ABSTRACT
Abstract This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.
Resumo Este estudo pretende identificar a prevalência de interações medicamentosas potenciais (IMP) em idosos institucionalizados e seus fatores associados. Realizamos um estudo observacional, multicêntrico e transversal, durante o último trimestre de 2010. Selecionamos uma amostra de 275 sujeitos (≥ 65 anos) de 10 instituições para idosos de Murcia (Espanha) mediante amostragem aleatória complexa em duas etapas. As IMP foram identificadas usando a base de dados do College of Pharmacists. Estimamos a prevalência de IMP de relevância clínica e analisamos os fatores associados com análise de regressão uni e multinível. Identificamos 210 IMP, das quais 120 foram consideradas clinicamente relevantes (57,1%) e afetaram 70 idosos (25,8%). Oito grupos farmacológicos constituíram 70,2% das IMP clinicamente relevantes. A prevalência de IMP esteve associada à multimorbidade (OR = 2,3; IC 95% = 1,4-4,5) e tomar dez ou mais medicamentos diariamente (OR = 9,6; IC95% = 4,8-19,1) e uso de medicamentos anti-inflamatórios (OR = 3,9; IC 95% = 1,4-10,4). Este estudo revela que as IMP clinicamente relevantes são muito comuns em idosos institucionalizados e que os serviços devem melhorar seus processos para reduzir a prevalência deste fenômeno.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Drug Interactions , Homes for the Aged/statistics & numerical data , Anti-Inflammatory Agents/adverse effects , Nursing Homes/statistics & numerical data , Spain , Cross-Sectional Studies , Polypharmacy , Anti-Inflammatory Agents/administration & dosageABSTRACT
La enfermedad cardiovascular es la primera causa de morbilidad en la población Venezolana adulta, lo que conduce a un importante número de pacientes hospitalizados que reciben politerapia. De esta situación pueden resultar interacciones farmacológicas (IF). El objetivo del estudio fue evaluar las IF potenciales en pacientes con enfermedades cardiovasculares polimedicados. Para ello se diseñó un estudio de tipo observacional, descriptivo y transversal, se realizó revisión de historias clínicas de 87 pacientes hospitalizados, con un estadío igual o superior a tres días. Para la recolección de datos se empleó un formulario que contenía: número de historia, edad, género, fecha de ingreso y egreso; enfermedad cardiovascular que presentaban; fármacos administrados, fecha de inicio y culminación del tratamiento. La identificación de las IF potenciales se realizó usando el programa TOX MED. Los resultados mostraron edad promedio de 63,82; predominio del género masculino y asociación entre la IF potencial y la prescripción mayor a 7 medicamentos (p=0,002). Las patologías más frecuentes fueron síndrome coronario agudo e hipertensión arterial, y los medicamentos más indicados los agentes antitrombóticos. Se detectaron 519 IF potenciales, 51(30,32%) farmacocinéticas y 347 (69,68%) farmacodinámicas, siendo las más frecuentes las de metabolismo (84,79%) y las de sinergismo (75,79%) respectivamente. El mayor porcentaje de las IF potenciales de origen farmacocinético fue con la asociación atorvastatina - clopidrogel (22,52%) y el de origen farmacodinámico fué con la asociación ácido acetilsalicílico - heparina (15,71%). Se concluye que el número de IF potenciales, farmacocinéticas o farmacodinámicas, aumenta con el número de fármacos que reciben los pacientes.
Cardiovascular disease is the leading cause of morbidity in the adult Venezuelan population, leading to a significant number of hospitalized patients receiving combination therapy, which may cause drug interactions (IF). The aim of this study was to evaluate potential IF polypharmacy in patients with cardiovascular disease. This was an observational, descriptive cross-sectional study; medical records of 87 hospitalized patients were reviewed with a stage of three days or more. The data collection form recorded: history number, age, gender, admission and discharge dates, type of cardiovascular disease; administered drugs, treatment start and completion dates. Identification of potential IF was performed using the TOX MED program. Results showed an average age of 63.82; predominantly males and potential association between IF nd prescription of more than seven drugs (p = 0.002). The most frequent diseases were acute coronary syndrome and hypertension; antithrombotic agents were the most commonly prescribed drugs. 519 IF potential were identified; pharmacokinetic 51 (30.32%) and pharmacodynamic 347 (69.68%), the most frequent ones being metabolism (84.79%) and synergism (75.79%), respectively. The highest percentage of potential pharmacokinetic IF was associated with atorvastatin - clopidogrel (22.52%), and pharmacodynamic with aspirin - heparin (15.71%). It is concluded that the number of pharmacokinetic or pharmacodynamic IF potential increases with the number of drugs that patients take..Key words: Potential drug interactions, drug-drug, cardiovascular patients, polypharmacy.
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.