/caffeine interactions were classified as mild on the severity scale. Conclusion: Elderly being prescribed drugs that act on the CNS should be closely monitored, and furthermore, should be warned against potential drug-drug, drug-ethanol, and drug-tobacco interactions. Uniterms:Elderly. Drug-Drug interactions. Central nervous system. Tobacco. Ethanol.Objetivo: Descrever o uso de medicamentos que atuam no sistema nervoso central (SNC) e identificar as possíveis interações mais frequentes com esses medicamentos em idosos do sul do Brasil. Métodos: Estudo de base populacional, transversal e observacional, realizado durante [2006][2007]. Quatrocentos e oitenta idosos de ambos os sexos foram randomizados e entrevistados. Foram utilizados um questionário farmacoterapêutico validado e o programa Micromedex® Healthcare Series para analisar as potenciais interações com os medicamentos. Foi utilizada uma escala para descrever a gravidade das interações nas categorias de "leve", "moderada" e "grave". Resultados: A população idosa, moradora do sul do Brasil, que utilizava medicamentos para o SNC, era formada por 98 pacientes, 75,5% mulheres e 25,5% homens. Destes pacientes, 32,0% apresentaram interações farmacológicas graves ou moderadas relacionadas com a utilização de outros medicamentos. Alprazolam e Imipramina, usados pela população, apresentaram riscos de potenciais interações com tabaco. Foram encontradas vinte potenciais interações moderadas medicamento/etanol. As potenciais interações medicamento/cafeína foram classificadas como leves. Conclusão: Os pacientes idosos deveriam ser rigorosamente monitorizados, e ainda, é necessário advertir quanto às potenciais interações de medicamentos que atuam no SNC com outros medicamentos, etanol e tabaco. Unitermos:Idosos. Interações medicamento-medicamento. Sistema nervoso central. Tabaco. Etanol.

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Section: Discussionmentioning

confidence: 99%

Potential interactions of central nervous system drugs used in the elderly population

Morrone

Schroeter

Petitembert

et al. 2009

Braz. J. Pharm. Sci.

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“…It has been reported that the probability of an adverse drug event is 13% in patients taking 2 drugs, and increases to 82% in those taking more than seven concluded by study of Goldberg et al, (1996). 14 In patients taking 10 medications or more, this probability nears 100% concluded by study of Nolan and O'Malley (1988). 15 ( Fig.2) …”

Section: Fig 1: Age Distribution Of Study Populationmentioning

confidence: 94%

Evaluation of prescribing pattern of NSAIDs in south Indian teaching hospital

Kumar¹,

Thakur²,

Sowmya³

et al. 2017

J Chitwan Med Coll

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The present study was aimed to appropriateness of NSAIDs use with secondary objectives of assessment of co-prescription with gastro-protective agents, the nature and severity of adverse drug reactions and drug-drug interactions with an intention to prevent the inappropriate use of NSAIDs. A prospective study was carried out in 400 In-patients of various departments of the hospital during the 6 months period. Results: Out of 400 patients, 237 were male and 163 were females, in which most of the patients (63.5%) were belonging to age group of 21-50years. The major complaint of the patient was arthritic pain (25.5%). Most of the patients (77%) were prescribed single NSAID as monotherapy in different dosage forms, although some patients were prescribed with combination of Aceclofenac + Paracetamol (13.75%). The preferential COX-2 inhibitors were widely prescribed (84.5%) as compared to non-selective COX inhibitor (15.5%). Among various NSAIDs prescribed, Diclofenac (45.90%) and Aceclofenac (15.96%) were mostly prescribed. NSAIDs were mostly prescribed by parenteral route (36.31%). Most of the patients were co-prescribed NSAIDs with gastro-protective agents (80.5%). In the study, moderate drug interactions were found between NSAIDs and antibiotics and no adverse drug reactions were reported during the study. The study concluded that, prescription of NSAIDs was found to be rational. Education program, counselling program, alertness of community pharmacy regarding OTC drugs can be helpful to minimize harmful effect of the drug to patients.

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“…4,5,[7][8][9][10][11][12][13][14][15][16][17][18] The most recent comparison found programs that identified all of ten important potential interactions, or as few as five of ten. 5 In a similar study using a program called Drug Master Plus, Goldberg et al 23 found an almost threefold higher incidence of potential drug-drug interactions (47% vs 17%) in a county and community hospital population. They also found a higher number of potential interactions per patient (2.5 vs. 1.1) than the current study.…”

Section: 32mentioning

confidence: 99%

“…23 These have identified high-risk groups, such as elders [21][22][23] and those taking multiple medications. 22,23 Underlying these studies is the assumption that the computer does a better job than the physician, but to the best of our knowledge, this has never been systematically assessed. Furthermore, while potential drug-drug interactions have been studied, we believe the incidence of potential interactions between drugs and ethanol or laboratory tests have not been quantified.…”

Section: Langdorf Et Al • Drug Interactions In the Edmentioning

confidence: 99%

“…We know of only one report of potential drug-disease interactions. 23 The objectives of this study were twofold: 1. to compare the performance of emergency medicine (EM) faculty and an ''expert'' EP physician with that of a criterion standard computer database 2. to report the incidence of potential drug-ethanol and drug-laboratory test interactions.…”

Section: Langdorf Et Al • Drug Interactions In the Edmentioning

confidence: 99%

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Physician versus Computer Knowledge of Potential Drug Interactions in the Emergency Department

Langdorf

Fox

Marwah

et al. 2000

Academic Emergency Medicine

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Abstract. Introduction: Proliferation of Food and Drug Administration-approved drugs makes it impossible for emergency medicine (EM) faculty to stay current on potential interactions between drugs, and with diseases, laboratory tests, and ethanol. A computer database may augment physician knowledge. Objectives: To compare the performance of EM faculty and an ''expert'' emergency physician (EP) with that of a criterion standard computer database in identifying potential drug interactions, and to report the incidence of drug-ethanol and drug-laboratory test interactions. Methods: This was a retrospective review of 276 emergency department charts for drug, ethanol, lab, and medical history. Evaluation by both EM faculty and an ''expert'' EP of patient history was done to identify potential interactions, and comparison with the Micromedex Drug-Reax database for potential interactions (graded minor, moderate, or major) was made. Clinical significance of potential interactions was judged by a second EM faculty member. Results: Seventeen percent of the patients had potential drug-drug interactions, and 25% of these were judged to be clinically significant. Up to 52% of the patients had potential drug-ethanol interactions, while 38% of the patients could have potential druglab interactions. Sensitivity, specificity, and positive and negative predictive values of the EM faculty for potential drug-drug interactions compared with the computer were poor, at 14%, 58%, 6%, and 23%, respectively. The corresponding values for the ''expert'' EP were 25%, 86%, 26%, and 85%. The ''expert'' EP was statistically better than the EM faculty, but still less sensitive and predictive than the computer. Conclusions: A computer can aid the physician in avoiding potential drug interactions. Prospective validation of these findings should be done.

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Drug-drug and drug-disease interactions in the ED: Analysis of a high-risk population

Cited by 277 publications

References 8 publications

Potential interactions of central nervous system drugs used in the elderly population

Potential interactions of central nervous system drugs used in the elderly population

Evaluation of prescribing pattern of NSAIDs in south Indian teaching hospital

Physician versus Computer Knowledge of Potential Drug Interactions in the Emergency Department

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