Evaluation of Potential Drug-drug Interactions in the Prescriptions in Outpatient Settings

Year 2020, Volume: 14 Issue: 4, 564 - 571, 20.12.2020

Seçkin Engin Elif Barut Feride Sezen Ersin Yarış

https://doi.org/10.21763/tjfmpc.713208

Abstract

Introduction: Drug-drug interactions (DDIs) are an important component of drug-related adverse events, leading to morbidity and mortality worldwide. The aim of the present study was to evaluate the frequency and severity of potential DDIs (pDDIs) in the prescriptions written in outpatient primary care clinics in Trabzon, Turkey. Material and Methods: A retrospective descriptive study was carried out in 169 prescriptions from 15 primary care clinics. pDDIs were identified by using Lexi-Interact™ software program. Results: A total of 169 prescriptions involving 506 drugs were analyzed, of which 59 had at least one pDDI. The prevalence of pDDIs was 34.91%. The mean number of drugs per prescription was 2.99±1.08. A total of 124 pDDIs were identified with mean of 0.73±1.45 per each prescription. Hydrochlorothiazide was the most frequently prescribed drug involved in pDDIs (n=15, 12.10%). The most common pDDIs was between hydrochlorothiazide and metformin (n=4, 3.22%). The number of pDDIs are positively correlated with increasing age (r=0.33 p<0.01) and the number of prescribed drugs (r=0.41, p<0.01). The majority of pDDIs (n=96, 77.42%) were in the risk category C (monitor therapy). Conclusion: Our findings indicate that polypharmacy and age were associated with the risk of having pDDIs. Physicians and pharmacists should be aware of pDDIs to improve drug safety, patient compliance and, prevent adverse drug reactions. Analyzing of DDIs with softwares should be effective for management of risks associated with pDDIs.

Keywords

drug use, family practice, polypharmacy, primary care, prescription

Ayaktan Tedavi Edilen Hasta Reçetelerinde Potansiyel İlaç-ilaç Etkileşimlerinin Değerlendirilmesi

Abstract

Giriş:İlaç-ilaç etkileşimleri, dünya çapında morbidite ve mortaliteye yolaçan ilaçlarla ilgili advers olayların önemli bir bileşenidir. Bu çalışmada, Trabzon'da aile sağlığı merkezlerinde ayakta tedavi gören hastalara ait reçetelerdeki potansiyel ilaç-ilaç etkileşimlerinin yaygınlığını ve ciddiyetini değerlendirmek amaçlandı. Materyal ve Metot: Trabzon'da bulunan 15 farklı aile sağlığı merkezinden çıkmış olan 169 reçetede retrospektif tanımlayıcı bir çalışma yapıldı. Potansiyel ilaç-ilaç etkileşimleri Lexi-Interact™ programı kullanılarak analiz edildi. Bulgular: Beş yüz altı adet ilaç içeren toplam 169 reçetenin 59 tanesinde en az bir potansiyel etkileşim saptandı. Potansiyel ilaç-ilaç etkileşimi prevalansı %34.91 ve reçete başına düşen ortalama ilaç sayısı 2.99 ± 1.08 idi. Reçete başına ortalama 0.73±1.45 adet olmak üzere toplam 124 potansiyel etkileşim tanımlandı. Hidroklorotiyazid potansiyel ilaç etkileşimlerinde en fazla yer alan ilaçtı (n = 15,% 12.10). En yaygın potansiyel ilaç-ilaç etkileşimi hidroklorotiyazid ve metformin arasındaydı (n = 4,% 3.22). Potansiyel etkileşim sayısı ile hastaların yaşı (r = 0.33, p <0.01) ve ilaç sayısı (r = 0.41, p <0.01) arasında pozitif korelasyon mevcuttu. Etkileşimlerin büyük çoğunluğu C grubu (n=96, 77.42%) risk kategorisine aitti. Sonuç: Bulgularımıza göre polifarmasi ve ileri yaş, potansiyel ilaç-ilaç etkileşim riskini artırmaktadır. Hekimler ve eczacılar ilaç güvenliği ve hasta uyumunu iyileştirmek, ve olumsuz ilaç reaksiyonlarını önlemek için potansiyel etkileşimlerin farkında olmalıdır. İlaç-ilaç etkileşimlerinin yazılımlarla analiz edilmesi, potansiyel etkileşimlere ilişkili risklerin yönetimi için etkili olabilir.

Keywords

aile hekimliği, etkileşim, polifarmasi, birincil bakım

References

• 1. Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, Redelmeier DA. Rates of hyperkalemia after publication of the randomized aldactone evaluation study. N Engl J Med. 2004; 351:543-551.
• 2. Aparasu R, Baer R, Aparasu A. Clinically important potential drug–drug interactions in outpatient settings. Res Social Adm Pharm.2007; 3. 426-37.
• 3. Delafuente CJ. Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol. 2003; 48: 133–143.
• 4. Bjerrum L, Gonzalez Lopez-Valcarcel B, Petersen G. Risk factors for potential drug interactions in general practice. Eur J Gen Pract. 2008; 14: 23–29.
• 5. Mateti UV, Rajakannan T, Nekkanti H, Rajesh V, Mallaysamy SR, Ramachandran P. Drug–drug Interactions in Hospitalized Cardiac Patients. J Young Pharm. 2011; 3(4): 329-333.
• 6. Grattagliano I, Portincasa P, D'Ambrosio G, et al.Avoiding drug interactions: here's help. J Fam Practice.2010; 59: 322-329.
• 7. Mistry M, Gor A. Ganguly B.Potential Drug-Drug Interactions among Prescribed Drugs in Paediatric Outpatients Department of a Tertiary Care Teaching Hospital.J Young Pharm.2017; 9(3): 371-375.
• 8. Fadare JO, Ajayi AE, Adeoti AO, Desalu OO, Obimakinde AM, Agboola SM. Potential drug-drug interactions among elderly patients on anti-hypertensive medications in two tertiary healthcare facilities in Ekiti State, South-West Nigeria. Sahel Medical Journal. 2016; 19:32-37.
• 9. ObreliNeto PR, Nobili A, de Lyra DP Jr, Pilger D, Guidoni CM, de Oliveira Baldoni A, Cruciol-Souza JM, de Carvalho Freitas AL, Tettamanti M, Gaeti WP, Nakamura Cuman RK. Adverse drug reactions caused by drug–drug interactions in elderly outpatients: a prospective cohort study. J Pharm Pharm Sci. 2012;15(2):332-43.
• 10. Teixeira JJV, Crozatti MTL, dos Santos CA, Romano-Lieber NS (2012) Potential Drug-Drug Interactions in Prescriptions to Patients over 45 Years of Age in Primary Care, Southern Brazil. PLoS ONE 7(10): e47062. https://doi.org/10.1371/journal.pone.0047062
• 11. Sancar M, Kaşik A, Okuyan B, Batuhan S, İzzettin FV. Determination of Potential Drug–Drug Interactions Using Various Software Programs in a Community Pharmacy Setting. Turk J Pharm Sci 2019;16:14-19.
• 12. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment, 2020.Oslo, 2019.
• 13. Kaya-Yaşar Y, Engin S, Barut EN, Sevgi S, Eroglu G, Sezen FS. Evaluation of potential drug-drug interactions in hospitalized patients at a tertiary care hospital: A pilot study. Medicine Science 2020;9(2):389-92.
• 14. Chavda BN, Solanky PP, Baria H, Naik R, Bhart K. Study of potential drug-drug interaction between prescribed drugs in patients attending outpatient department of medicine at tertiary-care hospital in South Gujarat region. Natl J Physiol Pharm Pharmacol. 2015; 5 (3):236-242.
• 15. Soherwardi S, Chogtu B, Faizal P. Surveillance of the potential drug-drug interactions in the medicine department of a tertiary care hospital. J Clin Diagn Res. 2012; 6(7): 1258–1261.
• 16. Liao H, Chen JT, Ma TC, Chang YS. Analysis of drug-drug interaction (DDIs) in nursing homes in Central Taiwan. Arch GerontolGeriatr. 2008; 47: 99-107.
• 17. Nobili A, Pasina L, Tettamanti M, Lucca U, Riva E, Marzona I, Monesi L, Cucchiani R, Bortolotti A, Fortino I, Merlino L, Walter Locatelli G, Giuliani G. Potentially severe drug interactions in elderlyoutpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther. 2009; 34: 377–386.
• 18. Patel PS, Rana DA, Suthar JV, Malhotra SD, Patel VJ. A study of potential adverse drug-drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital. J Basic Clin Pharm. 2014;5(2):44-48.
• 19. Murtaza G, Khan MY, Azhar S, Khan SA, Khan TM. Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients. Saudi Pharm J. 2016;24(2):220-225.
• 20. Opie L. Drug interactions of antihypertensive agents. S Afr Fam Pract.2012; 54(2), 23-25.
• 21. May M, Schindler C. Clinically and pharmacologically relevant interactions of antidiabetic drugs. Ther Adv Endocrinol Metab. 2016;7(2):69-83.
• 22. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag. 2015;11:1061-1075.
• 23. Nalamachu S, Pergolizzi JV, Raffa RB, Lakkireddy DR, Taylor R Jr. Drug-drug interaction between NSAIDS and low-dose aspirin: a focus on cardiovascular and GI toxicity. Expert Opin Drug Saf. 2014;13(7):903-917.
• 24. Mousavi S, Norouzi M, Ashouri A, Javadi MR, Gholami K, Hadjibabaie M. Study of Potential Drug-Drug Interactions in Prescriptions of University Based Pharmacies. J Pharm Care. 2014; 2(2): 60-65.