ABSTRACT
Background: It is essential to spread awareness about known adverse drug reactions (ADRs) for identification, prevention and their proper management. The aim of this study is to assess disparities in documented ADRS of antiepileptic drugs in various sources of drug information.Methods: An observational, cross sectional study was done to compare different drug information sources for ADRs. Six sources of information namely: National Formulary India (2011), Drug Today (2018), Current index of medical specialties (CIMS), and some textbooks like Lippincott’s illustrated reviews: Pharmacology (2012), Brenner and Stevens' Pharmacology (2018) and George and Goodman and Gilman's (GG): The pharmacological basis of therapeutics (2018) were critically analysed for ADRs of a total of 34 drugs. Prototype drugs and most commonly prescribed antiepileptic drugs, were chosen for study. They were categorized according to therapeutic classification and guidelines by Indian Society of Epilepsy. ADRs were categorized according to various body systems, and serious and life threatening ADRs, then were tabulated and compared. Qualitative and quantitative analysis of this data was also done.Results: None of analysed sources mentioned all antiepileptic drugs. GG contained information for maximum number of drugs studied (76.4%) and National Formulary of India gave information for (52.9%) drugs only. There was wide variability among various resources while listing ADRs. CIMS listed maximum number of ADRs (85.5%) while minimum was included in Brenner and Stevens' Pharmacology (13%) for all antiepileptic drugs. The quality of data though limited was relatively better in CIMS, but none of sources studied were found to be complete.Conclusions: No source of information provided complete information about adverse effects of all 34 anti-epileptic drugs. Academicians and policymakers can work towards providing complete ADR information in all sources of information and updating it from time to time. Thus, making drug use safer in patients of epilepsy.
ABSTRACT
Drug interactions are an important cause of medication errors. The present study was conducted to evaluate the nature and clinical significance of potential drug-drug interactions (DDIs) in inpatients of Medicine Department at a tertiary care hospital in India. The second day prescription of every alternate indoor patient from five randomly selected medical units of a tertiary care hospital were collected. Prescriptions were analyzed for potential DDIs using the web based interaction checkers of Medscape and Current Index of Medical Specialties. The average numbers of drugs per prescription and potential DDIs per prescription and the types, age wise distribution and clinical significance of the potential DDIs were evaluated. A total of 3405 potential DDIs were detected in 257 prescriptions. An average 8.28 drugs were prescribed per prescription. The most common drug groups involved in potential DDIs were diuretics (n=255), NSAIDs (n=225), β blockers (n=143), cardiac glycosides (n=129) and statins (n=122). Potential DDIs were most frequent in patients between 61-75 years of age. The clinical significance was graded as serious (n=123), significant (n=949), minor (n=2328) and contraindicated (n=5). An increased risk of rhabdomyolysis (n=41) and an increase in QTc interval (n=38) were the most common potentially serious DDIs detected. Of the 1077 DDIs (excluding minor DDIs), 615 were pharmacodynamic and 462 were pharmacokinetic interactions. Potential DDIs increased with an increase in the number of prescribed drugs. Improved awareness among prescribers is required to reduce the risks associated with DDIs. Use of drug groups, commonly involved in potential DDIs, should be minimized and optimized while prescribing.