Drug Interactions in At-risk Emergency Department Patients

Gaddis, Gary M.; Holt, Todd R.; Woods, Mark

doi:10.1111/j.1553-2712.2002.tb01571.x

Cited by 36 publications

(18 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Each prescription had a median of 8 drugs (IQR 6-11). These frequencies were similar to those reported by other groups[2526]. Correlation coefficient between the number of drugs given to the patient and number of average potential adverse drug reactions found among the patients was 0.86.…”

supporting

confidence: 89%

Prospective observational evaluation of incidences and implications of drug-drug interactions induced adverse drug reactions in critically Ill patients

et al. 2010

View full text Add to dashboard Cite

The primary aim of this study is to identify and analyze the importance of adverse drug reaction due to drug-drug interaction as a contributing factor towards drug safety. Patients more than 18 years of age admitted in multidisciplinary intensive care unit of a tertiary care hospital were included in this study. Patients who stayed less than 48 h and patients in whom all treatment modalities have been withdrawn and were on comfort measures only (no drugs were prescribed), were excluded. All the drugs that were given during intensive care unit stay were checked for presence of potential interactions which led to adverse drug reaction. Drug-drug interactions that were detected clinically or through investigations were recorded and also any therapeutic actions taken for drug-drug interactions were noted. From June 2006 to April 2007, 400 patients-prescriptions were analyzed. Adverse drug reactions due to drug-drug interactions were identified in 64% patients. Among those patients 38.67% had a single drug-drug interaction. Potential drug-drug interactions were 602. Clinically significant drug-drug interactions among the potential were 208 (34.55%). Clinically relevant drug-drug interactions were 103 (49.52% of 208 episodes). The adverse drug reactions due to drug-drug interactions in our sample were managed either by substituting another drug (50.48% of 103 episodes) or by adjusting the dose (1% of 103 episodes) or by omitting the drug (48.54% of 103 episodes). Among the 208 observed drug-drug interactions induced adverse drug reactions 21.63% was severe drug-drug interactions induced adverse drug reactions, 23.08% was moderate drug-drug interactions induced adverse drug reactions and 55.29% was minor drug-drug interactions induced adverse drug reactions. The interactions which were life threatening and/ or require medical intervention to minimize or prevent serious adverse effects were considered as severe drug-drug interactions and those interaction which resulted in an exacerbation of the patient's condition and/ or require an alteration in therapy were considered as moderate drug-drug interactions. The interactions which were limited clinical effects and manifestations may include an increase in the frequency or severity of side effects but generally would not require a major alteration in therapy were classified as minor drug-drug interactions. The correlation coefficient was 0.86 between the number of drugs given to the patient & number of average potential adverse drug reactions found among the patients. Increase in number of prescribed drug significantly (one way) increases number of potential adverse drug reaction due to drug-drug interaction (p<0.0001). Critically ill patients are more susceptible to drug-drug interactions due to the administration of multiple drugs and complex drug combinations. Several drug-drug interactions were clinically irrelevant.

show abstract

supporting

confidence: 89%

Prospective observational evaluation of incidences and implications of drug-drug interactions induced adverse drug reactions in critically Ill patients

et al. 2010

View full text Add to dashboard Cite

show abstract

“…31,32 Our study adds to this information by demonstrating that the proportion of patients achieving clinically significant improvements due to hydrocodone is altered by the presence of drug-drug interactions. While previous studies have suggested that medications prescribed in the ED theoretically interact with the patients' regular medications, 33 our current study found that these interactions result in clinically significant changes in medication effectiveness. One interpretation of these data is that oxycodone should be preferred over hydrocodone due to more consistent clinical effects regardless of drug-drug interactions.…”

Section: Discussioncontrasting

confidence: 75%

The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness

et al. 2014

View full text Add to dashboard Cite

Objectives The hepatic cytochrome 2D6 (CYP2D6) is a saturable enzyme responsible for metabolism of approximately 25% of known pharmaceuticals. CYP interactions can alter the efficacy of prescribed medications. Hydrocodone is largely dependent on CYP2D6 metabolism for analgesia, ondansetron is inactivated by CYP2D6, and oxycodone analgesia is largely independent of CYP2D6. The objective was to determine if CYP2D6 medication co-ingestion decreases the effectiveness of hydrocodone. Methods This was a prospective observational study conducted in an academic U.S. emergency department (ED). Subjects were included if they had self-reported pain or nausea; and were excluded if they were unable to speak English, were less than 18 years of age, had liver or renal failure, or carried diagnoses of chronic pain or cyclic vomiting. Detailed drug ingestion histories for the preceding 48 hours prior to the ED visit were obtained. The patient's pain and nausea were quantified using a 100-millimeter visual analogue scale (VAS) at baseline prior to drug administration and following doses of hydrocodone, oxycodone, or ondansetron. We used a mixed model with random subject effect to determine the interaction between CYP2D6 drug ingestion and study drug effectiveness. Odds ratios (OR) were calculated to compare clinically significant VAS changes between CYP2D6 users and non-users. Results Two hundred fifty (49.8%) of the 502 subjects enrolled had taken at least one CYP2D6 substrate, inhibitor, or inducing pharmaceutical, supplement, or illicit drug in the 48 hours prior to ED presentation. CYP2D6-drug users were one third as likely to respond to hydrocodone (OR 0.33, 95% CI = 0.1 to 0.8), and more than three times as likely as non-users to respond to ondansetron (OR 3.4, 95% CI = 1.3 to 9.1). There was no significant difference in oxycodone effectiveness between CYP2D6 users and non-users (OR 0.53, 95% CI = 0.3 to 1.1). Conclusions CYP2D6 drug-drug interactions appear to change effectiveness of commonly prescribed drugs in the ED. Drug-drug interaction should be considered prior to prescribing CYP2D6 drugs.

show abstract

“…One of the most commonly prescribed cardiac medications, digoxin interacts with numerous drugs, and these interactions often result in toxicity 17,18 . In a recent retrospective assessment of 200 emergency department outpatients at least 60 years old and taking multiple medications, more drug interactions were attributed to digoxin than any other medication 20 . Of the 86 drug interactions detected in these patients, 28 involved digoxin.…”

Section: Discussionmentioning

confidence: 99%

No Pharmacokinetic or Pharmacodynamic Interaction Between Digoxin and the Oral Direct Thrombin Inhibitor Ximelagatran in Healthy Volunteers

Sarich

Schützer

Wall

et al. 2004

The Journal of Clinical Pharma

View full text Add to dashboard Cite

The interaction potential of digoxin and ximelagatran, an oral direct thrombin inhibitor being developed for the prevention and treatment of thromboembolic disease, was investigated in this randomized, double-blind, 2-way crossover study. On 2 separate occasions, healthy female and male volunteers (n = 16) received ximelagatran 36 mg or placebo twice daily for 8 days separated by a 4- to 14-day washout period. All volunteers received a single oral dose of digoxin 0.5 mg on day 4 of both study periods. No interaction between ximelagatran and digoxin was detected in the pharmaco-kinetic parameters (using a 90% confidence interval [CI] of least squares mean estimate ratios), including melagatran (the active form of ximelagatran) AUC(tau) and C(max) and digoxin AUC(t) and C(max). Digoxin did not alter the melagatran-induced prolongation of the activated partial thromboplastin time, and both drugs were well tolerated when administered in combination. In conclusion, no pharmacokinetic or pharmacodynamic interaction between digoxin and ximelagatran was observed in this study.

show abstract

Drug Interactions in At-risk Emergency Department Patients

Cited by 36 publications

References 10 publications

Prospective observational evaluation of incidences and implications of drug-drug interactions induced adverse drug reactions in critically Ill patients

Prospective observational evaluation of incidences and implications of drug-drug interactions induced adverse drug reactions in critically Ill patients

The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness

No Pharmacokinetic or Pharmacodynamic Interaction Between Digoxin and the Oral Direct Thrombin Inhibitor Ximelagatran in Healthy Volunteers

Contact Info

Product

Resources

About