Potentially Harmful Drug–Drug Interactions and Their Associated Factors Among Hospitalized Cardiac Patients: A Cross-Sectional Study

Abstract

Background Cardiovascular diseases are responsible for a significant proportion of mortalities worldwide. Elderly patients are the most affected by cardiovascular diseases, and because of factors such as polypharmacy, multimorbidity, and age-related changes in drug availability and metabolism, they are highly susceptible to the occurrence of drug–drug interactions. Drug–drug interactions are among the many drug-related problems leading to negative outcomes among inpatients and outpatients. Thus, it is important to investigate the prevalence, involved drugs, and factors related to potential drug–drug interactions (pDDIs) to properly optimize pharmacotherapy regimens for these patients. Objective We aimed to determine the prevalence of pDDIs, drugs most frequently implicated, and significant predictors associated with these interactions among hospitalized patients in the Cardiology Unit at Sultan Qaboos University Hospital in Muscat, Oman. Methods This retrospective cross-sectional study included 215 patients. Micromedex Drug-Reax ® was used to identify pDDIs. Data extracted from patients’ medical records were collected and analyzed. Univariable and multivariable linear regression was applied to determine the predictors associated with the observed pDDIs. Results A total of 2057 pDDIs were identified, with a median of nine (5–12) pDDIs per patient. Patients with at least one pDDI accounted for 97.2% of all the included patients. The majority of pDDIs were of major severity (52.6%), fair level of documentation (45.5%), and pharmacodynamic basis (55.9%). Potential drug–drug interactions between atorvastatin and clopidogrel were the most frequently observed (9%). Of all the detected pDDIs, around 79.6% of them included at least one antiplatelet drug. Having diabetes mellitus as a comorbidity ( B = 2.564, p < 0.001) and the number of drugs taken during the hospitalization period ( B = 0.562, p < 0.001) were factors positively associated with the frequency of pDDIs. Conclusions Potential drug–drug interactions were highly prevalent among hospitalized cardiac patients at Sultan Qaboos University Hospital, Muscat, Oman. Patients having diabetes as a comorbidity and with a high number of administered drugs were at a higher risk of an increased number of pDDIs.

Drug Dispensation by ‘Signature Pharmacists’ in South Asia

“…Pharmacist assistants likely have a more limited understanding of various potential drug–drug interactions (pDDIs) and drug–drug interactions (DDIs) compared to registered pharmacists. Kalash et al (2023) define pDDIs as the simultaneous prescription of two drugs recognised to have interactions, while DDIs are ‘a clinically meaningful alteration in the exposure and/or response to a drug that has occurred as a result of the co-administration of another drug’ (Kalash et al, 2023: 372). Since pDDIs and DDIs are often complex, involving variables and interactions that can be challenging even for seasoned doctors and pharmacists (Mavlankar, 1988: 7–8), the risk of complex and potentially life-threatening interactions is obvious (Herxheimer, 1975).…”