Drug–Drug Interactions of Infectious Disease Treatments in Low‐Income Countries: A Neglected Topic?

Abstract

Despite recent advances in recognizing and reducing the risk of drug–drug interactions ( DDI s) in developed countries, there are still significant challenges in managing DDI s in low‐income countries ( LIC s) worldwide. In the treatment of major infectious diseases in these regions, multiple factors contribute to ineffective management of DDI s that lead to loss of efficacy or increased risk of adverse events to patients. Some of these difficulties, however, can be overcome. This review aims to evaluate the inherent complexities of DDI management in LIC s from pharmacological standpoints and illustrate the unique barriers to effective management of DDI s, such as the challenges of co‐infection and treatment settings. A better understanding of comprehensive drug‐related properties, population‐specific attributes, such as physiological changes associated with infectious diseases, and the use of modeling and simulation techniques are discussed, as they can facilitate the implementation of optimal treatments for infectious diseases at the individual patient level.

Pharmacogenetic and drug interaction aspects on ketamine safety in its use as antidepressant ‐ implications for precision dosing in a global perspective

“…Patients with infectious diseases in low‐income countries (LICs) such as malaria, tuberculosis and HIV/AIDS are predisposed to potential DDI due to polypharmacy 120 . Although DDIs are well recognized by regulatory agencies and drug developers, training of healthcare providers to ensure safe and effective use of anti‐infective drugs and management of DDIs in LICs is still in its infancy 120 . The rampant use of over‐the‐counter drugs without prescription further complicates the problem 121 .…”

“…120 Although DDIs are well recognized by regulatory agencies and drug developers, training of healthcare providers to ensure safe and effective use of anti-infective drugs and management of DDIs in LICs is still in its infancy. 120 The rampant use of over-the-counter drugs without prescription further complicates the problem. 121 Unlike in high income countries where ketamine is used as an adjuvant in combination with other anaesthetic drugs, it is the sole anaesthetic agent in use in some LICs.…”

Come Dance With Me: Transformative Changes in the Science and Practice of Drug–Drug Interactions

“…Certain therapeutic areas, like HIV medicine, have been highly successful in integrating DDI risk management and associated healthcare provider education as part of the practice community, considering the substantial challenges with complex DDIs resulting from antiretroviral agents, as reviewed by Devanathan and colleagues . However, challenges remain with major implications for public health in certain clinical contexts of use as exemplified by the unique considerations for DDI risk evaluation and management in low‐income countries for anti‐infective agents, as reviewed by McFeely and colleagues . Similarly, the educational efforts to move from risk aversion to risk management for the new generation of physicians and clinical pharmacists shall not be underestimated.…”