Interactions between antidepressants and antihypertensive and glucose lowering drugs among patients in the HIPERDIA Program, Coronel Fabriciano, Minas Gerais State, Brazil

Abstract

The aims of this study were to investigate the prevalence and to describe the most frequent potential interactions between antidepressants and antihypertensive and glucose lowering drugs in the HIPERDIA Program at two primary care units in Coronel Fabriciano, Minas Gerais State, Brazil. Data were collected through the patient registry in the HIPERDIA Program and the local psychoactive drug dispensing system. Interactions were classified as due to pharmacokinetic and/or pharmacodynamic mechanisms. Prevalence of antidepressant use in the HIPERDIA Program was 4.37% (29 of patient 663 records). Of the HIPERDIA patients in treatment with antidepressants, 19 were exposed to 47 interactions, 23.4% of which involving pharmacokinetic, 61.7% pharmacodynamic synergy, and 15.9% simultaneous pharmacokinetic and pharmacodynamic mechanisms. Complications can arise from drug-drug interactions, a situation that can escape the attention of prescribing health professionals.

Drug interactions in Brazilian type 2 diabetes patients

“…7,[9][10][11][22][23][24][25][26][27] The presence of interaction in the combined use of OAD and ACEI was observed in other studies, which also detected increased insulin production in DM 2 patients taking ACEI, a favourable aspect to reach glucose control. Publications in the United States, Canada, Europe, Asia and Brazil have argued that the number of drug interactions in chronic patients is increasing and that this might entail different effects for glucose control.…”

“…7,9,11,[17][18][19] This might be related to the fact that most of these patients depended on medication distribution at local public health services in the primary care network, differently from the studies cited, which were mostly conducted at secondary care services. 7,9,11,[17][18][19] This might be related to the fact that most of these patients depended on medication distribution at local public health services in the primary care network, differently from the studies cited, which were mostly conducted at secondary care services.…”

“…This situation, in combination with the chronic nature of the illness, generally imposes difficulties to prevent acute and chronic complications without the adoption of drugs like oral antidiabetics (OADs), antihypertensives and anti-lipidaemics, among others. [7][8][9][10] This polypharmacy demands increased knowledge on these drugs classes, particularly regarding drug interactions. Polypharmacy is associated with increased risk and severity of adverse drug reactions, with precipitating pharmacological interactions, causing cumulative toxicity, bringing about drug intake errors and reducing treatment adherence.…”

“…[2][3][4] As a result, patients might be confronted with polypharmacy situations, when five or more drugs are continuously used, which represents a public health problem. 9,11 Hence, one of the main challenges health professionals face in care delivery to DM 2 patients, mainly when elderly, is to know about the interaction between OAD and other drugs or about the interference of certain drugs in glucose control. 5 It is difficult to establish a causal relation, but one can predict some interactions between OADs and other drugs.…”

“…6,7 Due to the high simultaneous incidence of DM 2 and other chronic conditions like hypertension (70%) and depression (30%), patients who combine other drugs with OAD are common. [7][8][9][10] This polypharmacy demands increased knowledge on these drugs classes, particularly regarding drug interactions. Besides, the complexity of these illnesses and very narrow therapeutic spectrum of the drugs can negatively affect DM control.…”