Prevalence and clinical significance of potential drug–drug interaction in hematopoietic stem cell transplantation

Abstract

Patients undergoing hematopoietic stem cell transplantation (HSCT) are at risk of developing potential drug-drug interactions (PDDIs). The aim of this study was to assess the prevalence of PDDIs that occur in HSCT patients on the day of hematopoietic stem cell infusion. We performed a cross-sectional study based on the evaluation of prescriptions to HSCT patients on the day of infusion (day 0). The PDDIs were analyzed using the DRUG-REAX(®) system and classified according to the severity level, available scientific evidence, time of onset, and potential clinical impact. Forty patients undergoing HSCT were included in this study; 33 patients (82.5%) were exposed to at least one major and one contraindicated PDDI in a concomitant manner. All patients exposed to PDDIs had an increased risk of cardiotoxicity. Most cases of PDDIs were classified as being of major severity (80.9%), with time of onset not specified (61.9%), and with good or excellent scientific evidence (52.4%). HSCT patients have a high prevalence of clinically significant PDDIs. The management of PDDIs requires an approach that includes biochemical tests, installation of cardiac monitors, periodic electrocardiograms, implementation of electronic prescriptions with a PDDI alert system, and availability of the PDDI databases.

Carga de trabalho de enfermagem em transplante de células-tronco hematopoiéticas: estudo de coorte

“…In agreement with a study that shows the complexity of drug therapy in HSCT (20) , the activity related to medication was scored by the entire sample. In these patients, drugs are administered almost exclusively intravenously (IV) and, in a IV line replacement a nurse may spend, on average, 11.95 minutes (21) .…”

Clarifying busulfan metabolism and drug interactions to support new therapeutic drug monitoring strategies: a comprehensive review

“…Multiple drug therapy is common in today’s oncology medical practice, increasing the risk of single and/or multiplex drug-drug interactions (DDIs) – that often lead to adverse drug toxicities and unanticipated treatment outcomes [13]. HSCT patients are commonly subjected to poly-pharmacy, taking on average at least 8 or more drugs on admission, and they are exposed for lengthy periods of time to complex drug regimens consisting of multiple pharmacological classes, many of which interact with each other [13–15].…”

“…HSCT patients are commonly subjected to poly-pharmacy, taking on average at least 8 or more drugs on admission, and they are exposed for lengthy periods of time to complex drug regimens consisting of multiple pharmacological classes, many of which interact with each other [13–15]. In HSCT patients, the signs/symptoms of a DDI may go undetected in the pre-HSCT phase and/or be dismissed as a symptom of the primary tumor, but may appear during later periods following the transplant [15].…”

Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil

“…Polypharmacy is a factor which is well documented in the literature as a factor associated with PDDI, independent of the disease investigated, country or place of care, and health treatment [8,9,[12][13][14][15][16][17][18]. The polypharmacy recorded in this study is expected for this population, given that these individuals present an increased risk for cardiovascular diseases, such as SAH, dyslipidemias, and abnormalities related to coagulation.…”

“…Studies in different scenarios have indicated negative outcomes related to DDI, which can result in adverse events, a reduction or increase in the medications' therapeutic effects, an increase in the toxicity of medications, an increase in the health services' costs, failure of the treatment, and/or serious complications for the patient, including the risk of death [8,9,[12][13][14][15][16][17][18].…”