Evaluation of drug-drug interactions among patients with chronic kidney disease in a South-Eastern Nigeria tertiary hospital: a retrospective study

Introduction: The risk of drug-drug interactions (DDIs) is high in patients with chronic kidney disease (CKD) necessitating dose adjustments or the avoidance of drug combinations. This study aimed to evaluate DDIs among patients with CKD in the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria.Methods: this study was a retrospective review of patients with CKD who received treatment at the nephrology unit of UNTH between January 2004 and December 2014. The drug-drug interactions (DDIs) of the prescribed drugs were classified using the RxList interaction checker. The IBM SPSS Version 21.0 was utilized for statistical analysis with P-value ≤ 0.05, considered statistically significant.Results: a total of 749 DDIs were identified from the folders of the 169 patients with CKD that were eligible. Majority were above 50 years old and in stage 4 or 5 CKD. Furosemide,lisinopril and amlodipine were the most frequently prescribed drugs and had the greatest likelihood for nephrotoxicity. The number of medications and hypertension (as co-morbidity) were significant and independent predictors of DDIs among the patients. About 70% of the drug combinations required monitoring as they fell within the "significant category" of the RxList interaction checker. The most common interactions were between lisinopril and furosemide; furosemide and calcium carbonate; lisinopril and calcium carbonate.Conclusion: the prevalence of DDIs was high among the CKD patients. Prescribers and pharmacists in Nigerian hospitals may need to pay close attention to prescriptions of patients with CKD to identify, prevent and resolve undesirable DDIs

Antiretrovirals and Co-Prescribed Drugs for People Living with HIV/AIDS (PLWHA) in a University Teaching Hospital; South West Nigeria

Background: Lifelong usage of antiretroviral drugs (ARVs) put them among the most therapeutically risky drugs for clinically significant drug interactions (CSDIs). It is; therefore; essential to document the types of antiretroviral (ARV) and non-ARV drugs co-prescribed (CPD) for PLWHA in order to facilitate the assessment of clinical significance of their interactions. Objectives: To document the most commonly prescribed ARV drugs and CPD among PLWHA and to assess the frequency of prescriptions of the first; second and third lines ART regimen. Methods: All the prescriptions received between January 2009 and June 2014 totaling 22;458 from 500 patients registered in APIN clinic in 2009; were reviewed with a view to documenting the most and the least prescribed CPD and ARV drugs. Results: Zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) (4996/9302; 53.71%) was the most commonly prescribed ART regimen followed by tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV) (1468/9302; 15.78%)and zidovudine/lamivudine/efavirenz (AZT/3TC/EFV) (683/9302; 7.34%). Abacavir/lamivudine/saquinavir/ritonavir (ABC/3TC (SQV/RTV) (1/9302; 0.01%) was the least prescribed ART regimen. The first line ART regimens (8574/9302; 92.17%) were mostly prescribed; followed by the second line (698/9302; 9.5%). Cotrimoxazole (7546/9302; 81.12%) was the most common non-ARV drug co-prescribed with ART regimen; followed by multivitamin (433/9302; 4.65%) and rifampin (316/9302; 3.40%). Conclusion: Co-trimoxazole was the most commonly co-prescribed non-ARV drug. Zidovudine/ lamivudine/nevirapine was the most commonly prescribed ART regimen. Considering the wide range of non- ARV drugs co-prescribed with ART regimens in this study; evaluation of their potential interactions is hereby suggested

Drug Interactions in Primary Health Care in the George Subdistrict; South Africa: a Cross-Sectional Study

Objectives: To investigate the prevalence of potential drug-drug interactions in primary healthcare clinics in the George subdistrict; to determine which drugs were involved; and to identify associated risk factors. Design: A cross-sectional retrospective folder review was performed.Setting and subjects: Four hundred randomly selected patient files from four primary care clinics in the George subdistrict. Outcome measures: The prevalence of potential drug-drug interactions in primary care; drugs involved in potential drug-drug interactions and associated risk factors. Results: The prevalence of scripts containing at least one moderate potential interaction was 42; severe potential interaction; 5.25; and contraindicated combinations; 0.5. The most common drugs involved were enalapril; aspirin; ibuprofen; furosemide and fluoxetine. The most common implicated drugs in potentially severe interactions were warfarin; aspirin; fluoxetine; tramadol and allopurinol. Two contraindicated combinations were found; namely verapamil plus simvastatin; and hyoscine butyl bromide plus oral potassium chloride. Advancing age and polypharmacy were associated with an increased risk of potential drug-drug interactions. Input from the regional hospital specialist departments greatly increased the risk of a patient being given a prescription that contained a potential drug-drug interaction. Eighty one per cent of severe interactions were from this group. Conclusion: The potential for drug-drug interactions occurring was common in primary healthcare clinics in the George subdistrict. Drug interactions are predictable and preventable. The risk factors identified in this study may assist in the design of interventions that reduce the risk

Digging a little Bellow the Surface of the relationship between blood Plessure and Obesity: Dichotomous Correlations in Young-Adult Nigerians

The relationship between blood pressure (BP) and obesity is still controversial; and was studied in a population of young-adult Nigerians. Systolic BP (SBP) and diastolic BP (DBP) were measured using an oscillometric device while relevant anthropometric indices were measured and derived using standard protocol. Body fat (BF) was measured by bioelectrical impedance analysis. The Pearson's correlation coefficients were calculated for the general population and based on BP phenotype; and scatter plots generated (for both sexes). The results show that in the general population; SBP was correlated with BF (males; r = +0.093; P 0.01; females; r 0.05) correlated with either BF or BMI. The BP versus BF or BMI curve shows sex variations; and plateaus once the BP value exceeds 120/80 mmHg. This dichotomous relationship implies that weight management may be useful in hypertension prevention in normotensive subjects; but may not be very useful; as a therapeutic option; in hypertensives

Artemether-Lumefantrine Combination Therapy for Treatment of Uncomplicated Malaria: The Potential for Complex Interactions with Antiretroviral Drugs in HIV-Infected Individuals

Treatment of malaria in HIV-infected individuals receiving antiretroviral therapy (ART) poses significant challenges. Artemether-lumefantrine (AL) is one of the artemisisnin-based combination therapies recommended for treatment of malaria. The drug combination is highly efficacious against sensitive and multidrug resistant falciparum malaria. Both artemether and lumefantrine are metabolized by hepatic cytochrome P450 (CYP450) enzymes which metabolize the protease inhibitors (PIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) used for HIV treatment. oadministration of NNRTIs and PIs with AL could potentially cause complex pharmacokinetic drug interactions. NNRTI by inducing CYP450 3A4 enzyme and PIs by inhibiting CYP450 3A4 enzymes could influence both artemether and lumefantrine concentrations and their active metabolites dihydroartemisinin and desbutyl-lumefantrine; predisposing patients to poor treatment response; toxicity; and risk for development of resistance. There are scanty data on these interactions and their consequences. Pharmacokinetic studies to evaluate these interactions in the target populations are urgently needed

Traitement de l`erysipele de jambe

La prise en charge d`un erysipele de jambe est a adapter en fonction de la severite de l`atteinte cutanee; du retentissement de l`infection sur l`etat general; et des antecedents du patient. L`antibiotherapie reduit la mortalite; les complications; la duree de l`infection et les douleurs de l`erysipele

Analysis of possible drug-drug interactions between ritonavir and other antiretrovirals in a section of the private health care sector in South Africa

Background: The introduction of human immunodeficiency virus (HIV) protease inhibitors (PIs) has led to a dramatic decline in the morbidity and mortality associated with HIV infection. However; the concomitant use of PIs and other antiretrovirals (ARVs) can be complicated by drug-drug interactions (DDIs); adversely affecting levels of PIs. Methods: A quantitative; retrospective drug utilisation study was performed using data obtained from the medicine claims database of a pharmacy benefit management company during 2004; 2005 and 2006. The possible DDIs found among ARVS themselves were identified using the classification by Tatro.Results: The percentage of ARV prescriptions claimed of the total number of medicine items increased from 1.68(n = 43 482) during 2004 to 3.18(n = 51 613) during 2005; then to 4.74(n = 47 085) during 2006. A total of 1 326; 1 863 and 960 possible DDIs were identified among ARVs themselves for 2004; 2005 and 2006 respectively. Of these; ritonavir (unboosted or boosted) presented with the most possible DDIs; accounting for 74.28(n = 985) for 2004; 67.90(n = 1 265) for 2005; and 27.50(n = 264) for 2006. The highest prevalence of DDIs identified was between ritonavir (unboosted) and saquinavir (n = 974; 5) for 2005 and 2006; followed by indinavir (n = 490; 129; 155) for 2004 to 2006; and efavirenz (n = 274) for only 2004; then ritonavir (boosted); co-formulated as lopinavir/ritonavir; and efavirenz (n = 118; 88; 34) for 2004 to 2006; nevirapine (n = 49; 37) for 2004 and 2005; indinavir (n = 9) for 2004; and saquinavir (n = 22) for 2006.Conclusion: These findings indicate that concomitant use of PIs such as ritonavir; a potent cytochrome P450(CYP)3A4 enzyme inhibitor; and other ARVs is complicated by possible DDIs and therefore further studies need to be done on the ARV combinations and management of these DDIs. How to cite this article: Katende-Kyenda; N.L.; Lubbe; M.S.; Serfontein; J.H.P.; Truter; I. 2009. Analysis of possible drug-drug interactions between ritonavir and other antiretrovirals in a section of the private health care sector in South Africa. African Journal of Primary Health Care et Family Medicine; 1(1); Art. #21; 6 pages. DOI: 10.4102/ phcfm.v1i1.21

Prevalence of Drug-Drug Interactions of Antiretroviral Agents in the Private Health Care Sector in South Africa

Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART); requiring concomitant administration of three to four different agents; often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book; Drug Interactions Facts and comparisons. Results. A total of 5305882 medicine items were prescribed; of these; 1.92(N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions; 1.68(N=43 482); were ARVs. A total number of 18035 DDIs (81 different types) were identified; of these; 83.89; (n=15130) were DDIs between ARVs and other drugs; while 16.11(n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major; n=17) and 2 (moderate; n=1436) represented 8.06(n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing; there is a great need of understanding and anticipating these DDIs; overcoming them by dose adjustments and patient education by pharmacists; so that they are not life threatening to HIV/AIDS patients

In vitro interaction between caffeine and some penicillin antibiotics against Staphylococcus aureus

Purpose: The aim of this study is to evaluate the in vitro interaction of some penicillins (amoxicillin; ampicillin and benzylpenicillin) and caffeine against Staphylococcus aureus. Method: The interaction between the penicillins and caffeine was studied using the Overlay Inoculum Susceptibility Disc (OLISD) method. Minimum inhibitory concentrations (MIC) of the drugs were determined separately and in combination with caffeine (5 and 10 mg/ml). Result: At 5 and 10 mg/ml; caffeine decreased the MIC of amoxicillin by 22 and 25 times respectively; while that of ampicillin was decreased by 6 and 8 times. The MIC of benzylpenicillin against Staphylococcus aureus was; however; increased by 59 and 40 times at caffeine concentrations of 5 and 10 mg/ml respectively. The inhibition zone diameter increment above 19(index of synergism in OLISD method) was recorded only for amoxicillin at amoxicillin concentrations of 7.81; 15.3; 31.25 and 62.5 mg/ml. Conclusion: The results of this study revealed that the concomitant use of caffeine and the studied antibiotics may potentiate the antibacterial effect of amoxicillin against Staphylococcus aureus; decrease that of benzylpenicillin and has virtually no effect on that of ampicillin. This implies that the intake of caffeine in form of analgesic combination or as tea; coffee; beverages or from other food sources may affect the effectiveness of a co-administered amoxicillin and bezylpenicillin

Traitement medical de l'ulcere gastroduodenal

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Les meningites bacteriennes (2eme partie)

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Mieux prescrire l'amoxicilline (2eme partie)

Nous presentons la 2eme partie de notre systeme sur l'amoxicilline; celle consacree aux aspects pratiques de l'utilisation de cet antibiotique. Nous avons volontairement limite l'utilisation de l'amoxicilline a la voie orale. L'utilisation de l'amoxicilline associee a d'autres antibiotiques; lors d'infections graves chez les sujets ages et / ou alcoolo dependants et / o denutris; ainsi que chez les patients immunodeprimes n'est pas non plus abordee

Risques d'interactions medicamenteuses: 7 principes a observer pour une bonne pratique

Avant d'associer deux medicaments; il faut reflechir aux risques encourus par le patient; tout particulierement quand les effets indesirables lies a une interaction entre ces deux medicaments ont ete decrits. Le plus souvent; on est confronte au cas d'un traitement medicamenteux deja installe; auquel on envisage d'ajouter un autre medicament. Parfois; on est amene a retirer un medicament d'une association jusque-la bien supportee. Et ce retrait peut provoquer un desequilibre de posologie pour le medicament restant. D'autres fois; ce sont deux medicaments qui sont susceptible d'agir l'un sur l'autre qui sont administres en meme temps.Pour prevenir les effets indesirables par surdosage; par addition d'effets indesirables; ou encore par sous dosage et defaut d'efficacite; de l'un ou de deux medicaments de l'association; on peut guider sa pratique autour de 7 principes simples; mais fondamentaux