Prevalence and Risk of Potential Cytochrome P450–Mediated Drug-Drug Interactions in Older Hospitalized Patients with Polypharmacy

Doan, Julie; Zakrzewski-Jakubiak, Hubert; Roy, Julie; Turgeon, Jacques; Tannenbaum, Cara

doi:10.1345/aph.1r621

Cited by 158 publications

(147 citation statements)

References 21 publications

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“…This may be due to the nature of our study population, including very elderly patients with high multimorbidity and polypharmacy. Similar to our results, Doan et al33 showed that the prevalence of potential cytochrome P450-mediated drug interactions was 80% in elderly patients with polypharmacy. Although a high number of potential significant drug interactions were detected by the Micromedex database, in the LTCH most interactions were considered of minor clinical importance by the interdisciplinary team or risk-benefit analyses were justified by the clinical characteristics of these patients.…”

Section: Discussionsupporting

confidence: 92%

Improvement on prescribing appropriateness after implementing an interdisciplinary pharmacotherapy quality programme in a long-term care hospital

2018

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ObjectivesTo determine the prevalence of inappropriate prescribing in elderly patients with polypharmacy admitted to a long-term care hospital (LTCH) and to evaluate the impact of an interdisciplinary pharmacotherapy quality programme on improvement of prescribing appropriateness.MethodsAn interventional, longitudinal, prospective study was conducted in a Spanish LTCH (October 2013 to July 2014) including 162 elderly (≥70 years) patients with polypharmacy (≥5 medications). Pharmacists conducted the pharmacotherapy follow-up of patients with medication reconciliation, pharmacotherapeutic optimisation and educational interviews from admission to discharge. Reconciliation errors, potentially inappropriate medications (PIMs), potentially prescribing omissions (PPOs) and significant drug interactions rates were calculated. The impact of the programme was evaluated considering the difference between the inappropriateness score per patient (total number of reconciliation errors, PIMs, PPOs and significant drug interactions) before and after implementing pharmacotherapy recommendations.ResultsAt admission, 163 reconciliation errors (median(range), 1(1-6)) in 92 (56.8%) patients (65.6% drug omissions), 335 PIMs (2(1-6)) in 147 (90.7%) patients (39.3% use ≥2 anticholinergic drugs), 43 PPOs (1(1-3)) in 32 (19.8%) patients (48.5% statin omission) and 594 significant drug interactions (4(1-19)) in 130 (80.2%) patients were detected. After implementing pharmacotherapy recommendations, statistically significant reductions in admission reconciliation errors (8.3% to 0.1%), PIMs (17.0% to 12.2%), PPOs (2.2% to 0.7%) and significant drug interactions (30.2% to 26.8%) rates were found. The programme achieved a 31% improvement in prescribing appropriateness, with a statistically significant reduction in the inappropriateness score (6(IQR:4–9) to 4(IQR:2–7)).ConclusionReconciliation errors, PIMs and drug interactions are highly prevalent in elderly patients with polypharmacy admitted to an LTCH. This interdisciplinary pharmacotherapy quality programme seems to be a useful approach in the improvement of prescribing appropriateness in a high-risk older population.

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Section: Discussionsupporting

confidence: 92%

Improvement on prescribing appropriateness after implementing an interdisciplinary pharmacotherapy quality programme in a long-term care hospital

2018

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“…Multiple studies have shown that polypharmacy increases the number of adverse drug events, 72,73 including severe hypoglycemia, 63,74 drug-drug interactions, 75,76 interactions with coexisting comorbidities, 77 and patient costs. 78 In addition, the higher the number of medications, the less likely the patient will remain adherent with the treatment regimen.…”

Section: Resultsmentioning

confidence: 99%

Polypharmacy in the Aging Patient

Lipska

Krumholz

Soones

et al. 2016

JAMA

258

111

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IMPORTANCE-There is substantial uncertainty about optimal glycemic control in older adults with type 2 diabetes mellitus.OBSERVATIONS-Four large randomized clinical trials (RCTs), ranging in size from 1791 to 11440 patients, provide the majority of the evidence used to guide diabetes therapy. Most RCTs of intensive vs standard glycemic control excluded adults older than 80 years, used surrogate end points to evaluate microvascular outcomes and provided limited data on which subgroups are most likely to benefit or be harmed by specific therapies. Available data from randomized clinical trials

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“…More the medications that are prescribed, the more the possibility of irrational polypharmacy. A study conducted by Doan et al determined the probability of potent cytochrome P450 (CYP 450) interactions in older hospitalized people taking more than five concurrent medicines [14]. Potential drug-drug interactions were present in 80% of people taking more than five concurrent medicines.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Potential Drug Interactions Among Hospitalized Patients at the Cardiac and Pulmonary Departments in Tertiary Care Hospitals

Ramalingam

Rajagopal²,

Kandasamy

et al. 2018

Asian J Pharm Clin Res

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Objective: The aim of this study was to assess the potential drug interactions among hospitalized patients in cardiac and pulmonary wards in three tertiary care hospitals. Methods:A prospective, observational study was carried out for 12 months. A sample of 1150 patients were assessed for potential drug-drug interactions (pDDIs) using Micromedex ® -2.7 and Drugs.com. Results:A total of 1150 patients were analyzed, and it was found that 685 were cardiac and 465 were pulmonary patients. The study identified 524 (76.49%) cardiac patients and 345 (74.19%) pulmonary patients, with pDDIs higher in male cardiac (298 [56.87%]) and male pulmonary (199 [57.68%]) patients, compared to females. Incidences of pDDIs were found to be higher in the age group of 60-70 years in cardiac (193 [36.83%]) and pulmonary (146 [42.31%]) patients and incidences of interactions based on duration of 4-6 days' hospital stays in cardiac were 380 (72.53%) and 215 (62.31%) in pulmonary patients, respectively. Moreover, 51.90% of cardiac patients and 56.52% of pulmonary patients were found to be prescribed with more number of drugs (cardiac 7 drugs and pulmonary 5-6 drugs) causing higher incidences of pDDIs. Some of the most common drug interacting pair was aspirin and clopidogrel combination observed in 245 cardiac patients, whereas in the pulmonary department, it was ranitidine-theophylline combination with a frequency of 195 pDDIs. Drug-food interactions were found with atorvastatin-citrus fruits in cardiac and theophylline-caffeine in pulmonary patients. The most common drug-disease interaction was found to be isosorbide dinitrate-myocardial infarction in cardiac and diazepam-COPD in pulmonary, respectively. Conclusion:Pharmacists must take responsibility in the monitoring of drug interactions and notifying the physician and patient about potential problems. With their detailed knowledge of drugs, pharmacists have the ability to relate unexpected symptoms experienced by patients to possible adverse effects of their drug therapy.

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Prevalence and Risk of Potential Cytochrome P450–Mediated Drug-Drug Interactions in Older Hospitalized Patients with Polypharmacy

Cited by 158 publications

References 21 publications

Improvement on prescribing appropriateness after implementing an interdisciplinary pharmacotherapy quality programme in a long-term care hospital

Improvement on prescribing appropriateness after implementing an interdisciplinary pharmacotherapy quality programme in a long-term care hospital

Polypharmacy in the Aging Patient

Assessment of Potential Drug Interactions Among Hospitalized Patients at the Cardiac and Pulmonary Departments in Tertiary Care Hospitals

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