Potential drug–drug interactions in patients with cardiovascular diseases: findings from a prospective observational study

Abstract

Background Patients with cardiovascular diseases (CVD) are at high risk of experiencing drug–drug interactions (DDIs). The objective of this study was to evaluate the frequency, level and risk factors associated with potential-DDIs (pDDIs) in hospitalized CVD patients at cardiology departments of two tertiary care hospitals in Quetta, Pakistan. Methods In the current prospective observational study, a total of 300 eligible CVD inpatients were evaluated for pDDIs using Lexicomp Interact®. The pDDIs were classified into class A (no known interaction); B (no action needed); C (monitor therapy: it is documented that the benefits of an interaction outweigh the risk, appropriately monitor therapy in order to avoid potential adverse outcomes); D (consider therapy modification: it is documented that proper actions must be taken to reduce the toxicity resulting from an interaction); X (avoid combination: the risk of an interaction outweighs the benefits and are usually contraindicated). Multivariate binary logistic regression analysis was used to find factors associated with the presence of Class-D and/or X pDDIs. A p-value < 0.05 was considered statistically significant. Results With a median of 8.50 pDDIs per patient, all patients (100%) had ≥ 1 pDDIs. Out of total 2787 pDDIs observed, 74.06% (n = 2064) were of moderate and (n = 483) 17.33% of major severity. Class C pDDIs were most common (n = 1971, 70.72%) followed by D (n = 582, 20.88%), B (n = 204, 7.32%) and X (n = 30, 1.08%). Suffering from cardiovascular diseases other than myocardial infarction (OR 0.053, p-value < 0.001) and receiving > 12 drugs (OR 4.187, p-value = 0.009) had statistical significant association with the presence of class D and/or X pDDIs. Conclusion In the current study, pDDIs were highly prevalent. The inclusion of DDI screening tools, availability of clinical pharmacists and paying special attention to the high-risk patients may reduce the frequency of pDDIs at the study sites.

Potential Drug–Drug Interactions in Ambulatory Patients with Hypertension: a Retrospective Study

“…Other studies also reported t that the most common types of pDDIs in CVD patients were moderate level. A survey conducted in the cardiology departments of two tertiary care teaching hospitals in the Quetta, Balochistan indicated 74.06% of moderate pDDIs (Akbar et al, 2021). Another study found a higher frequency of severe pDDIs (45%) than our study (Murtaza et al, 2016).…”

“…A significant increase in hypertension among people on polytherapy regimenshas shown to meet their blood pressure goal (Gu et al, 2012). In hypertensive patients, comorbidities, complex drug treatment plans, and polypharmacy have raised the risk of incidence of drugdrug interaction (DDI) (Akbar et al, 2021).…”

Evaluation of potential drug-drug interactions in cancer patients at a tertiary care hospital in Pakistan

“…24 This wide variation in the reported prevalence of pDDIs in cancer patients could be due different study settings (outpatient vs. inpatient) and designs (cross-sectional vs. longitudinal), the use of different DDI screening tools, proportion of patients with comorbidities, and different prescribing practices in terms of selection and number of drugs prescribed and their therapeutic windows. 11,13,[22][23][24] In this study, a total of 72.9% and 25.1% of the detected pDDIs were respectively of major and moderate severity. Although, only 37.8% of these severe pDDIs were of good evidence (good and excellent documentation level), but such high rates of severe pDDIs with potential life threatening consequences are of a major concern.…”

“…Even though, pDDI screening tools are valuable in detecting pDDIs and making a clinical decision about treatment regimens, however, clinical decisions exclusively made on the basis of information provided by these tools without weighing the patient's specific needs may result in irrational clinical decisions, thereby compromising the effectiveness of the regimen and complicating the patient's condition. 11 The presence of multiple certain anti-cancer drugs in a regimen have been proved to be effective and tolerated, and such combination could be a part of the cancer treatment. For instance, the combination of 5-flourouracil and leucovorin which was received by 17 patients in the current cohort is used to optimize the effect of 5-flourouracil in the treatment of colorectal, breast and head/neck cancers.…”

“…9 As pDDIs are considered the predictable causes of adverse drug events (ADEs) and 20–30% of all ADEs caused by DDIs are clinically relevant in up to 80% of elderly patients, 10 therefore, the current standards in research and routine clinical practice stress on evaluating the prevalence, severity, drug pairs involved and factors associated with pDDIs. 11 Information from such studies can be helpful for healthcare professionals to protect cancer patients from ADEs caused by pDDIs, improve their adherence and therapeutic outcomes. 11 Furthermore, in order to devise interventions to reduce the incidence of pDDI and its adverse outcomes, it is necessary to evaluate the incidence, pattern and risk factors of pDDIs in various clinical settings of a country.…”