Yeşim KAYA YAŞAR, Seçkin ENGİN, Elif Nur BARUT, Serhat SEVGİ, Gamze EROĞLU, Feride Sena SEZEN

Evaluation of potential drug-drug interactions in hospitalized patients at a tertiary care hospital: A pilot study

Drug-drug interactions (DDIs) are termed as alteration of drug response with concurrent use of another drug. DDIs which are responsible from 20-30% of all adverse drug reactions lead to preventable morbidity and mortality, prolonged hospital stay and higher financial burden. The aim of this retrospective study was evaluation of prevalence and severity of potential DDIs in inpatient settings. We conducted this study between February-April 2019 in inpatient services of Farabi Hospital of Karadeniz Technical University. Data which consist of patient demographic features and drugs used by patients were obtained from patient files and case sheets. In this study, 25 patients (68% female; 32% male) were included; the mean age of the subjects was 63.32 ± 15.72 years. The drugs were analyzed for the potential DDIs using Lexi-Interact™ Online which is available on the www.uptodate.com. According to our results the prevalence of potential DDIs which involve alimentary tract and metabolism drugs (n=69, 27.4%) followed by cardiovascular system drugs (n =43; 17.06 %) were common among the drugs. The average number of drugs received in the units were similar. The total number of pDDIs determined as 204, and the mean number of pDDIs per patient was 8.16±6.4 in the units. It is identified that among the total drug interactions 76.5% in the risk category C (monitor therapy), 15.2% in the risk category B (no action needed), and 4.4% in the risk category D (consider therapy modification). The highest total number of pDDIs were identified in the patients of chest diseases unit. Furosemide (n=24, 11.8%) followed by salbutamol (n=21, 10.3%) and the furosemide-budesonide (n=5, 2.5%) combination were the most prevalent drugs which involved in pDDIs. These results indicate the importance of critical evaluation of the patient’s medication order in the hospital and the urgency of developing strategies to improve drug safety.

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1. Juurlink D, Mamdani M, Kopp A, et al. Drug–drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652-8.

2. McDonnell P, Jacobs M. Hospital admissions resulting from preventable adverse drug reactions. Ann. Pharmacother. 2002;36:1331-6.

3. Aparasu R, Baer R, Aparasu A. Clinically important potential drug–drug interactions in outpatient settings. Res Social Adm Pharm. 2007;3:426-37.

4. Kinney E. Expert system detection of drug interactions: results in consecutive inpatients. Computers and Biomedical Research. 1986;19:462-7.

5. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2013. Oslo, 2012.

6. (URL-1) Lexi-Interact™ online, http://www.uptodate.com/crlsql/interact/ frameset.jsp.

7. Glintborg B, Andersen S, Dalhoff K. Drug-drug interactions among recently hospitalised patients: Frequent but mostly clinically insignificant. Eur J Clin Pharmacol. 2005;61:675-81.

8. Barot P, Malhotra S, Patel V. Evaluation of potential drug-drug interactions in patients of emergency medicine department at a tertiary care teaching hospital: a prospective study. IJSS. 2015;3:48-53.

9. Herr R, Caravati E, Tyler L, et al. Prospective evaluation of adverse drug interactions in the emergency department. Ann Emerg Med. 1992;21:1331-6.

10. Mousavi S, Ghanbari G. Potential drug-drug interactions among hospitalized patients in a developing country. Caspian J Intern Med. 2017;8:282-8.

11. Zwart-van Rijkom J, Uijtendaal E, ten Berg M, et al. Frequency and nature of drug-drug interactions in a Dutch university hospital. Br J Clin Pharmacol. 2009;68:187-93.

12. George A, Ramesh M, Sebastian J. Adverse drug interactions in elderly hospitalized patients: a prospective analysis. Int J Pharm Sci. 2018;9:1913-20.

13. Cruciol-Souza J, Thomson J. Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9:427-33.

14. Zheng W, Richardson L, Day R, et al. Drug-drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2018;74:15-27.

15. Obreli Neto P, Nobili A, de Lyra Júnior D, et al. Incidence and Predictors of Adverse Drug Reactions Caused by Drug-Drug Interactions in Elderly Outpatients: A Prospective Cohort Study. J Pharm Pharm Sci. 2012;15:332- 43.

16. Ahmad A, Khan M, Haque I, et.al. Evaluation of potential drug-drug interactions in general medicine ward of teaching hospital in southern India. J Clin Diagn Res. 2015;9:FC10-3.

17. Pardo‑Cabello A, Manzano‑Gamero V, Del Pozo E, et al. Potential drug–drug interactions in deceased inpatients. Intern Emerg Med. 2019;14:325-8.

18. Geerts A, De Koning F, De Smet P, Laboratory Tests in the Clinical Risk Management of Potential Drug-Drug Interactions. Drug Saf. 2009;32:1189-97.

19. de Godoi C, Molino R, Carnelvale R, et al. Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection. Ther Clin Risk Manag. 2014;10:631-9.

20. Leape L, Cullen D, Clapp M, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282:267-70

21. Bond C, Raehl C, Franke T. Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals. Pharmacotherapy. 2002; 22:134-47

22. Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet 2002;359:1373-8.

23. Wiltink E. Medication control in hospitals: a practical approach to the problem of drug–drug interactions. Pharm World Sci 1998;20:173-7.

24. Chan A. Pharmacist intervention when interacting drugs are prescribed despite alerts. Am J Health Syst Pharm. 2005;62:1760-63.