Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease

Abstract

IntroductionPolypharmacy is common in patients with chronic heart failure (HF) and/or chronic obstructive pulmonary disease (COPD), but little is known about the prevalence and significance of drug-drug interactions (DDIs). This study evaluates DDIs in hospitalized patients.Material and methodsWe retrospectively screened medical charts over a 6-month period for diagnosis of chronic HF and/or COPD. Potential DDIs were evaluated using Lexi-Interact software.ResultsSeven hundred and seventy-eight patients were included in the study (median age 75 years, 61% men). The median number of drugs on admission and discharge was 6 (interquartile range (IQR) 4–9) and 7 (IQR 5–), respectively (p = 0.10). We recorded 6.5 ±5.7 potential DDIs per patient on admission and 7.2 ±5.6 on discharge (p = 0.2). From admission to discharge, type-C and type-X potential DDIs increased (p < 0.05 for both). Type X interactions were rare (< 1%), with the combination of a β-blocker and a β2 agonist being the most common (64%). There were significantly more type-C and type-D potential DDIs in patients with chronic HF as compared to patients with COPD (p < 0.001). Patients with concomitant chronic HF and COPD had more type-C and type-X potential DDIs when compared to those with individual disease (p < 0.005). An aldosterone antagonist and ACE inhibitor/ARB were prescribed to 3% of chronic HF patients with estimated glomerular filtration rate < 30 ml/(min × 1.73 m2).ConclusionsThe DDIs are common in patients with chronic HF and/or COPD, but only a few appear to be of clinical significance. The increase in potential DDIs from admission to discharge may reflect better guideline implementation rather than poor clinical practice.

The prevalence and preventability of potentially relevant drug-drug interactions in patients admitted for cardiovascular diseases: A cross-sectional study

“…7,22,31,33 In our study PR for exposure to potentially relevant pDDIs in patients with higher number of drugs ranged from 3.07 up to 25.20, compared to 1-3 drugs as a reference category. The highest PR values were calculated for D class exposure.…”

“…20 Other studies conducted on the cardiology ward, reported DDI and drug-food interactions frequency altogether or assessed only DDIs in the heart failure patients. 21,22 The potential of using supporting electronic systems to manage pDDIs in CVD patients was not assessed. In this regard, the aim of the study was to describe the type and prevalence of potentially relevant pDDIs in CVD patients, and to assess the concurrent exposure to additional risk factors such as renal or liver disease, which may further affect drug exposure and therapy outcomes.…”

Potential Drug–Drug Interactions Among Critically Ill Pediatric Patients in a Tertiary Pulmonary Center

“…Drug–drug interactions (DDIs) are common causes of preventable adverse drug events (ADEs), in which the effects of one drug are changed by the presence of another one. The outcome can be harmful if the interaction causes an increase in the toxicity or decrease in the efficacy of a drug . Polypharmacy (the use of 4 or more medications by a patient) has been identified as a major risk factor for the occurrence of ADEs related to potential drug–drug interactions (pDDIs) …”

Geriatric patients in the ICU

“…(24) In clinical practice, guideline based (poly) pharmacy due to several chronic conditions gives perfect ground to drug-drug interactions. (25) Even very simple systems can be helpful, and it generally holds true that physicians with training in geriatrics are less likely to prescribe potentially inappropriate medications. (26,27) These issues need to be given first line priority by the decision makers to allow adequate development of geriatric medicine at all levels of a health care system.…”