Potential drug-drug interactions among hospitalized cardiac patients

Abstract

Drug-drug interactions (DDIs) represent a special category of adverse drug reactions in which the effects of one drug influence the effects of the other, thus either limiting effectiveness or inducing toxicity. Overall, 1% of hospital admissions and 16% of admissions due to ADRs can be attributed to DDIs. A higher number of DDIs is also significantly associated with longer hospitalization and higher treatment costs. 1,2 Approximately 37-60% of patients admitted to hospital may have one or more potentially interacting drug combinations at admission. In inpatients, the risk of having potentially interacting drug combinations can additionally increase because new drugs are often added to the existing drug therapy. DDIs are a concern for patients and providers, as polypharmacy is becoming more common in managing complex diseases or comorbidities and the consequences can range from untoward effects to drug-related morbidity and mortality. Healthcare professionals' ability to recognize potential DDIs is important in reducing their potential risks and adverse consequences. 3 Studies have revealed that DDIs are a major clinical problem along with other adverse drug reactions especially in the hospitalized cardiac patients. Cardiovascular patients are more often reported with potential drug-drug interactions (pDDIs) as compared to patients with other diseases. The possible reason behind higher pDDI rate in cardiovascular diseases may include ABSTRACT Background: Drug-drug interactions (DDIs) are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. The objective of our study was to identify potential drug-drug interactions among hospitalized cardiac patients and to identify the risk factors associated with these interactions. Methods: After obtaining approval from Institutional Ethical Committee, a prospective observational study was carried out among 367 hospitalized cardiac patients in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru. Cardiac patients prescribed at least 2 drugs and having hospital stay of more than 24 hour duration were enrolled into the study. The prescriptions were analysed for potential DDIs using MEDSCAPE multidrug interaction checker tool. Descriptive statistics, Student 't' test, ANOVA and Pearson correlation coefficient were used to analyse the results. Results: The incidence of potential DDIs was 98% with 360 prescriptions having at least one potential DDI. A total of 38 potentially interacting drug pairs were identified among which majority were of significant grade while only 3 were serious. Majority of interactions were pharmacodynamic (76.3%) in nature. Aspirin/clopidogrel (71.1%) and pantoprazole/clopidogrel (69.8%) were the most common interacting pairs. Drugs most commonly involved were aspirin, clopidogrel, heparin, pantoprazole and ramipril. Age, female gender, polypharmacy, prolonged hospital stay, stay in ICU and diabetes mellitus were the risk factors found associated...

Assessment of potential drug–Drug interactions in hospitalized cardiac patients of a secondary care hospital in the United Arab Emirates

“…The higher occurrence of pDDIs in males in our study is consistent with previously published reports. [131415] The average number of drugs prescribed/patient in our study was also similar to other studies. [1314] The similarities in observations could be due to similarities in the prescribing pattern of the medications in CVD patients.…”

Potential drug-drug interactions among elderly in-patients with cardiac illness at a tertiary care centre

“…Most commonly observed mechanism of drug-drug interactions in this study was pharmacodynamic as also supported by other studies. 4,5 This is in contrast to the finding reported in a few studies. [11][12][13] Polypharmacy is widely prevalent in hospitalized patients and although it poses threat to patients' overall recovery, it sometimes becomes unavoidable.…”

“…Study revealed very high prevalence of drug-drug interactions in the cardiac in-patients as supported by other studies. [4][5][6][7] The high prevalence may be due to presence of various risk factors in hospitalized patients. Elderly age group, cardiac illness and associated multiple co-morbidities which in turn lead to polypharmacy, may result into development of drug-drug interactions.…”

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“…Binary logistic regression showed that the risk of having more than seven pDDIs was significantly higher when patients stayed at the hospital for 5-12 days compared to 1-4 days, among patients prescribed with more than nine medications compared to patients prescribed with 1-8 medications, patients having comorbid conditions compared to patients without comorbid conditions, patients with comorbid conditions like hypertension and diabetes mellitus (HTN + DM) and diabetes mellitus (DM) only compared to patients with CVD alone, and patients prescribed with narrow therapeutic index medications compared to patients not prescribed with narrow therapeutic index medications Table 8. 20 . These medical conditions seem to have a pathophysiological association with each other and are often observed to occur in the presence of one another, which might be the reason for a higher number of patients with DM and HTN as comorbidities 21 .…”

“…Recent studies around the world had shown the incidence of DDIs to be in the range of 21.3%-98% 16,[18][19][20] . Although a large number of studies have been conducted throughout the world assessing the DDIs in patients with CVD, there are variations in the reported rates of pDDIs.…”