Assessment of Potential Drug Interactions Among Hospitalized Patients at the Cardiac and Pulmonary Departments in Tertiary Care Hospitals

Abstract

Objective: The aim of this study was to assess the potential drug interactions among hospitalized patients in cardiac and pulmonary wards in three tertiary care hospitals. Methods:A prospective, observational study was carried out for 12 months. A sample of 1150 patients were assessed for potential drug-drug interactions (pDDIs) using Micromedex ® -2.7 and Drugs.com. Results:A total of 1150 patients were analyzed, and it was found that 685 were cardiac and 465 were pulmonary patients. The study identified 524 (76.49%) cardiac patients and 345 (74.19%) pulmonary patients, with pDDIs higher in male cardiac (298 [56.87%]) and male pulmonary (199 [57.68%]) patients, compared to females. Incidences of pDDIs were found to be higher in the age group of 60-70 years in cardiac (193 [36.83%]) and pulmonary (146 [42.31%]) patients and incidences of interactions based on duration of 4-6 days' hospital stays in cardiac were 380 (72.53%) and 215 (62.31%) in pulmonary patients, respectively. Moreover, 51.90% of cardiac patients and 56.52% of pulmonary patients were found to be prescribed with more number of drugs (cardiac 7 drugs and pulmonary 5-6 drugs) causing higher incidences of pDDIs. Some of the most common drug interacting pair was aspirin and clopidogrel combination observed in 245 cardiac patients, whereas in the pulmonary department, it was ranitidine-theophylline combination with a frequency of 195 pDDIs. Drug-food interactions were found with atorvastatin-citrus fruits in cardiac and theophylline-caffeine in pulmonary patients. The most common drug-disease interaction was found to be isosorbide dinitrate-myocardial infarction in cardiac and diazepam-COPD in pulmonary, respectively. Conclusion:Pharmacists must take responsibility in the monitoring of drug interactions and notifying the physician and patient about potential problems. With their detailed knowledge of drugs, pharmacists have the ability to relate unexpected symptoms experienced by patients to possible adverse effects of their drug therapy.

Risk of potential drug-drug interactions in the cardiac intensive care units

“…This study was conducted in 2 tertiary care hospitals of Peshawar, the Khyber Teaching Hospital and Hayatabad Medical Complex, and the prevalence of PDDIs in the respective CCUs was 96.5% and 95.7%. Previous studies conducted in the cardiology departments of hospitals in Pakistan reported PDDI prevalence of 91.6% and 77.5%, whereas high prevalences of PDDIs was also reported from India (74.5%)16 and Brazil (70.6%) 17. However, these studies were conducted in the cardiology wards and not in the CCUs where higher prevalence would be expected.…”

Interakcje wybranych leków kardiologicznych ze składnikami diety

“…[20] w badaniu z 2018 roku z udziałem 685 pacjentów kardiologicznych, trwającym 12 miesięcy, stwierdzili, że interakcje zachodzące między lekami obniżającymi ciśnienie a pokarmem mogą stanowić istotne zagrożenie dla zdrowia oraz obniżać skuteczność działania leków hipotensyjnych. Wykazano możliwość wystąpienia interakcji farmakokinetycznych między atenololem a sokiem pomarańczowym u 79 badanych pacjentów [20,21]. Obserwowano ryzyko wystąpienia hiperkaliemii u 47 badanych pacjentów przyjmujących enalapril bezpośrednio przed zjedzeniem banana lub po jego spożyciu [20].…”

“…Wykazano możliwość wystąpienia interakcji farmakokinetycznych między atenololem a sokiem pomarańczowym u 79 badanych pacjentów [20,21]. Obserwowano ryzyko wystąpienia hiperkaliemii u 47 badanych pacjentów przyjmujących enalapril bezpośrednio przed zjedzeniem banana lub po jego spożyciu [20].…”

Adverse drug reactions related to potential serious drug interactions in patients with cardiovascular diseases

“…One of these errors that can cause harm to the patient is drug interaction, an alteration of the pharmacological effects between two or more drugs administered concomitantly, which results in an increase or decrease in therapeutic efficacy or in adverse events caused by these, or even in the onset of new effects (2) .…”

“…Unwanted drug interactions are a reality in the clinical practice and their occurrence can favor: ineffective therapy, increased length of stay and cost of hospitalization, and even serious events that compromise the patient's life. The main risk factor for the interaction is polypharmacy, that is, the concomitant use of five or more drugs (2)(3)(4) .…”