Comorbidity, Polytherapy, and Drug Interactions in a Neurological Context: An Example of a Multidisciplinary Approach to Promote the Rational Use of Drugs

Busà, G.; Damuzzo, Vera; Chiumente, Marco; Palozzo, Angelo Claudio

doi:10.1177/0897190017699138

Cited by 16 publications

(21 citation statements)

References 32 publications

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“…( 29 ) Cardiovascular diseases have been associated with drug interactions, ( 27 , 28 ) which often require the combination of drugs in the treatment, as well as in patients with heart failure. Busa et al ( 30 ) also identified a correlation between an increased number of drugs prescribed and an increase in drug interactions. In addition, drugs that act on the cardiovascular system was the main group involved in the drug interactions identified.…”

Section: Discussionmentioning

confidence: 96%

“…( 29 ) Doenças cardiovasculares têm sido associadas com presença de interações medicamentosas ( 27 , 28 ) que frequentemente requerem associação de medicamentos no tratamento, bem como em pacientes com insuficiência cardíaca. Busa et al ( 30 ) também identificaram correlação entre aumento do número de medicamentos prescritos e aumento da interação medicamentosas. Além disso, os medicamentos que atuam no sistema cardiovascular foram os principais grupos envolvidos nas interações medicamentosas identificadas.…”

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Drug interactions among older adults followed up in a comprehensive medication management service at Primary Care

Santos¹,

Nascimento²,

Oliveira³

et al. 2019

Einstein (São Paulo)

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Objective: To estimate the prevalence of drug interactions and associated factors among older adults followed up in a Comprehensive Medication Management Service at Primary Care. Methods: Firstly, the Beers criteria 2015 was used to define drug interactions; later, drug interactions proposed by Dumbreck for patients with diabetes, depression, and heart failure were evaluated. The associated factors were assessed by univariate (Pearson's χ 2 ) and multivariate analyses (logistic regression). The significance level of 5% was set for all analyses. Results: The mean age of the studied population was 70.2±7.8 years; 52.2% were between 60 and 69 years, and 61.3% were female. Among the older adults, 94.5% used two or more drugs (condition for the occurrence of drug-drug interaction). The prevalence of drug interaction according to the Beers criteria was 4.9%. After multivariate analysis, diseases of the central nervous system, arrhythmia, number of medications, and female sex were positively associated with drug interaction. The prevalence of drug interaction according to Dumbreck was 27.2%. After multivariate analysis, the number of medications, the presence of heart failure, and Charlson comorbidity index greater than 1 were conditions positively associated with drug interactions. Conclusion: The holistic and individualized approach used in comprehensive medication management services for older patients is important, considering the prevalence of drug interactions and the need to minimize adverse events.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionunclassified

Drug interactions among older adults followed up in a comprehensive medication management service at Primary Care

Santos¹,

Nascimento²,

Oliveira³

et al. 2019

Einstein (São Paulo)

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“…From the other side, complete set of information about consequences of potential DDIs and final descicion about final outcome of therapy could be summarized in the presence of other informations derived as from medical and practical knowledge as also from medical records of patients (20,21). Neurological disorders are one of the most common reasons for treatment in hospital facilities in modern society (16). It is known that neurological disease has chronic and progressive clinical course and due these reasons patients in neurological ward needed to be treat mostly with more than one drug.…”

Section: Introductionmentioning

confidence: 99%

“…Our results shown that the most frequently prescribed drugs were anticonvulsants, anticoagulant drugs, antidepressants, antiarrhythmic medicines, NSAIL and ACE inhibitors. These different groups of drugs have ability to increase possibility of development of clinically relevant drugdrug interactions and due this reason, neurological patients are more vulnerable population regarding DDIs and require special concern in detecting potential drug-drug interactions in a timely manner and preventing additional deterioration of health in these complex patients(15)(16)(17)(18).Antidepressants have many indications and are frequently prescribed to neurological patients(22). It is not surprising that patients who are prescribed antidepressants have a higher risk of potential DDIs since the majority of antidepressant drugs are substrates for one or more of the cytochrome P-450 isozymes.…”

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confidence: 99%

“…All calculations were performed by the Statistical Program for Social Sciences (SPSS version 18).ResultsIn total there were 144 inpatients who participated in the study. Mean age of hospitalized patients was 59.0 ± 1.4, and median number of prescribed drugs per patient was 7(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).The most common co-morbidity was hypertension (55.6%). The most common reason for admission was diagnostic evaluation of patients with neurological symptoms like headache or vertigo (34.7%).…”

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Risk factors for potential drug-drug interactions in a general neurology ward

2021

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Introduction. Treatment of neurological diseases usually requires polypharmacy, and it is crucial to detect potential drug-drug interactions (DDIs) and recognize risk factors in timely manner, as consequences of DDIs could be serious. The aim of our study was to analyze risk factors for occurrence and number of potential drug-drug interactions among patients. Methods. This study was conducted in 144 inpatients in general-care neurological department of a tertiary care hospital. Effects of risk factors for potential DDIs were evaluated by multiple linear regression. The study had retrospective cohort design. Frequencies of various types of potential DDIs (according to severity) discovered by Medscape, Epocrates and Micromedex online interaction checkers. Results. Number of prescribed drugs, age of a patient, value of the Charlson comorbidity index and prescription of an antidepressant increase risk of potential DDIs in a general neurology ward. On the other hand, being paralyzed, number of prescribers for a single patient, being bedridden for at least one day of hospitalization decreased number of potential DDIs per patient. Number of prescribed drugs per patient (OR=1.466±0.250; p=0.000) and age (OR=1.027±0.026; p=0.041) increased, and number of prescribers per patient (OR=0.056±0.028; p=0.016), especially if the patients were paralyzed (OR=0.214±0.294; p=0.007), decreased risk of contraindicated, serious, "use alternative" or major potential DDIs. Antidepressant increase risk of absolute number of all monitor/modify potential DDIs (OR=1.257±0.726; p=0.035). Conclusions. Frequency of potential DDIs among neurological patients is considerable and influenced to the largest extent by advanced age, comorbidities, total number of prescribed drugs per patient and concomitant use of antidepressants.

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Man vs. machine: comparison of pharmacogenetic expert counselling with a clinical medication support system in a study with 200 genotyped patients

Marchetti

Simmaco

Gohlke

et al. 2021

Eur J Clin Pharmacol

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Background Medication problems such as strong side effects or inefficacy occur frequently. At our university hospital, a consultation group of specialists takes care of patients suffering from medication problems. Nevertheless, the counselling of poly-treated patients is complex, as it requires the consideration of a large network of interactions between drugs and their targets, their metabolizing enzymes, and their transporters, etc. Purpose This study aims to check whether a score-based decision-support system (1) reduces the time and effort and (2) suggests solutions at the same quality level. Patients and methods A total of 200 multimorbid, poly-treated patients with medication problems were included. All patients were considered twice: manually, as clinically established, and using the Drug-PIN decision-support system. Besides diagnoses, lab data (kidney, liver), phenotype (age, gender, BMI, habits), and genotype (genetic variants with actionable clinical evidence I or IIa) were considered, to eliminate potentially inappropriate medications and to select individually favourable drugs from existing medication classes. The algorithm is connected to automatically updated knowledge resources to provide reproducible up-to-date decision support. Results The average turnaround time for manual poly-therapy counselling per patient ranges from 3 to 6 working hours, while it can be reduced to ten minutes using Drug-PIN. At the same time, the results of the novel computerized approach coincide with the manual approach at a level of > 90%. The holistic medication score can be used to find favourable drugs within a class of drugs and also to judge the severity of medication problems, to identify critical cases early and automatically. Conclusion With the computerized version of this approach, it became possible to score all combinations of all alternative drugs from each class of drugs administered (“personalized medication landscape “) and to identify critical patients even before problems are reported (“medication alert”). Careful comparison of manual and score-based results shows that the incomplete manual consideration of genetic specialties and pharmacokinetic conflicts is responsible for most of the (minor) deviations between the two approaches. The meaning of the reduction of working time for experts by about 2 orders of magnitude should not be underestimated, as it enables practical application of personalized medicine in clinical routine.

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Comorbidity, Polytherapy, and Drug Interactions in a Neurological Context: An Example of a Multidisciplinary Approach to Promote the Rational Use of Drugs

Abstract: The study demonstrated that the neurological patient, especially if elderly, has a high risk of DDI and ADRs and that many of these can be avoided by case discussion in multidisciplinary team meetings, in which the presence of a dedicated clinical pharmacist is crucial.

Cited by 16 publications

References 32 publications

Drug interactions among older adults followed up in a comprehensive medication management service at Primary Care

Drug interactions among older adults followed up in a comprehensive medication management service at Primary Care

Risk factors for potential drug-drug interactions in a general neurology ward

Man vs. machine: comparison of pharmacogenetic expert counselling with a clinical medication support system in a study with 200 genotyped patients

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