Potential drug–drug interactions and associated factors among hospitalized cardiac patients at Jimma University Medical Center, Southwest Ethiopia

Abstract

Background: Concomitant use of several drugs for a patient is often imposing increased risk of drug–drug interactions. Drug–drug interactions are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. This study is aimed to assess the prevalence of potential drug–drug interactions and associated factors among hospitalized cardiac patients at medical wards of Jimma University Medical Center, Southwest Ethiopia. Methods: A hospital-based prospective observational study was conducted among hospitalized cardiac adult patients based on the inclusion criteria. Patient-specific data were collected using structured data collection tool. Potential drug–drug interaction was analyzed using Micromedex 3.0 DRUG-REAX ® System. Data were analyzed using statistical software package, version 20.0. To identify the independent predictors of potential drug–drug interaction, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at a p-value < 0.05. Written informed consent from patients was obtained and the patients were informed about confidentiality of the information obtained. Results: Of the total 200 patients, majority were male (52.50%) and with a mean(±standard deviation) age of 42.54(±7.89) years. Out of 673 patients’ prescriptions analyzed, 521 prescriptions comprised potential drug interactions and it was found that 967 drug interactions were present. The prevalence rate of potential drug–drug interactions among the study unit was 4.83 per patient and 1.44 per prescription regardless of the severity during their hospital stay. Overall the prevalence rate of potential drug interactions was 74.41%. Older age (adjusted odds ratio (95% confidence interval): 1.067 (2.33–27.12), p = 0.049), long hospital stay (⩾7 days) (adjusted odds ratio (95% confidence interval): 2.80 (1.71–4.61), p = 0.024), and polypharmacy (adjusted odds ratio (95% confidence interval): 1.64 (0.66–4.11), p = 0.041) were independent predictors for the occurrence of potential drug–drug interactions. Conclusion: This study demonstrated a high prevalence of potential DIs among hospitalized cardiac patients in medical wards due to the complexity of pharmacotherapy. The prevalence rate is directly related to age, number of prescribed drugs, and length of hospital stay. Pharmacodynamic drug–drug interaction was the common mechanism of drug–drug interactions. Therefore, close monitoring of hospitalized patients is highly recommended.

Prevalence of potential drug- drug interactions and associated factors among outpatients and inpatients in Ethiopian Hospitals: a systematic review and Meta-analysis of observational studies

“…Similarly, this review showed all (100%) HIV infected patients treated in the outpatient setting [6]97.5% of adult patients with heart diseases treated in inpatient ward [5] and 92.23% cardiac disorder patients treated in the outpatient setting [26] were susceptible to DDIs. A high number of prescribed drugs, prescribing drugs with many potential DDIs, pharmacodynamics nature of drugs used in cardiology, and the in uence of heart disease on drug metabolism may cause the high occurrence of potential DDIs in this group of patients.…”

“…WA also prepared the manuscript for publication. All authors have read and approved the manuscript Footnote: Seven studies did not report the mechanisms of drug-drug interaction Patients taking three or more than three concomitant drugs are at higher risk of the occurrence of potential DDIs [27,28] There is an association of the occurrence of one or more potential DDIs with the number of medications prescribed per patient who took more than four medications [35] Polypharmacy(five or more medications) is an important factor which leads to potential DDIs [5,29,30,31,33,34] Co-morbid disease Co-morbid condition independently increased the potential DDIs almost 2-folds [33] Age Older age was found to be predisposing factors for the occurrence of DDI [5,28,30,31] Potential DDIs were occurring more frequently in the age group of 2-6 years than any other age group of the pediatric population [29] Hospital stay The chance of taking multiple drugs increases with longer stays(greater than or equal to seven) in the hospital, which in turn increases the risk for potential DDIs [5] International Normalized ratio (INR value) Increase in international normalized ratio value was found to be strongly associated with DDI and hence the risk of bleeding [32] Footnote: Ten studies did not report the mechanisms of drug-drug interaction Forest plot depicting the pooled prevalence of moderate potential DDIs of 14 studies in Ethiopian Hospitals Figure 5 Forest plot depicting the pooled prevalence of minor potential DDIs of 14 studies in Ethiopian Hospitals Figure 6 Subgroup analysis of the prevalence of potential DDIs based on region…”

“…Different studies were also supported as polypharmacy and comorbid disease increases the likelihood of the occurrence of potential DDIs [15,33,42,43]. In the review, taking ve or more medications was an important factor that leads to potential DDIs [5,29,30,31,33,34]. This may be due to the probability of taking interacting drugs is increased.…”

“…Because this type of patient requires multiple types of drugs, their kidney and liver may decrease the excretion and metabolize the ability of medications. Therefore, the occurrence of DDIs in this type of patient may be signi cant [5,6,7,11,12].…”

“…There are different factors for the occurrence of potential DDIs. The age of the patient, common disease state and polypharmacy; pharmacokinetic and pharmacodynamic nature of drugs; the in uence of disease on drug metabolism; prescriber issues such as multiple drug prescription by multiple prescribers, inadequate knowledge of prescribers' on DDIs or poor recognition of the relevance of DDIs by prescribers are among the risk factors signi cantly associated with the occurrence of potential DDIs [5,[6][7][8][9][10].…”