Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_med-2019-0093_s_007_w2aab3b7d432b1b6b1aab1c15b1Aa"><jats:title>Background</jats:title><jats:p>Clinically relevant potential drug-drug interactions are considered preventable adverse drug reactions.</jats:p></jats:sec><jats:sec id="j_med-2019-0093_s_008_w2aab3b7d432b1b6b1aab1c15b2Aa"><jats:title>Objective</jats:title><jats:p>The aim of this study was to ascertain the frequency of potential drug-drug interactions in acute ischemic stroke patients and to explore factors associated with occurrence of potentially contraindicated drug-drug interactions.</jats:p></jats:sec><jats:sec id="j_med-2019-0093_s_009_w2aab3b7d432b1b6b1aab1c15b3Aa"><jats:title>Methods</jats:title><jats:p>This observational retrospective cohort and nested case-control study was carried out among patients treated for acute ischemic stroke at the Neurological Intensive Care Unit in the Clinical Centre Kragujevac, Serbia. The potentially drug-drug interactions for each day of hospitalization were identifi ed using Micromedex® soft ware. Based on the existence or absence of potentially contraindicated drug-drug interactions, the participants were divided into a group of cases (n=111) and the control group (n=444).</jats:p></jats:sec><jats:sec id="j_med-2019-0093_s_010_w2aab3b7d432b1b6b1aab1c15b4Aa"><jats:title>Results</jats:title><jats:p>A total of 696 patients were analysed. All patients had a minimum of one potential drug-drug interaction during hospitalization. The most common drugs involved in potential drug-drug interactions were aspirin (8.02%), diclofenac (7.49%) and warfarin (7.14%). The number of medications prescribed for simultaneous use during hospitalisation and the use of antipsychotics in therapy signifi cantly increased the likelihood of potentially contraindicated drug-drug interactions aft er adjustment by means of logistic regression for 1.2 and 3 times, respectively.</jats:p></jats:sec><jats:sec id="j_med-2019-0093_s_011_w2aab3b7d432b1b6b1aab1c15b5Aa"><jats:title>Conclusions</jats:title><jats:p>This study suggests that patients with acute ischemic stroke are frequently exposed to potential drug-drug interactions. It is essential to identify potentially drug-drug interactions in these patients as early as possible in order to prevent adverse drug reactions and ensure safe recovery. Besides, full attention should be paid when adding each new medication in therapy, particularly when a neurologist decides to prescribe antipsychotics, such as risperidone.</jats:p></jats:sec>

Frequency and predictors of potential drug: Drug interactions in hospitalized patients with Parkinson's diseases

“…Also, predictors of number of interactions per patient in our study almost coincide with the results of the other authors. Higher number of prescribed medications and comorbidities increased the risk of pDDIs both among neurological patients [5,16,17] and patients treated for other diseases [15,18]. Certain drug groups, such as antiplatelet drugs [19] and antipsychotics [20], showed high potential for drug-drug interactions due to their specific pharmacokinetic and pharmacodynamic profile.…”

“…Drug-drug interactions represent the changes in the effects of one drug which occur as a consequence of concomitant therapy with another drug. Contraindicated and major interactions to be avoided have the greatest clinical relevance, although moderate interactions also should be monitored with extreme caution [5]. Nowadays, potential drug-drug interactions (pDDIs) could be detected by online checkers such as Micromedex® [6], Lexi-Interact [7], Medscape [8], Epocrates [9], etc.…”

“…Certain risk factors for occurrence of pDDIs in hospitalized patients were previously recognized, such as higher number of prescribed medications, longer duration of hospitalization and comorbidity [5,15,16]. However, to our best knowledge there are no published studies that have investigated potential drugdrug interactions in patients with PD.…”

Pharmacist intervention and anti‐platelet medication monitoring in patients following stroke and transient ischemic attack

“…3 However, some patients do experience recurrent ischemic events and many of these patients do not demonstrate optimal antiplatelet effects 7 from these therapies for reasons such as drug-drug interactions, [8][9][10][11] nonadherence, pharmacokinetic factors (including absorption, distribution, and metabolism) 12 and inadequate dosing, 7,13 and pharmacodynamic resistance. [14][15][16][17] Numerous drug-drug interactions may occur in stroke patients due to polypharmacy, prolonged hospital stays, and comorbidities. 16 Nonadherence to antiplatelet regimens decreases efficacy and may provoke platelet aggregation.…”

“…[14][15][16][17] Numerous drug-drug interactions may occur in stroke patients due to polypharmacy, prolonged hospital stays, and comorbidities. 16 Nonadherence to antiplatelet regimens decreases efficacy and may provoke platelet aggregation. 17 In addition, some medications, such as estrogen used as hormone replacement therapy, may increase recurrent stroke risk and may therefore be inappropriate for use following a stroke or TIA.…”