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

Abstract

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. Chisquare 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.

Toxicity, Side Effects, and Furosemide Interactions in Therapy of Heart Failure Patients (Systematic Review)

“…22 Interaction of furosemide in the treatment of heart failure patients is caused by various conditions such as advanced age and comorbid diseases of the patient, thus requiring various treatments (polypharmacy). 23,24,25 Interaction of furosemide in the treatment of heart failure patients could occur in several drugs, including: aspirin, digoxin, ramipril, enalapril, aminophylline and albuterol. 23,24,25 Among these journals there are no data regarding the interaction of furosemide and beta-blockers in the research hypothesis.…”

“…23,24,25 Interaction of furosemide in the treatment of heart failure patients could occur in several drugs, including: aspirin, digoxin, ramipril, enalapril, aminophylline and albuterol. 23,24,25 Among these journals there are no data regarding the interaction of furosemide and beta-blockers in the research hypothesis.…”

“…Studies conducted by Faisal Shakeel et al, Inamul Haq et al, and Yelbeneh Abayneh Assefa et al, with a total sample of 1150 patients showed that there was a potential drug interaction with furosemide and aspirin as many as 387 patients, with digoxin as many as 177 patients, with ramipril as many as 172 patients, with enalapril as many as 46 patients, with aminophylline as many as 23 patients and with albuterol as many as 40 patients. 23,24,25 Based on the research results of Inamul Haq et al who monitored the effect of the potential interaction of furosemide on the treatment of heart failure patients who were hospitalized, the results showed that the interaction of furosemide and ramipril caused 26 patients had hypotension, 3 patients had nausea, 2 patients had vomiting, 1 patient had vertigo and 9 patients had dizziness. While the administration of digoxin and furosemide resulted in 5 patients had dizziness, 4 patients had nausea, 3 patients vomiting, and 2 patients had headaches.…”

“…While the administration of digoxin and furosemide resulted in 5 patients had dizziness, 4 patients had nausea, 3 patients vomiting, and 2 patients had headaches. 25 Interaction between furosemide and aspirin (NSAID as an antiplatelet which is a COX-1 inhibitor) is an antagonist pharmacodynamic…”

“…Diniafelsa Wola, Noor Wijayahadi, Mochamad Ali Sobirin, Erwin Kresnoadi 209 interaction, where aspirin can cause a decrease in the effectiveness of furosemide through the action of aspirin that decrease sodium excretion. 23,24,25 The interaction between furosemide and digoxin is a synergistic pharmacodynamic interaction, because furosemide can cause hypokalemia and digoxin's mode of action also inhibits the Na+/K+-ATPase pump (to increase heart muscle contraction), this condition will certainly increase the risk of digoxin toxicity (nausea, vomiting, and cardiac arrhythmias) 23,24 .…”