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Drug utilization, prescription errors and potential drug-drug interactions: an experience in rural Sri Lanka

Drug utilization, prescription errors and potential drug-drug interactions: an experience in rural Sri Lanka

Consideration of pDDIs in a prescription not only helps to avoid or minimize them it also assists in moni- toring and warning the patient on pDDIs. Comparison of the findings of pDDIs was made with the study done in Ahmedabad, India in 2014 [34] again using the Meds- cape drug interaction checker (Additional file 2). The comparison shows similarity in distribution of severity of pDDIs and commonest pharmacodynamic pDDI (as- pirin-losartan). Percentage of prescriptions having pDDIs and mean pDDI per prescription was low in our study (53 % &1.6) compared to the Indian (83 % & 5.9). Maximum number of pDDI per prescription was 21 in our study compared to 33 in the Indian. The commonest pDDI was aspirin-losartan in our study and metoprolol- aspirin in the Indian [34]. The reasons for the dissimilar- ity may be due to the differences in the disease and prescribing pattern.
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Epidemiology of potential drug-drug interactions in elderly population admitted to critical care units of Peshawar, Pakistan

Epidemiology of potential drug-drug interactions in elderly population admitted to critical care units of Peshawar, Pakistan

Results: A total of 70.17% elderly patients were observed to have at least one PDDI. A significant association was observed between presence of PDDIs and number of prescribed drugs, duration of stay and age (p < 0.05). A total of 3019 PDDIs were observed, attributing to 225 drug pairs. Prevalent PDDIs were of moderate severity, good documentation and pharmacodynamic in nature. One-way ANOVA revealed a significant difference in the means of PDDIs between Northwest general hospital and the rest of the hospitals. Moreover, there was a significant difference in the means of PDDIs of CCU and SU with rest of the units.
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An Assessment of Potential Drug-Drug Interactions in
Hypertensive Patients in a Tertiary Care Hospital

An Assessment of Potential Drug-Drug Interactions in Hypertensive Patients in a Tertiary Care Hospital

Department of Pharmacy Practice 20 J.K.K. Nattraja College of Pharmacy Pankti S. Patel et al., (2014) 11 conducted a study on to evaluate prevalence, types, and severity of potential adverse drugdrug interaction in medicine out ‑ patient department. A single‑point, prospective, and observational study was carried out in medicine OPD. The study began after obtaining approval Institutional Ethics Committee. Data were collected and potential drugdrug interactions (pDDIs) were identified using Medscape drug interaction checker and were analyzed. A total of 350 prescriptions with a mean age of 52.45 ± 14.49 years were collected over a period of 5 months. A total of 2066 pDDIs were recorded with a mean of 5.90 ± 6.0. The prevalence of pDDI was 83.42%. Aspirin was the most frequently prescribed drug in 185 (10.15%) out of a total of 1821 drugs It was also the most frequent drug implicated in pDDI i.e. in 48.16%. The most common pDDI identified was metoprolol with aspirin in 126 (6.09%). Mechanism of interactions was pharmacokinetic in 553 (26.76%), pharmacodynamic in 1424 (68.92%) and 89 (4.30%) having an unknown mechanism. Out of all interactions, 76 (3.67%) were serious, 1516 (73.37%) significant, and 474 (22.94%) were minor interaction. Age of the patients (r = 0.327, P = 0.0001) and number of drugs prescribed (r = 0.714, P = 0.0001) are significantly correlated with drug interactions. Aspirin is the most common drug interacting. The use of electronic decision support tools, continuing education, and vigilance on the part of prescribers toward drug selection may decrease the problem of pDDIs.
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Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean

Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean

Abstract Background Potential DrugDrug Interactions (DDI) account for many emergency department visits. Polypharmacy, as well as herbal, over-the-counter (OTC) and combination medication may compound this, but these problems are not well researched in low-and-middle-in- come countries. Objective To compare the incidence of drugdrug interactions and polypharmacy in older and younger patients attending the Emergency Department (ED). Setting The adult ED of a tertiary teaching hospital in Trinidad. Methods A 4 month cross sectional study was conducted, comparing potential DDI in older and younger patients discharged from the ED, as defined using Micro- medex 2.0. Main outcome measure The incidence and severity of DDI and polypharmacy (defined as the use of C5 drugs simultaneously) in older and younger patients attending the ED. Results 649 patients were included; 275
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An analysis of potential drug-drug interactions in patients admitted in medicine wards of a tertiary care hospital

An analysis of potential drug-drug interactions in patients admitted in medicine wards of a tertiary care hospital

Drug- Drug Interactions (DDIs) are one of the most significant problems with drug prescribing. The present study was conducted to analyse potential DDIs in inpatients of medicine wards of a tertiary care hospital, based on severity, mechanisms etc. and to create awareness about the implications of such potential DDIs among treating physicians. Data from patient’s prescriptions admitted to the medicine department was collected over a period of 3 months and prescriptions were analysed for potential DDIs using medscape online drug interaction checker software. In this study, out of 200 prescriptions reviewed, 177(88.5%) prescriptions had potential DDIs. The total number of potential DDIs was 1135. Pharmacodynamic DDIs (58.23%) were most common as compared to pharmacokinetic DDIs (38.50%). Based on severity, 0.08% were contraindicated, 6% were serious, 72% to be monitor closely and 22% were minor DDIs. The most common drug class involved in DDIs were antibiotics(234). It was observed that polypharmacy played a crucial role for such a rise in number of DDIs. The study revealed that a large number of DDIs were clinically significant and seen with routinely used drugs in clinical practice. Hence, it is the need of the hour to create awareness among treating physicians the implications of DDIs and to prescribe carefully to minimise such DDIs in future.
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Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future

Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future

We excluded from our analysis the drug pairs that yielded no or unknown interactions (A rating). If a given drug interaction was listed more than once with different risk ratings, the most severe risk rating was used to determine the severity grade. The mechanism of action of the interactions, and their management, were as documented in the interaction checkers. Evidence for documentation of the potential DDI in the literature is classified according to the method of Feinstein et al. as excellent (existence of the drug interaction is clearly established by randomized controlled trial studies), good (reports in the literature strongly suggests that the interaction exists, but not supported by well-controlled studies), fair (the interaction is scarcely documented in the literature; however, the interaction is suspected based on some pharmacologic considerations of the interacting drugs), poor (only few studies and limited reported cases support the existence of the interaction), or unlikely (insufficient documentation of the interaction in the literature and no pharmacological basis). 29
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POTENTIAL DRUG-DRUG INTERACTIONS IN MEDICAL WARDS OF TIKUR ANBESSA SPECIALIZED HOSPITAL, ETHIOPIA

POTENTIAL DRUG-DRUG INTERACTIONS IN MEDICAL WARDS OF TIKUR ANBESSA SPECIALIZED HOSPITAL, ETHIOPIA

Assessment and categorization of drug-drug interactions on the basis of severity is very important in order to decide on the risk versus benefit alternatives. On the basis of severity, drug-drug interactions are categorized as minor, moderate and severe. Minor drug interactions do not result in any significant troublesome outcomes. Management of these types of interactions is usually not required. Moderate drug-drug interactions could result in worsening of clinical condition of the patient. Treatment to manage such type of interactions could be considered. Major drug-drug interactions could lead to life threatening condition; therefore it should be considered essential to address such problems as soon as they are identified.
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Potential Drug−Drug Interactions in Infant, Child, and Adolescent Patients in Children’s Hospitals

Potential Drug−Drug Interactions in Infant, Child, and Adolescent Patients in Children’s Hospitals

Furthermore, the level of evidence for assignment of severity to a PDDI was good to excellent for only 62% of the PDDIs, indicating that the remaining PDDIs have a theoretical basis for inferring the possibility of an ADE, but that these inferences have not been empirically substantiated in clinical practice. Classifying drug interactions into various levels of seriousness (severity) is challenging. Thus, interpreting the results according to level of seriousness may be misleading. Even medication combinations labeled as

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Study on polypharmacy and potential drug – drug interactions in drug therapy of elderly patients at a tertiary care teaching hospital

Study on polypharmacy and potential drug – drug interactions in drug therapy of elderly patients at a tertiary care teaching hospital

The administration of many drugs at the same time or the administration of an excessive number of drugs can cause the potentially serious drug-drug interactions and adverse drug events. Adverse drug events and serious harms occurs at all ages, although they are more commoner in older people, who are more vulnerable to drug toxicity because of age related physiologic changes and increased risk of disease associated with aging and because of polypharmacy. The objective of this study was to identify the degree of polypharmacy and the frequency of potential drug- drug interactions in the medication regimen of elderly patients. This is a cross – sectional observational study conducted in the general medicine department of a tertiary care teaching hospital over a period of 6 months. Sample size of 150 cases of elderly patients was collected from general medicine ward and was reviewed for polypharmacy and potential drug-drug interactions. From among the 150 cases collected, 65(43%) cases were identified with polypharmacy out of which 23(35%) were male and 42(65%) were female. The average number of drug prescribed per patient was 6.05. Among 150 cases, 71(47%) cases were identified with 152 potential drug-drug interactions out of which 8 cases (11%) were with clinically observed adverse drug reaction due to drug interactions. Majority of the potential drug-drug interactions were pharmacodynamic in nature (67%). It was observed that out of 152 pDDIs identified,17(11%) were major, 110(72%) were moderate and 25(16%) were minor in severity.
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A STUDY ON POTENTIAL DRUG - DRUG INTERACTIONS IN MEDICINE DEPARTMENT OF A MULTI SPECIALTY TEACHING HOSPITAL

A STUDY ON POTENTIAL DRUG - DRUG INTERACTIONS IN MEDICINE DEPARTMENT OF A MULTI SPECIALTY TEACHING HOSPITAL

All the hospitalized patients under the general medicine department were reviewed on daily basis from the day of admission till the day of discharge and those who met the study criteria were enrolled into the study. All the relevant and necessary details of the patients including the demographic data, laboratory parameters and drug therapy details were collected from the patient case notes and by interviewing patient bystanders and healthcare professionals if necessary. The demographic details consists of age, gender, reason for admission, past medical history, medication history, co-morbities and any history of allergic reactions. The recording of laboratory parameters includes haematology, biochemistry and any other tests that were carried out during their hospital stay. The drug therapy details such as dose, duration, frequency, route, time of administration and concomitant drug were also noted. All the collected data were documented in the suitably designed data collection form designed as per the need of the study. The patient drug therapy were reviewed every day and assessed for any drug- drug interactions by using standard text books such as stockley’s drug interactions and online resources such as drug.com and micromedex software. The identified potential drug- drug interactions were notified to the healthcare professionals for their appropriate action and were documented by the pharmacist in the drugdrug interaction documentation form. At the end of the study, the evaluation of potential drug-drug interactions was performed among the identified hospitalized patients for its level of severity, onset and documentation status of drug-drug interactions.
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Incidence of Potential Drug–Drug Interactions in Cardiac Patients in a Tertiary Care Hospital

Incidence of Potential Drug–Drug Interactions in Cardiac Patients in a Tertiary Care Hospital

Kafeel et. al., (2014) 54 conducted a study on “Possibility of Drug-Drug Interaction inPrescription Dispensed by Community and Hospital Pharmacy.”This study is to analyze the use of all subsidized prescription drugs including their use of drug combination generally accepted as carrying a risk of severe interactions. It is a cross sectional study, they analyzed all prescriptions (n = 1014) involving two or more drugs dispensed to the population (age range 4 - 85 years) from all pharmacies, clinics and hospitals. Data were stratified by age and sex, and frequency of common interacting drugs. Potential drug interactions were classified according to clinical relevance as significance of severity (types A: major, B: moderate, and C: minor) and documented evidence (types 1, 2, 3, and 4). The growing use of pharmacological agents means that drug interactions are of increasing interest for public health. Monitoring of potential drug interactions may improve the quality of drug prescribing and dispensing, and it might form a basis for education focused on appropriate prescribing. To make the manifestation of adverse interaction subside, management strategies must be exercised if two interacting drugs have to be taken with each other, involving: adjusting the dose of the object drug; spacing dosing times to avoid the interaction. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action they should take. They concluded that it is unrealistic to expect clinicians to memorize the thousands of drug-drug interactions and their clinical significance, especially considering the rate of introduction of novel drugs and the escalating appreciation of the importance of pharmacogenomics. Reliable regularly updated decision support systems and information technology are necessary to help avert dangerous drug combinations.
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Possibility of Drug Drug Interaction in  Prescription Dispensed by Community and Hospital Pharmacy

Possibility of Drug Drug Interaction in Prescription Dispensed by Community and Hospital Pharmacy

Potential drug interactions were classified according to clinical relevance as significance of severity as types A: major, B: moderate, and C: minor and documented evidence types 1, 2, 3[r]

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Potential drug&ndash;drug interactions in inpatients treated at the Internal Medicine ward of Tikur Anbessa Specialized Hospital

Potential drug&ndash;drug interactions in inpatients treated at the Internal Medicine ward of Tikur Anbessa Specialized Hospital

tial DDIs were identified using Medscape Drug Interaction Checker, which is an online reference database accessed from reference.medscape.com/drug-interactionchecker. The data- base contains drug information updated through systematic review of major medical and pharmacy journals, US Food and Drug Administration (FDA) announcements and practice guidelines. In addition to information from the database, patient factors were also considered while recording interac- tions. Thus, potential DDIs identified by the database would not be recorded if measures were taken by prescribers (eg, modification of dose, route of administration and so on) upon prescription to prevent those potential interactions. Identified interactions were classified by severity as major, moderate and minor, as well as based on underlying mechanisms as phar- macokinetic, pharmacodynamic and unknown mechanisms. The data were analyzed using SPSS software v16 (SPSS Inc., Chicago, IL, USA). Logistic regression analysis was used to determine the presence of association between variables and p-value < 0.05 was considered as statistically significant.
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Assessment of prescribed medications and pattern of distribution for potential drug&ndash;drug interactions among chronic kidney disease patients attending the Nephrology Clinic of Lagos University Teaching Hospital in Sub-Saharan West Africa

Assessment of prescribed medications and pattern of distribution for potential drug&ndash;drug interactions among chronic kidney disease patients attending the Nephrology Clinic of Lagos University Teaching Hospital in Sub-Saharan West Africa

Results: This study involved 123 adult CKD patients (63 [51.22%] males and 60 [48.78%] females) with a mean age of 53.81 ± 16.03 years. The most common comorbid conditions were hypertension (112 [91.10%]) and diabetes mellitus (45 [36.60%]). Regarding the form of nephrological interventions being offered, the majority of the respondents - 66 (53.66%) were on maintenance dialysis, followed by 53 (43.09%) respondents on conservative care, while 4 (3.25%) respondents were on renal transplantation. A total of 1264 prescriptions were made, and the mean number of prescribed medications per patient was 10.28±3.85. The most fre- quently prescribed medications were furosemide (88 [71.6%]), heparin (67 [54.47%]), lisinopril (65 [52.9%]), oral calcium carbonate (CaCO 3 ) (63 [51.2%]), α -calcidol (62 [50.4%]), and erythropoietin (61 [49.6%]). A total number of 1851 potential DDIs were observed among 118 patients. The prevalence of potential DDIs in this study was 78.0%, while the mean DDI per prescription was 1.50. Among the potential DDIs observed, the severity was mild in 639 (34.5%) patients, moderate in 1160 (62.7%) patients, and major in 51 (2.8%) patients and only 1 (0.1%) patient was of contraindicated drug combination. The most frequent DDIs’ pattern observed was between oral CaCO 3 and oral ferrous sulfate. There was a statistically significant association between the number of prescribed medications and the estimated glomerular filtration rate (eGFR; pre-ESRD and ESRD staging) with a P-value of 0.00000119. This implies that the number of prescribed medications increases as the eGFR declines in advance CKD stage patients. Conclusion: Most of these interactions have moderate severity and delayed onset, hence the need to follow-up these patients after prescription in order to reduce associated morbidity, mortality, length of hospital stay, and health care cost. Physicians and clinical pharmacists should utilise available interaction software to avoid harmful DDIs in these patients.
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A STUDY ON POLY PHARMACY CAN CAUSE DRUG DRUG INTERACTIONS AND ITS SEVERITY ANALYSIS AMONG PATIENTS ADMITTED IN GENERAL MEDICINE & CCU OF A TERTIARY CARE HOSPITAL IN EASTERN INDIA

A STUDY ON POLY PHARMACY CAN CAUSE DRUG DRUG INTERACTIONS AND ITS SEVERITY ANALYSIS AMONG PATIENTS ADMITTED IN GENERAL MEDICINE & CCU OF A TERTIARY CARE HOSPITAL IN EASTERN INDIA

The potential for development of drug-drug interactions increases not only with the number of medications in use, but also the number of physicians who treat the same patient and older age of patients in CCU are another risk factors that complicate the treatment process. [6,7] These DDIs could result in serious life threatening conditions in a desire to alter the therapeutic end point of drugs. DDI monitoring not only applicable on those drugs which are contraindicated, but the required monitoring and the adjustment of dose should also be deemed essential for those combinations which are considered beneficial for certain conditions. Therefore, it is essential to identify possible DDIs in clinical settings and approach towards the management of potential loss of effectiveness and appearance of toxicity because of the use of certain drug combinations. [8]
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Clinical relevancy and determinants of potential drug&ndash;drug interactions in chronic kidney disease patients: results from a retrospective analysis

Clinical relevancy and determinants of potential drug&ndash;drug interactions in chronic kidney disease patients: results from a retrospective analysis

The majority of the pDDIs identified in this study are of moderate and minor severity. A few interactions with serious and contraindicated severity have also been observed, which have considerable potential to deteriorate patients’ clinical condition, if left unmanaged (Tables 2 and 3). We observed that the pDDIs identified in this study are not specific only to CKD patients. Some interactions, such as furosemide + lisinopril, captopril + furosemide, and aspirin + insulin, have also been observed in internal medicine ward patients who were suffering from stroke, pyrexia, gastroenteritis, conges- tive heart failure, malaria, anemia, tuberculosis, ischemic heart disease, liver cirrhosis, pneumonia, meningitis, and urinary tract infection. 26
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Prospective observational study in cardiac unit with impact of clinical pharmacist in tertiary care hospital

Prospective observational study in cardiac unit with impact of clinical pharmacist in tertiary care hospital

Adverse drug interactions occurred due to drug-drug interaction was recorded in an ADR Reporting Form. For each adverse drug reaction, the following information was recorded: type of adverse event, seriousness, onset and resolution, severity, casualty, action taken, and event outcome, and was analyzed using the following methods: causality assessment by WHO and Naranjo scales, severity by Hartwig scale. Drug- drug interaction check was performed using Micromedex-2. According to this tool, drug interactions were categorized as minor, moderate or major which indicates the possible risks of occurrence of the potential drug interactions which can occur in patients, but not the actual severity of drug interactions. The data obtained was used to categorize interactions based on the mechanism as pharmacokinetic or pharmacodynamics. The pharmacokinetic drug interactions were further categorized into interactions based on absorption, distribution, metabolism and elimination. The severities of the interactions were assessed and categorized as major (can cause permanent damage or life risk), moderate (can cause harm and treatment are required) or minor (can cause small or no clinical effect, with no treatment required).The data were stored confidentially and subjected to further analysis using the appropriate software.
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Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine

Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine

Differences between the transporter protein-binding profiles of second-generation antihistamines may explain some of the substantial differences in clinical activity and tolerability that exist between agents in this class (Table 2). Further research in this area is clearly warranted. Indeed, transporter protein interactions might ultimately explain important clinical differences, such as the potentially longer duration of action for bilastine over fexofenadine. 56

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A Prospective Study on Clinically Significant Drug – Drug Interactions by Systematic Review of Case files in a South Indian Tertiary Care Hospital

A Prospective Study on Clinically Significant Drug – Drug Interactions by Systematic Review of Case files in a South Indian Tertiary Care Hospital

The results also showed that majority of the patients with Drug-Drug Interactions (DDIs) were prescribed with 5-9 drugs per prescription (61%). As per the results from pre interventional and post interventional phase, the number of DDIs increased with age. Majority of drug- drug interactions were seen in patients above 60 years (40.5%) and least num- ber of DDIs was found in patients below 20 years (7%). (Figure 2) The data obtained showed a P value of 0.075 which indicated that the rela- tion between Age and DDIs was statistically significant. There was no significant relationship between gender and drug-drug interactions as the P value obtained was greater than 0.05. The no. DDIs increased with an increase in number of drugs per prescription. The relationship was highly statistically significant as the obtained P value was less than 0.01. Out of 368 DDIs in Phase 1 and 127 DDIs in Phase III, occurrence of major DDIs were 136 (74.3%) and 21 (25.65%) respectively. Moderate DDIs were 217 (43.83%) and 98 (19.79%) and minor DDIs were found to be 15 (4%) and 8 (6.29%) respectively.
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Potential drug drug and drug disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

Potential drug drug and drug disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

During the last decades in Mexico, as elsewhere, the pop- ulation has aged, causing an increase in the level of chronic degenerative diseases and a consequent incre- ment in medication. Polypharmacy is now common, and carries a high risk of drug-drug interactions and drug-dis- ease interactions. These may cause adverse effects, or the therapeutic effects of the combined medicines may change, with serious consequences for health. In the United States 25% of ambulatory patients taking drug combinations were at risk for clinically important interac- tions [1]. Furthermore, it has been reported that about 40% of hospitalized patients had at least one potential drug-disease interaction [2]; a large study including 70,203 outpatient visits by patients aged 65 and older found that 2.6% ofvisits with at least one prescription had one or more of the 50 inappropriate drug-disease combi- nations examined [3]. A European study of 1601 ambula- tory elderly patients, taking an average of seven different drugs, found that 46.0% were at risk for at least one clini- cally important potential drug-drug interaction [4]. It has been shown that inappropriate prescription combina- tions increase with patient age, are more frequent in men, rise in line with the Charlson co-morbidity index [5], and increase as the number of prescribed drugs increases [2,3,6-8]. It is possible that other risk factors for potential interactions exist, and these should be identified to estab- lish successful methods for improving prescription prac- tices.
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