Extent of poly-pharmacy, occurrence and associated factors of drug-drug interaction and potential adverse drug reactions in Gondar Teaching Referral Hospital, North West Ethiopia

Abstract

The aim of this study was to assess the extent of poly-pharmacy, occurrence, and associated factors for the occurrence of drug–drug interaction (DDI) and potential adverse drug reaction (ADR) in Gondar University Teaching Referral Hospital. Institutional-based retrospective cross-sectional study. This study was conducted on prescriptions of both in and out-patients for a period of 3 months at Gondar University Hospital. Both bivariate analysis and multivariate logistic regression were used to identify risk factors for the occurrence of DDI and possible ADRs. All the statistical calculations were performed using SPSS® software. A total of 12,334 prescriptions were dispensed during the study period of which, 2,180 prescriptions were containing two or more drugs per prescription. A total of 21,210 drugs were prescribed and the average number of drugs per prescription was 1.72. Occurrences of DDI of all categories (Major, Moderate, and Minor) were analyzed and DDI were detected in 711 (32.6%) prescriptions. Sex was not found to be a risk factor for the occurrence of DDI and ADR, while age and number of medications per prescription were found to be significant risk factors for the occurrence of DDI and ADR. The mean number of drugs per prescription was 1.72 and hence with regard to the WHO limit of drugs per prescription, Gondar hospital was able to maintain the limit and prescriptions containing multiple drugs supposed to be taken systemically. Numbers of drugs per prescription as well as older age were found to be predisposing factors for the occurrence of DDI and potential ADRs while sex was not a risk factor.

Prevalence of potential drug- drug interactions and associated factors among outpatients and inpatients in Ethiopian Hospitals: a systematic review and Meta-analysis of observational studies

“…WA also prepared the manuscript for publication. All authors have read and approved the manuscript Footnote: Seven studies did not report the mechanisms of drug-drug interaction Patients taking three or more than three concomitant drugs are at higher risk of the occurrence of potential DDIs [27,28] There is an association of the occurrence of one or more potential DDIs with the number of medications prescribed per patient who took more than four medications [35] Polypharmacy(five or more medications) is an important factor which leads to potential DDIs [5,29,30,31,33,34] Co-morbid disease Co-morbid condition independently increased the potential DDIs almost 2-folds [33] Age Older age was found to be predisposing factors for the occurrence of DDI [5,28,30,31] Potential DDIs were occurring more frequently in the age group of 2-6 years than any other age group of the pediatric population [29] Hospital stay The chance of taking multiple drugs increases with longer stays(greater than or equal to seven) in the hospital, which in turn increases the risk for potential DDIs [5] International Normalized ratio (INR value) Increase in international normalized ratio value was found to be strongly associated with DDI and hence the risk of bleeding [32] Footnote: Ten studies did not report the mechanisms of drug-drug interaction Forest plot depicting the pooled prevalence of moderate potential DDIs of 14 studies in Ethiopian Hospitals Figure 5 Forest plot depicting the pooled prevalence of minor potential DDIs of 14 studies in Ethiopian Hospitals Figure 6 Subgroup analysis of the prevalence of potential DDIs based on region…”

An Investigation Into the Knowledge of South African Pharmacists on the Identification and Management of Drug-Drug Interactions

“…DDIs occur when two or more drugs react with each other resulting in the modification of one or more of the concurrently administered drugs, thereby decreasing their efficacy, resulting in unwanted or toxic effects, and ultimately complete treatment failure (Chatsisvili et al, 2010). DDIs can be divided into three groups depending on the mechanism of the interaction (Admassie, Melese, Mequanent, Hailu, & Srikanth, 2013). These include pharmacodynamic, pharmacokinetic and pharmaceutical interactions.…”

“…A pharmacokinetic interaction occurs when one drug alters the absorption, distribution, metabolism and excretion of another medication. Finally, a pharmaceutical interaction occurs when mixing chemically incompatible drugs outside the body resulting in the inactivation of one or both drugs (Admassie et al, 2013). DDIs can play a significant role in the health outcomes of patients and limiting these DDIs would ultimately benefit patient therapeutic outcomes.…”

Drug Interactions in Palliative Cancer Care and Oncology

“…Several issues arise in an oncology population that make drug interactions more likely-60 % in a recent review were over the age of 65; renal and hepatic clearance are diminished; older patients are often taking medication for other conditions, 5-10 medications on average; and the likelihood of drug-drug interactions increases with an increase in the number of medications (Blower et al 2005 ;Admassie et al 2013 ;Buajordet et al 2001 ;Fainsinger et al 1995 ).…”

“…In populations of patients with cancer, survey articles using differing methods to screen for interactions show that there is a potential interaction in 20-40 % for different groups of patients and in different countries, both developed and developing (Admassie et al 2013 ;Beijnen and Schellens 2004 ;Tavakoli-Ardakani et al 2013 ).…”