Potential drug-drug interactions in outpatient department of a tertiary care hospital in Pakistan: a cross-sectional study

Abstract

BackgroundPotential drug–drug interactions (pDDIs) are one of the preventable drug related problems having the risk of serious adverse events or therapeutic failure. In developing countries like Pakistan, this issue remains poorly addressed. The objective of this study was to explore prevalence of pDDIs in the Outpatient Department (OPD) of a tertiary care hospital in Pakistan. The secondary aim was to describe the levels of reported pDDIs and develop a list of widespread clinically relevant interactions.MethodsPrescriptions of 2400 OPD patients were analyzed for pDDIs through Micromedex Drug-Reax®. Prevalence, severity- and documentation-levels and widespread clinically relevant interactions were reported.ResultsOf total 2400 prescriptions, pDDIs were present in 22.3%. Whereas, moderate- and major-pDDIs were found in 377 (15.7%) and 225 (9.4%), respectively. PDDIs were more prevalent in Medicine (9.2%) and Cardiology (2.6%) as compared with other OPD specialties. Total 942 pDDIs were identified, of which, the majority were either moderate- (61.9%) or major-pDDIs (32.1%). Some of the most common interactions were ibuprofen + levofloxacin (n = 50), ciprofloxacin + diclofenac (32), aspirin + atenolol (24), and diclofenac + levofloxacin (19). The potential adverse outcomes of widespread interactions were seizures, bleeding, QT-interval prolongation, arrhythmias, tendon rupture, hypoglycemia/hyperglycemia, serotonin syndrome, drug toxicity, and decreased therapeutic response.ConclusionsOPD patients were at risk to pDDIs, particularly to major- and moderate-pDDIs. Screening of prescriptions for pDDIs and monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3579-7) contains supplementary material, which is available to authorized users.

Prevalence of potential drug–drug interactions in outpatients of a general hospital in China: a retrospective investigation

“…Enhanced central nervous system suppression function was the most frequent clinical consequences of the identified pDDIs. However, the previous study found that the most common interactions in outpatient department were ibuprofen + levofloxacin, ciprofloxacin + diclofenac, aspirin + atenolol, and diclofenac + levofloxacin with the potential adverse outcomes such as seizures, bleeding, QT-interval prolongation, arrhythmias, tendon rupture, hypoglycemia/hyperglycemia and so on [14]. This inconsistency may be attributed to DDIs screening system and different drugs prescribing pattern.…”

“…As shown in Table 4, the majority of pDDIs with category X were related to thalidomide with the potential clinical consequence of enhanced central nervous system suppression function through the mechanism of reinforced pharmacological effects. The most frequent interaction found in [14]. Janja Jazbar et al conducted a retrospective nationwide study in Slovenia and reported 24.1% of the population was exposed to pDDIs with 9.3% D or X risk rating [18].…”

“…DDIs are highly prevalent not only in outpatients but also in hospitalized patients especially in ICU [6,7], oncology [8][9][10] and hematology [11,12]. The prevalence of pDDIs varies from 16% to 96% in different studies [13][14][15][16]. Given the lack of investigation on the epidemiology of DDIs in the outpatients of Jinshan Hospital, Fudan University, the present study aimed to gain insight into the real-world prevalence of pDDIs in outpatient prescriptions and classify the severity of the interactions.…”

CLINICAL PHARMACOLOGY OF FLOROCHINOLONS: A FOCUS ON SAFETY. Review

“…Ïðè öüîìó ïîì³ðí³ òà òÿaeê³ ïîá³÷í³ ðåàêö³¿ â³äì³÷àëèñü ó 15,7% òà 9,4%, â³äïîâ³äíî. Ñåðåä íàéá³ëüø ÷àñòèõ íåáåçïå÷íèõ âçàºìîä³é ë³êàðñüêèõ çàñîá³â: ëåâîôëîêñàöèí + ³áóïðîôåí, öèïðîôëîêñàöèí + äèêëîôåíàê, ëåâîôëîêñàöèí + äèêëîôåíàê, ÿê³ â³äì³÷àëèñü â³äïîâ³äíî ó 50, 32 òà 19 âèïàäêàõ [24]. Äîâåäåíî, ùî âèêîðèñòàííÿ íåñòåðî¿äíèõ ïðîòèçàïàëüíèõ ë³êàðñüêèõ çàñîá³â (ÍÏËÇ) â êîìá³-íàö³¿ ç âèñîêèìè äîçàìè ôòîðõ³íîëîí³â ìîaeå âèêëèêàòè ñóäîìè [40].…”

Factors associated to potential drug interactions in one Intensive Care Unit: a cross-sectional study

“…ADE accounts for approximately 5% of hospitalizations, of which 0.25 to 25% are due to drug interactions. 5 Although often unidentified, the interactions are vertiginously present, especially in the hospital reality. In a multicenter study, it was observed that in the first 24 hours of hospitalization in Intensive Care Units, 70.6% of the patients presented at least one drug interaction.…”