Prevalence of Drug Interactions and Potentially Inappropriate Medications Among Geriatric Patients in India.

Aim: The study aimed to determine the prevalence of potential drug-drug interactions (PDDIs) and potentially inappropriate medications (PIMs) among geriatrics. Methods: A prospective observational study was conducted for six months in the Department of Geriatrics, M.S. Ramaiah Teaching Hospital, Bangalore. PDDIs and PIMS were analyzed using micromedex database and Beer's criteria respectively. Results: Among 395 prescriptions, 221(56%) prescriptions showed 559 pDDIs and 41(10.4%) PIMs. Almost 281(50.3%), 260(46.5%), 16(2.7%) and 2(0.3%) pDDIs were categorised as major, moderate, minor and contraindicated respectively. Almost 321(57.5%) were synergistic and 196(35.0%) were antagonistic drug interactions. Pearson correlation value (R) is 0.9957 which showed a strong positive correlation. Conclusion: This study created awareness on drug interactions among geriatrics and help the practitioners to prescribe drugs with a low risk of pDDIs. The authors suggest PIM monitoring in geriatrics to avoid adverse effects and improve patients' quality of life.

An observational study on potential drug-drug interaction among hypertensive patients in a tertiary care hospital

Background: Drug-drug interactions are quite prevalent, especially in the geriatric population with comorbidities. It affects the effectiveness, safety, and tolerability of the medications they use. Aims and Objectives: This study aims to analyze and identify potential drug-drug interactions (pDDIs) in hypertensive patients using Medscape databases. Materials and Methods: A prospective and observational study was conducted in the Hypertension clinic of KMC, Chennai, for 3 months during November 2019–January 2020. Hypertensive patients of both sexes attending hypertension clinics with an age of more than 18 years and taking more than two antihypertensive drugs were included in the study. The use of Medscape databases enabled the appropriate data to be gathered and evaluated for pDDIs. Results: Three hundred patients in all were enrolled for the trial. One hundred and forty out of the 300 patients had pDDIs. Out of 140 patients, the majority (55%) were between the ages of 40 and 60. Males (56.4%) had a higher prevalence of pDDIs than females (43.6%). Atenolol, enalapril, and furosemide were the most frequently used medications in the present study that caused pDDIs, accounting for 29.8%, 19.5%, and 18.6%, respectively. Conclusion: The prevalence of pDDIs was found to be 46.6% overall, and an increase in comorbidities and polypharmacy were revealed to be important risk factors for the emergence of several pDDIs. Most of the antihypertensives were shown to interact frequently with calcium carbonate.

Prevalence, predictors and outcomes of potential drug-drug interactions in left ventricular failure: considerable factors for quality use of medicines

Hospitalized patients with left ventricular failure (LVF) are at high risk for potential drug-drug interactions (pDDIs) and its related adverse effects owing to multiple risk factors such as old age, comorbidities and polypharmacy. This cross-sectional study conducted in two tertiary care hospitals aim to identify frequency, levels and predictors of pDDIs in LVF patients. Data about patients' demographic, hospital stay, medication therapy, sign/symptoms and laboratory test results were collected for 385 patients with LVF. Micromedex Drug-Reax® was used to screen patients' medication profiles for pDDIs. Overall prevalence and severity-wise prevalence of pDDIs were identified. Chi-square test was performed for comparative analysis of various variables. Logistic regression was applied to determine the odds-ratios (OR) for predictors of pDDIs. The prevalence of pDDIs was 96.4% (n=371). Overall 335 drug-interacting pairs were detected, which were presented in a total of 2870 pDDIs. Majority of pDDIs were of major- (48.9%) and moderate-severity (47.5%). Logistic regression analysis shows significant association of >6 all types of pDDIs with >12 drugs as compared with <8 drugs (OR=16.5; p=<0.001). Likewise, there was a significant association of >4 major-pDDIs with men as compared with female (OR=1.9; p=0.007) and >12 drugs as compared with <8 drugs (OR=10.9; p=<0.001). Hypotension (n=57), impaired renal function (23) and increased blood pressure (22) were the most frequent adverse outcomes associated with pDDIs. This study shows high prevalence of pDDIs in LVF patients. Majority of pDDIs were of major- and moderate-severity. Male patients and those prescribed greater number of medicines were more exposed to major-pDDIs

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Abstract Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for > 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results.

Severe potential drug-drug interactions in older adults with dementia and associated factors

OBJECTIVE: To identify the main severe potential drug-drug interactions in older adults with dementia and to examine the factors associated with these interactions. METHOD: This was a cross-sectional study. The enrolled patients were selected from six geriatrics clinics of tertiary care hospitals across Mexico City. The patients had received a clinical diagnosis of dementia based on the current standards and were further divided into the following two groups: those with severe drug-drug interactions (contraindicated/severe) (n=64) and those with non-severe drug-drug interactions (moderate/minor/absent) (n=117). Additional socio-demographic, clinical and caregiver data were included. Potential drug-drug interactions were identified using Micromedex Drug Reax 2.0® database. RESULTS: A total of 181 patients were enrolled, including 57 men (31.5%) and 124 women (68.5%) with a mean age of 80.11±8.28 years. One hundred and seven (59.1%) patients in our population had potential drug-drug interactions, of which 64 (59.81%) were severe/contraindicated. The main severe potential drug-drug interactions were caused by the combinations citalopram/anti-platelet (11.6%), clopidogrel/omeprazole (6.1%), and clopidogrel/aspirin (5.5%). Depression, the use of a higher number of medications, dementia severity and caregiver burden were the most significant factors associated with severe potential drug-drug interactions. CONCLUSIONS: Older people with dementia experience many severe potential drug-drug interactions. Anti-depressants, antiplatelets, anti-psychotics and omeprazole were the drugs most commonly involved in these interactions. Despite their frequent use, anti-dementia drugs were not involved in severe potential drug-drug interactions. The number and type of medications taken, dementia severity and depression in patients in addition to caregiver burden should be considered to avoid possible drug interactions in this population.

ANALYSIS OF DRUG USE OF PATIENTS IN PICU / 现代医院

Objective To evaluate the rationality of medication in Pediatric Intensive Care Unit (PICU).Methods The medication of 46 children in PICU of the First Affiliated Hospital of Sun Yat-Sen University with the average age of (34.74 ±45.5) months during May 3, 2011 and December 5, 2011 were retrospectively analyzed.The study was conducted statistically on the basis of pharmacopoeia, medical documents and other related medical materials.Results Among 46 ca-ses, irrational drug use was found in 28 patients (60.87%).A total of 100 irrational drug using habits such as potential drug interactions and incompatibility were presented.Compatibility taboo and pDDIs top four drugs were16 cases of furosemide (16%), 12 cases of vancomycin and dexamethasone (12%), 11 cases of midazolam injection (11%), and 9 cases of Phe-nobarbital (9%).Conclusion According to the characteristics of pediatric medication, pharmacists should take advantage of drug synergy when vigilant about the side effects of multi -medication, especially paying close attention to the potential inter-action of some commonly-prescribed drugs as well as reducing the prescriptions of multi -medications in order to improve the rationality of drug use in PICU.