Risk management strategy for preventing the reduced treatment effectiveness from the position of drug interactions and polypharmacy in patients with coronary heart disease

Abstract

Introduction: In modern clinical practice, various drug combinations are widely used, especially in cardiological patients. The existing clinical recommendations necessitate using organ protective agents, especially with a patient having a comorbid pathology and with an ineffective monotherapy. In some cases, drug interaction decreases the effectiveness of pharmacotherapy and increases the risk of developing adverse events (AE). The purpose of the study was to analyze the modern pharmacotherapy of patients with coronary heart disease (CHD), identify polypharmacy of treatment, evaluate its significance for the treatment process, and determine ways to solve the problem of using a multi-component system of pharmacotherapy risk management. Materials and methods: The study involved 156 patients with CHD, among whom 39 received more than 8 drugs at a time. Results and discussion: In these patients, the evaluation of drug interactions revealed 580 variants (48 were dangerous, 428 – significant, 104 – insignificant). The administration of a therapy to comorbid patients, taking into account possible changes in the activity of cytochrome P450 isoenzymes, is one of the promising ways to improve the safety of a combined pharmacotherapy. Conclusion: It was revealed that with a mutated cytochrome P450 most of processes of drug biotransformation occurs. And there is a greater risk of developing AE against the background of polypragmasia in polymorbid patients, which makes it possible to individually adjust the dose of beta-blockers, thus affecting the frequency of their development. The choice of management measures should be determined considering all the areas of personalized medicine, including pharmacogenetic predictors, pharmacoepidemiological data, pharmacoeconomic effectiveness, the development of adverse reactions, polypragmasia, and medical and social risk factors.

Personalized trimetazidine prescription as a cytoprotective agent in patients with coronary artery disease

“…КЛИНИКА И ФАРМАКОТЕРАПИЯ Персонализированный подход к выбору лекарственных препаратов в лечении пациентов с ишемической болезнью сердца (ИБС) обозначен экс-президентом Европейского общества кардиологов Roberto Ferrary как "бриллиантовый" [1]. Широкая распространённость и высокая смертность от ИБС нацеливают на поиск рациональных комбинаций лекарственных средств при лечении больных [2][3][4]. Принятые стандарты лечения стенокардии напряжения препаратами из групп антиагрегантов, антикоагулянтов, бета-адреноблокаторов, статинов, ингибиторов ангиотензинпревращающего фермента, нитратов, антагонистов кальция имеют высокий уровень доказательности, однако не обеспечивают в полной мере эффективности лечения [5].…”