Evaluation of potential drug-drug interactions in medical wards of a referral university hospital in southern part of Iran: a retrospective observational study

Document Type : Original Article

Authors

1 Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Student research committee, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Drug-drug interactions impose several financial and medical burden on medical system and can lead to various health problems. The aim of this study was to investigate the incidence of Potential Drug-Drug Interactions (PDDIs) and its related factors in patients admitted to a large university hospital in southern part of Iran.
Method: A retrospective observational study was conducted in neurology, infectious and endocrinology wards of a tertiary care teaching hospital, Shiraz, Iran. PDDIs were identified using Lexi-InteractTM Online database. The relationship betweenpatient’s age, gender, comorbidity, number of medications,administration of high risk drugs, physician's university rank and scientific level, type of hospital wardand PDDIs has been studied using logistic regression analysis.
Result and conclusion: Totally 600 patients were evaluated in our study. A total number of 5051 interactions were identified. 89.5% of patients experienced at least one interaction regardless of the severity. The most frequent interaction was reported to be class C (84.63%) interaction. According to our results, number of medications, administration of high risk drugs, and type of hospital ward were reported as significant risk factors for the incidence of PDDIs.
Discussion: This study suggest that the prevalence of PDDIs is still high even in a large university hospital.Using modern medical systems), regular monitoring of patients' medications,and paying special attention to patients who are elderly or have certain diseases could help to minimize drug interactions. Moreover, the role of pharmacist should not be ignored whom are the best professionals for preventing, monitoring and managing drug interactions.

Keywords

References

1. Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003 Apr 2;289(13):1652-8. doi: 10.1001/jama.289.13.1652. PMID: 12672733.
2. Seymour RM, Routledge PA. Important drug-drug interactions in the elderly. Drugs Aging. 1998 Jun;12(6):485-94. doi: 10.2165/00002512-199812060-00006. PMID: 9638396
3. Vonbach P, Dubied A, Krähenbühl S, Beer JH. Prevalence of drug-drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med. 2008 Oct;19(6):413-20. doi: 10.1016/j.ejim.2007.12.002. Epub 2008 Feb 7. PMID: 18848174.
4. Kovačević M, Vezmar Kovačević S, Miljković B, Radovanović S, Stevanović P. The prevalence and preventability of potentially relevant drug-drug interactions in patients admitted for cardiovascular diseases: A cross-sectional study. Int J Clin Pract. 2017 Oct;71(10). doi: 10.1111/ijcp.13005. Epub 2017 Sep 4. PMID: 28869702.
5. Köhler GI, Bode-Böger SM, Busse R, et al. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther. 2000 Nov;38(11):504-513. DOI: 10.5414/cpp38504. PMID: 11097142.
6. Bucşa C, Farcaş A, Cazacu I, Leucuta D, Achimas-Cadariu A, Mogosan C, Bojita M. How many potential drug-drug interactions cause adverse drug reactions in hospitalized patients? Eur J Intern Med. 2013 Jan;24(1):27-33. doi: 10.1016/j.ejim.2012.09.011. Epub 2012 Oct 5. PMID: 23041466.
7. De Almeida SM, Gama CS, Akamine N. Prevalence and classification of drug-drug interactions in intensive care patients. Einstein. 2008;5(4):347-51.
8. Koch L, Kränke B, Aberer W. Potential drug-drug interactions and adverse drug reactions in dermatological inpatients. J Dtsch Dermatol Ges. 2016 Nov;14(11):1122-1129. doi: 10.1111/ddg.12915. PMID: 27879085.
9. Ismail M, Iqbal Z, Khattak MB, Khan MI, Arsalan H, Javaid A, Gul Q, Khan F. Potential drug-drug interactions in internal medicine wards in hospital setting in Pakistan. Int J Clin Pharm. 2013 Jun;35(3):455-62. doi: 10.1007/s11096-013-9764-1. Epub 2013 Mar 13. PMID: 23483444.
10. de Palencia Espinosa MAF, Carrasco MSD, Soler JLF, Merino GR, De la Rubia Nieto MA, Miró AE. Pharmacoepidemiological study of drug–drug interactions in onco-hematological pediatric patients. Int J Clin Pharm. 2014;36(6):1160-9.
11. Ismail M, Iqbal Z, Khattak MB, Khan MI, Javaid A, Khan TM. Potential drug-drug interactions in cardiology ward of a teaching hospital. Health Med. 2012;6:1618-24.
12. Shakeel, F., Aamir, M., Khan, A.F. et al. Epidemiology of potential drug-drug interactions in elderly population admitted to critical care units of Peshawar, Pakistan. BMC Pharmacol Toxicol 2018;19:85. https://doi.org/10.1186/s40360-018-0276-4.
13. Chatfield AJ. Lexicomp online and Micromedex 2.0. Journal of the Medical Library Association: JMLA. 2015;103(2):112.
14. APINCHS classification of high risk medicines. available from : https://www.safetyandquality.gov.au/our-work/medication-safety/high-risk-medicines/apinchs-classification-high-risk-medicines. Accessed in 4 Apr 2021.
15. Lexi-InteractTM Online. Lexi-Comp's Comperhensive drug-to-drug interaction, drug-to-herb and herb-to-herb interaction analysis program. available from: https://www.uptodate.com/drug-interactions Accessed 21 feb 2021.
16. Guchelaar HJ, Colen HB, Kalmeijer MD, Hudson PT, Teepe-Twiss IM. Medication errors: hospital pharmacist perspective. Drugs. 2005;65(13):1735-46. doi: 10.2165/00003495-200565130-00001. PMID: 16114974.
17. Vessal G. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward. Pharm World Sci. 2010 Feb;32(1):59-65. doi: 10.1007/s11096-009-9341-9. Epub 2009 Oct 17. PMID: 19838816.
18. Lassetter JH, Warnick ML. Medical errors, drug-related problems, and medication errors: a literature review on quality of care and cost issues.
J Nurs Care Qual. 2003 Jul-Sep;18(3):175-81; quiz 182-3. doi: 10.1097/00001786-200307000-00003. PMID: 12856901.
19. Teka, F., Teklay, G., Ayalew, E. et al. Potential drug–drug interactions among elderly patients admitted to medical ward of Ayder Referral Hospital, Northern Ethiopia: a cross sectional study. BMC Res Notes 2016;9:431. https://doi.org/10.1186/s13104-016-2238-5.
20. Mousavi S, Ghanbari G. Potential drug-drug interactions among hospitalized patients in a developing country. Caspian J Intern Med. 2017 Fall;8(4):282-288. doi: 10.22088/cjim.8.4.282. PMID: 29201319; PMCID: PMC5686307.
21. Namazi S, Pourhatami S, Borhani-Haghighi A, Roosta S. Incidence of Potential Drug-Drug Interaction and Related Factors in Hospitalized Neurological Patients in two Iranian Teaching Hospitals. Iran J Med Sci. 2014 Nov;39(6):515-21. PMID: 25429173; PMCID: PMC4242985.
22. Saleem A, Masood I, Khan TM. Clinical relevancy and determinants of potential drug-drug interactions in chronic kidney disease patients: results from a retrospective analysis. Integr Pharm Res Pract. 2017 Feb 17;6:71-77. doi: 10.2147/IPRP.S128816. PMID: 29354553; PMCID: PMC5774325.
23. Labib JR, Labib-Youssef MR, Fatah S. High alert medications administration errors in neonatal intensive care unit: A pediatric tertiary hospital experience. Turk J Pediatr. 2018;60(3):277-285. doi: 10.24953/turkjped.2018.03.007. PMID: 30511540.
24. Foroughinia F, Mazraie S. Investigating the Use of Human Albumin in a Non-Teaching Hospital in Iran. Iran J Pharm Res. 2017 Spring;16(2):817-822. PMID: 28979337; PMCID: PMC5603893.
25. Aseeri M, Banasser G, Baduhduh O, Baksh S, Ghalibi N. Evaluation of Medication Error Incident Reports at a Tertiary Care Hospital. Pharmacy (Basel). 2020 Apr 19;8(2):69. doi: 10.3390/pharmacy8020069. PMID: 32325852; PMCID: PMC7356747.
26. Pirmohamed M, James S, Meakin S, Green C, Scott A K, Walley T J et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004; 329 :15 doi:10.1136/bmj.329.7456.15.
27. Vonbach P, Dubied A, Beer JH, Krähenbühl S. Recognition and management of potential drug-drug interactions in patients on internal medicine wards. Eur J Clin Pharmacol. 2007 Nov;63(11):1075-83. doi: 10.1007/s00228-007-0359-4. Epub 2007 Sep 6. PMID: 17805522.
28. S. Shah, B. S. Naqvi, Ale-Zehra Ale-Zehra, D. Ali, R. Saeed, G. Naqvi. Quantitative Analysis of Drug, Drug Interactions of OTC Drugs with other Prescribed Drugs Collected from Different Hospitals and Clinics of Karachi, Pakistan. Jordan J Pharm Sci. 2011;108(398):1-24.
29. Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, et al. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med. 1996;100(4):428-37.
30. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, Bates DW. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999 Jul 21;282(3):267-70. doi: 10.1001/jama.282.3.267. Erratum in: JAMA 2000 Mar 8;283(10):1293. PMID: 10422996.
31. Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, Vander Vliet M, Seger DL. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998 Oct 21;280(15):1311-6. doi: 10.1001/jama.280.15.1311. PMID: 9794308.
Trends in Pharmaceutical Sciences
Volume 7, Issue 4
December 2021
Pages 249-258

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