Utilization review of concomitant use of potentially interacting drugs in Thai patients using warfarin therapy

Kotirum, Surachai; Chaiyakunapruk, Nathorn; Jampachaisri, Katechan; Wattanasombat, Supharat; Rojnuckarin, Ponlapat

doi:10.1002/pds.1300

Cited by 29 publications

(31 citation statements)

References 12 publications

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“…This finding is consistent with study by Kotirum, et al [20] and other studies from different parts of the world [9,21,26,29-33]. Understanding the severity of the drug interaction is important for practitioners because major type of interaction is more likely to produce negative outcomes which include either ineffectiveness or over anticoagulation and bleeding risk.…”

Section: Discussionsupporting

confidence: 91%

“…Parallel to this study, an interventional study on recognition and management of drug – drug interactions in inpatients at the Cantonal Hospital of Baden, found 567 DDIs in 502 inpatients, of which 419 (74%) were judged to be clinically relevant [19]. Likewise, the prevalence of DDIs in outpatients was reported as high as 84% [20,21]. Higher prevalence of DDIs is expected from inpatients as compared to outpatients as more intensive management protocols are required to manage inpatients.…”

Section: Discussionmentioning

confidence: 82%

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Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

et al. 2014

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BackgroundWarfarin is known for its interaction with many drugs, resulting in undesired treatment outcomes such as bleeding. The study aimed to assess the prevalence of drug-drug interactions and determinants of bleeding among inpatients on warfarin therapy.MethodsA cohort of inpatients on warfarin treatment was prospectively followed from date of admission until discharge. The study was carried out from January to October 2013 in Ayder Referral Hospital, Northern Ethiopia. Patients on warfarin therapy during the study period and willing to participate were included as study subjects. Each concurrent medication was collected and checked for drug-drug interactions using Micromedex® online drug reference. Data were analyzed using statistical software, SPSS for windows version 16. The relationship between bleeding complications and independent variables (age, sex, residence, type and number of co-medications, dose and duration of warfarin treatment, INR value) was assessed using binary logistic regression analysis (Odds ratio, 95% confidence interval).ResultsOf the total 133 patients enrolled in the study, 78 (58.9%) were females. The mean age of the study participants was 40.81 ± 17.6 years. The prevalence of drug-drug interactions was 99.2%. Among these, 65 (49.2%) patients had at least one major while the others had moderate level of drug-drug interaction. Twenty two (16.5%) patients have developed bleeding complications. Increase in international normalized ratio value was found to be strongly associated with risk of bleeding (P value = 0.00; OR = 0.03 (0.00-0.46)).ConclusionDrug-drug interactions with warfarin were prevalent in the study hospital. Bleeding complications due to warfarin were also high. Thus, clinicians should be aware of potential interactions and monitor patients’ international normalized ratio closely.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

et al. 2014

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“…As polypharmacy is more common nowadays, other medications coadministered with warfarin can become more problematic in maintaining a stable INR in warfarin users (Greenblatt and von Moltke 2005). According to one research, 84% of the patients on warfarin were found to be also taking the medicines that can affect the INR (Kotirum et al 2007). Therefore a more detailed evaluation and sufficient information for drug interaction with warfarin are required for all drugs available in the market.…”

Section: Discussionmentioning

confidence: 99%

The Potential Inhibitory Effect of Revaprazan, an Acid Pump Antagonist, on Anticoagulation with Warfarin

Jung

Kang

Kwon

et al. 2011

Tohoku J. Exp. Med.

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Revaprazan is the first acid pump antagonist with a function similar to that of proton pump inhibitors (PPIs). It has a dual action, active suppression of gastric acid secretion and gastric mucosa protection. While PPIs are known to enhance the prolongation of prothrombin time by warfarin, no research has been done on the drug interaction between revaprazan and warfarin. This study was conducted in order to verify the potential drug interaction between revaprazan and warfarin. Omeprazole, a representative PPI, was used as the control for revaprazan. We searched for patients who were given either revaprazan or omeprazole along with warfarin using the medical record database of Seoul National University Hospital between July 2007 and June 2010. Among the 15 patients who took revaprazan and warfarin together, 73.3% (11/15) showed more than 30% reduction of anticoagulation effect by warfarin after revaprazan was added. The revaprazan group showed a significant shortening of prothrombin time during revaprazan administration compared to pre-and post-revaprazan medication (P < 0.05) while the omeprazole group did not show such difference. Revaprazan seems to have cumulative dose-dependent anti-warfarin or anti-coagulation effect, as judged from the fact that the longer medication with revaprazan showed correlation with the shortening of prothrombin time (R = −0.632, P < 0.05). This study shows a possible interaction between revaprazan and warfarin and suggests that revaprazan can cause shortening of prothrombin time. Therefore, when revaprazan is prescribed to patients on warfarin therapy, prothrombin time should be frequently monitored.

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“…Studies from different countries have been published reporting a pronounced increase in polypharmacy as patients age, which highlights the need for prescribers and pharmacists to be aware of drug interactions, particularly in elderly (Astrand et al, 2007;Johnell, Klarin, 2007;Kotirum S et al, 2007;Thijs et al, 2006). It has been estimated that patients taking two drugs face a 13% risk of drug interactions, rising to 38% when taking four drugs, and to 82% if seven or more drugs are given simultaneously (Goldberg et al, 1996).…”

Section: Discussionmentioning

confidence: 99%

Potential interactions of central nervous system drugs used in the elderly population

Morrone

Schroeter

Petitembert

et al. 2009

Braz. J. Pharm. Sci.

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Objective: To describe the use of CNS drugs and to identify the most frequently observed potential drug interactions in the elderly living in Southern Brazil. Methods: A population-based, transversal and observational study was carried out during [2006][2007]. Four hundred and eighty elderly individuals of both genders were randomly recruited and interviewed. A validated pharmacotherapeutic questionnaire and the Micromedex ® Healthcare Series were utilized to analyze potential drug interactions. A severity rating scale employing the categories of "mild", "moderate" and "severe" was used to describe the interactions. Results: A population of elderly living in Southern Brazil was interviewed and 98 reported using CNS drugs, 74.5% female and 25.5% male. Out of these patients, 32.0% reported severe or moderate pharmacological interactions related to the use of other drugs. Alprazolam and imipramine were reported to potentially interact with tobacco. Twenty potential moderate drug/ethanol interactions were found. The potential drug/caffeine interactions were classified as mild on the severity scale. Conclusion: Elderly being prescribed drugs that act on the CNS should be closely monitored, and furthermore, should be warned against potential drug-drug, drug-ethanol, and drug-tobacco interactions. Uniterms:Elderly. Drug-Drug interactions. Central nervous system. Tobacco. Ethanol.Objetivo: Descrever o uso de medicamentos que atuam no sistema nervoso central (SNC) e identificar as possíveis interações mais frequentes com esses medicamentos em idosos do sul do Brasil. Métodos: Estudo de base populacional, transversal e observacional, realizado durante [2006][2007]. Quatrocentos e oitenta idosos de ambos os sexos foram randomizados e entrevistados. Foram utilizados um questionário farmacoterapêutico validado e o programa Micromedex® Healthcare Series para analisar as potenciais interações com os medicamentos. Foi utilizada uma escala para descrever a gravidade das interações nas categorias de "leve", "moderada" e "grave". Resultados: A população idosa, moradora do sul do Brasil, que utilizava medicamentos para o SNC, era formada por 98 pacientes, 75,5% mulheres e 25,5% homens. Destes pacientes, 32,0% apresentaram interações farmacológicas graves ou moderadas relacionadas com a utilização de outros medicamentos. Alprazolam e Imipramina, usados pela população, apresentaram riscos de potenciais interações com tabaco. Foram encontradas vinte potenciais interações moderadas medicamento/etanol. As potenciais interações medicamento/cafeína foram classificadas como leves. Conclusão: Os pacientes idosos deveriam ser rigorosamente monitorizados, e ainda, é necessário advertir quanto às potenciais interações de medicamentos que atuam no SNC com outros medicamentos, etanol e tabaco. Unitermos:Idosos. Interações medicamento-medicamento. Sistema nervoso central. Tabaco. Etanol.

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Utilization review of concomitant use of potentially interacting drugs in Thai patients using warfarin therapy

Cited by 29 publications

References 12 publications

Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

The Potential Inhibitory Effect of Revaprazan, an Acid Pump Antagonist, on Anticoagulation with Warfarin

Potential interactions of central nervous system drugs used in the elderly population

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