Clinically significant drug interactions

Johnson, Michael D.; Newkirk, Gary R.; White, John R.

doi:10.3810/pgm.1999.02.560

Cited by 36 publications

(19 citation statements)

References 14 publications

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“…In general, DDIs usually have a specific time course i.e. onset and duration and this makes them more predictable and preventable than ADRs 20. This finding suggests that one should be careful while prescribing drugs that can cause delayed type of DDIs.…”

Section: Discussionmentioning

confidence: 99%

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

Bista

Saha

Mishra

et al. 2009

Pharmacy Practice (Internet)

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*Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixtyfour percent of the potential DDIs were of 'Moderate' type and 58% had a 'Delayed' onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a 'Good' documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during preintervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy. IMPACTO DE UNA INTERVENCION EDUCATIVA EN EL ESQUEMA E INCIDENCIAS DE INTERACCIONES MEDICAMENTOSAS POTENCIALES EN NEPAL RESUMENObjetivo: Estudiar el impacto de una intervención educativa en el esquema y la incidencia de las interacciones medicamentosas potenciales (DDI). Método: Se incluyó a todos los pacientes que visitaron el servicio de medicina interna del Hospital Universitario de Manipal. Los detalles de los pacientes se recogieron utilizando un formulario de perfil de paciente y los datos fueron analizados utilizando la base de datos electrónica Micromedex. Se realizó una intervención mediante una reunión clínica y discusión personal. El grupo diana eran los médicos y los enfermeros. Resultados: Se estudiaron 435 pacientes durante la pre-intervención y 445 durante la post-intervención. Las incidencia de DDI potenciales fue del 53% (pre-intervención) y 41% (post-intervención) [chi cuadrado=11,27, p=0,001]. La media de medicamentos por paciente fue de 8,53 (preintervención) y 7,32 (post-intervención) [t=3,493, p=0,001]. El 64% de las DDI potenciales eran de tipo 'Moderadas' y el 58% tenía una iniciación 'Retrasada' en ambas fases. El 70% de las DDI potenciales durante la fase de pre-intervención y el 61% en la post-intervención tenían un estado de documentación 'Bueno'. Mecanismo...

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Section: Discussionmentioning

confidence: 99%

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

Bista

Saha

Mishra

et al. 2009

Pharmacy Practice (Internet)

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“…Inhibition Inhibition of CYP enzymes is the most common mechanism that produces serious and potentially life-threatening drug interactions (Johnson et al, 1999). Most enzyme inhibitors act specifically on individual CYP enzymes, so a drug inhibiting CYP2A6 may have no effect on CYP2C19.…”

Section: Cyp Enzyme Induction and Inhibitionmentioning

confidence: 99%

Potentially hazardous drug interactions with psychotropics

Chadwick¹,

Waller

Edwards³

2005

Adv. psychiatr. treat

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Of the many interactions with psychotropic drugs, a minority are potentially hazardous. Most interactions are pharmacodynamic, resulting from augmented or antagonistic actions at a receptor or from different mechanisms in the same tissue. Most important pharmacokinetic interactions are due to effects on metabolism or renal excretion. The major enzymes involved in metabolism belong to the cytochrome P450 (CYP) system. Genetic variation in the CYP system produces people who are 'poor', 'extensive' or 'ultra-rapid' drug metabolisers. Hazardous interactions more often result from enzyme inhibition, but the probability of interaction depends on the initial level of enzyme activity and the availability of alternative metabolic routes for elimination of the drug. There is currently interest in interactions involving uridine diphosphate glucuronosyltransferases and the P-glycoprotein cell transport system, but their importance for psychotropics has yet to be defined. The most serious interactions with psychotropics result in profound sedation, central nervous system toxicity, large changes in blood pressure, ventricular arrhythmias, an increased risk of dangerous side-effects or a decreased therapeutic effect of one of the interacting drugs.

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“…Interactions involving the CYP450 enzymes are often due to either inhibition of an isoenzyme, leading to increased blood or tissue concentrations of the substrate, or induction of an isoenzyme, causing enhanced metabolism and lower substrate concentrations (Delafuente, 2003:137). According to Johnson et al (1999) enzyme inhibition is the mechanism most often responsible for life-threatening interactions. 32 Such interactions have been observed when zalcitabine is combined with stavudine or didanosine producing severe peripheral neuropathy, pancreatitis, and lactic acidosis (Simpson & Tagliati, 1995).…”

Section: Cytochrome P450 Isoenzymementioning

confidence: 99%

Drug-Drug Interactions as a Challenge in the Treatment of HIV/AIDS

Katende-Kyenda¹

2011

Understanding HIV/AIDS Management and Care - Pandemic Approaches in the 21st Century

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Clinically significant drug interactions

Cited by 36 publications

References 14 publications

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

Potentially hazardous drug interactions with psychotropics

Drug-Drug Interactions as a Challenge in the Treatment of HIV/AIDS

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