Rashida MUHAMMAD UMAR, Zeynep Yeşim CAN, Ece GÜVEN, Emine KARATAŞ KOÇBERBER, Omer Fatih OLMEZ

The Prevalence of Drug-Drug Interactions and Reported Therapy Related Side Effects in Oncology Out-Patients

Objective: The use of multiple medications in cancer patients is unavoidable; thus, adverse drug-drug interactions are frequent. This study aims to assess the prevalence of potential drug interactions in oncology patients visiting the outpatient chemotherapy unit. Method: Demographic and health-related information of patients visiting an outpatient chemotherapy unit was recorded using a pre-prepared form. A comprehensive list of all concurrently used medications was compiled and checked for interactions with the Micromedex online drug interaction tool. Results: A total of 179 adult patients were included. We recorded an average of 9.3 drugs per patient with 79 patients using more than 10 drugs. A total of 1671 drugs including 303 chemotherapeutic agents were assessed for drug-drug interactions. A total of 374 interactions, of which 203 were significant, were recorded in 118 (65.9%) patients with an average of 3.2 interactions per patient. Only 46 major interactions were recorded for anticancer agents. Cyclophosphamide (n=13) and cisplatin (n=12) were involved in most interactions. The number of interactions correlated with the number of drugs used (p=.001) and the presence of comorbidities (p=.002). The presence of comorbidities increased the risk of interaction by 1.21 (p=.04). Recorded side effects were not correlated to drug interactions. Conclusion: Medication review in cancer patients is essential in establishing all medications used by patients. Routine assessment in terms of potential drug interactions and evaluation of these interactions by a qualified pharmacist may help in optimizing patient outcomes.

Keywords:

Cancer patients, Antineoplastic agents, Drug-drug interaction, Side effects, Polypharmacy.,

PDF

___

Umar RM, Apikoglu-Rabus S, Yumuk PF. Significance of a clinical pharmacist-led comprehensive medication management program for hospitalized oncology patients. Int J Clin Pharm [Internet]. 2020;42(2):652–61. Available from: https://doi.org/10.1007/s11096-020-00992-8
Delpeuch A, Leveque D, Gourieux B, Herbrecht R. Impact of clinical pharmacy services in a hematology/oncology inpatient setting. Anticancer Res. 2015;35(1):457–60.
Thanacoody R. Drug interactions. Whittlesea C, Hodson K, editors. Clinical Pharmacy and Therapeutics. China: Elsevier; 2019.p53-65.
Wiffen P, Mitchell M, Snelling M SN. Oxford Handbook of Clinical Pharmacy. 2012.
Wf Van Leeuwen R, Swart EL, Boom FA, Schuitenmaker MS HJ. Potential drug interactions and duplicate prescriptions among ambulatory cancer patients: a prevalence study using an advanced screening method. 2010;
Lopez-Martin C, Garrido Siles M, Alcaide-Garcia J FF V. Role of clinical pharmacists to prevent drug interactions in cancer outpatients: a single-centre experience. 2014;
Conde-Estévez D. Targeted cancer therapy: interactions with other medicines. Clin Transl Oncol. 2017;19(1):21-30.
Ismail M, Khan S, Khan F, Noor S, Sajid H, Yar S, et al. Prevalence and significance of potential drug-drug interactions among cancer patients receiving chemotherapy. BMC Cancer. 2020;20(1):1–9.
Umar RM. Drug-drug interactions between antiemetics used in cancer patients. J Oncol Sci [Internet]. 2018; Available from: https://linkinghub.elsevier.com/retrieve/pii/S2452336418300141
Leveque D, Delpeuch A, Gourieux B. New anticancer agents: Role of clinical pharmacy services. Anticancer Res. 2014;34(4):1573–8.
Popa MA, Wallace KJ, Brunello A, Extermann M, Balducci L. Potential drug interactions and chemotoxicity in older patients with cancer receiving chemotherapy. J Geriatr Oncol [Internet]. 2014;5(3):307–14. Available from: http://dx.doi.org/10.1016/j.jgo.2014.04.002
Han JM, Ah YM, Suh SY, Jung SH, Hahn HJ, Im SA, et al. Clinical and economic impact of pharmacists’ intervention in a large volume chemotherapy preparation unit. Int J Clin Pharm. 2016;38(5):1124–32.
Chaudhari SJ. Methodology for Gender Identification , Classification and Recognition of Human Age. Int J Comput Appl [Internet]. 2015;(Ncac):5–10. Available from: https://research.ijcaonline.org/ncac2015/number2/ncac175023.pdf LK - https://academic.microsoft.com/paper/2375104003
Bayraktar-Ekincioglu A, Demirkan K, Keskin B, Aslantas O, Ozdemir E. Potential drug interactions and side effects in an outpatient oncology clinic: A retrospective descriptive study. Eur J Hosp Pharm. 2014;21(4):216–21.
Holweger K, Bokemeyer C, Lipp HP. Accurate measurement of individual glomerular filtration rate in cancer patients: An ongoing challenge. J Cancer Res Clin Oncol. 2005;131(9):559–67.
Vayalil RK, Shetty KJ, Mateti UV. Assessment of potential drug-drug interactions in an oncology unit of a tertiary care teaching hospital. Indian J Med Paediatr Oncol. 2018;39(4):436–42.
Rashdan S, Yang H, Le T, Selby C, Gerber DE, Alvarez CA. Prevalence and Significance of Potential Pharmacokinetic Drug–Drug Interactions Among Patients with Lung Cancer: Implications for Clinical Trials. Clin Drug Investig [Internet]. 2021;41(2):161–7. Available from: https://doi.org/10.1007/s40261-020-00994-4
Akbulut M, Urun Y. Onco-cardiology: Drug-drug interactions of antineoplastic and cardiovascular drugs. Crit Rev Oncol Hematol [Internet]. 2020;145(March 2019):102822. Available from: https://doi.org/10.1016/j.critrevonc.2019.102822
Ramos-Esquivel A, Víquez-Jaikel A, Fernández C. Potential drug-drug and herb-drug interactions in patients with cancer: A prospective study of medication surveillance. J Oncol Pract. 2017;13(7):e613–20.
Bibi R, Azhar S, Iqbal A, Jabeen H, Kalsoom UE, Iqbal MM, et al. Prevalence of potential drug-drug interactions in breast cancer patients and determination of their risk factors. J Oncol Pharm Pract. 2021;27(7):1616–22.
Alkan A, Yaşar A, Karcı E, Köksoy EB, Ürün M, Şenler FÇ, et al. Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients. Support Care Cancer. 2017;25(1):229–36.
Ramasubbu SK, Mahato SK, Agnihotri A, Pasricha RK, Nath UK, Das B. Prevalence, severity, and nature of risk factors associated with drug-drug interactions in geriatric patients receiving cancer chemotherapy: A prospective study in a tertiary care teaching hospital. Cancer Treat Res Commun [Internet]. 2021;26:100277. Available from: https://doi.org/10.1016/j.ctarc.2020.100277
Voll ML, Yap KD, Terpstra WE, Crul M. Potential drug-drug interactions between anti-cancer agents and community pharmacy dispensed drugs. Pharm World Sci. 2010;32(5):575–80.
Paul T, Palatty P, Adnan M, George T, Rao S, Baliga M. Audit of drug-drug interactions and adverse drug reactions due to polypharmacy in older cancer patients: First report from India. Indian J Cancer. 2020;57(4):405–10.
Lopez-Martin C, Garrido Siles M, Alcaide-Garcia J, Faus Felipe V. Role of clinical pharmacists to prevent drug interactions in cancer outpatients: a single-centre experience. Int J Clin Pharm. 2014;36(6):1251–9.
Vecchia S, Orlandi E, Confalonieri C, Damonti E, Riva A, Sartori A, et al. Prevalence study on potential drug–drug interaction in cancer patients in Piacenza hospital’s Onco-Haematology department. J Oncol Pharm Pract. 2018;24(7):490–3.
Mousavi M, Hayatshahi A, Sarayani A, Hadjibabaie M, Javadi M, Torkamandi H, et al. Impact of clinical pharmacist-based parenteral nutrition service for bone marrow transplantation patients: a randomized clinical trial. Support Care Cancer. 2013;21(12):3441–8.
Han JM, Ah YM, Suh SY, Jung SH, Hahn HJ, Im SA, et al. Clinical and economic impact of pharmacists’ intervention in a large volume chemotherapy preparation unit. Int J Clin Pharm. 2016;38(5):1124–32.