ANTİHİPERTANSİFLER KAYNAKLI İLAÇ ETKİLEŞİMLERİNİN TESPİTİ: GÖZLEMSEL BİR ÇALIŞMA

Öz

Amaç: Bu çalışma antihipertansifler kaynaklı ilaç-ilaç etkileşimlerini (DDI) tespit etmeyi amaçlamaktadır.

Gereç ve Yöntem: Kasım 2022 ve Nisan 2023 tarihleri arasında Diyarbakır’daki bir serbest eczane tarafından karşılanan, en az bir antihipertansif ve farklı farmakolojik gruptan bir ilaç içeren 325 reçete DDI açısından ele alınmıştır. Bu değerlendirmeler için üç farklı DDI kontrol programı (RxMediaPharma, Medscape, and Drugs.com) kullanılmıştır.

Sonuç ve Tartışma: Reçetelerin 232'sinde antihipertansiflere bağlı DDI saptanmıştır. Tespit edilen DDI'lar şu şekilde sınıflandırılabilir: (i) DDI'ların 254'ü beta blokerlerden kaynaklanmış ve 88 farklı aktif bileşen çifti arasında meydana gelmiştir, (ii) 73'ü ACE inhibitörlerinden kaynaklanmış ve 38 farklı aktif bileşen çifti arasında meydana gelmiştir, (iii) 113'ü kalsiyum kanal blokerlerinden kaynaklanmış ve 42 farklı aktif bileşen çifti arasında meydana gelmiştir, (iv) 128'i ARB'lerden kaynaklanmış ve 55 farklı aktif bileşen çifti arasında meydana gelmiştir, (v) 250'si diüretiklerden kaynaklanmış ve 93 farklı aktif bileşen çifti arasında meydana gelmiştir ve (vi) 7'si alfa blokerlerden kaynaklanmış ve 5 farklı aktif bileşen çifti arasında meydana gelmiştir. DDI'lar çoğunlukla metoprolol ve aspirin arasında tespit edilmiştir. Sonuç olarak DDI görülme sıklığının yüksek olduğu görülmüştür. Tespit edilen DDIlar hafiften ciddiye kadar farklı düzeyde olup, DDI kontrol programları etkileşim düzeyine ilişkin farklı sonuçlar vermiştir.

Anahtar Kelimeler

• Antihipertansifler
• gözlemsel çalışma
• ilaç-ilaç etkileşimleri
• serbest eczane

DETECTION OF DRUG-DRUG INTERACTIONS CAUSED BY ANTI-HYPERTENSIVES: AN OBSERVATIONAL STUDY

Öz

Objective: This study aimed to detect drug-drug interactions (DDIs) induced by antihypertensives.

Material and Method: 325 prescriptions containing at least one antihypertensive and a drug from a different pharmacological group, filled at a community pharmacy in Diyarbakir, were evaluated for DDIs between November 2022 and April 2023. Three DDI checking programs (RxMediaPharma, Medscape, and Drugs.com) were used for evaluations.

Result and Discussion: Antihypertensives-induced DDIs were found in 232 of the prescriptions. Detected DDIs can be classified as: (i) 254 of the DDIs were due to beta blockers and occurred between 88 different active ingredient pairs, (ii) 73 of them were due to ACE inhibitors and occurred between 38 different active ingredient pairs, (iii) 113 of them were due to calcium channel blockers and occurred between 42 different active ingredient pairs, (iv) 128 of them were due to ARBs and occurred between 55 different active ingredient pairs, (v) 250 of them were due to diuretics and occurred between 93 different active ingredient pairs, and (vi) 7 of them were due to alpha blockers and occurred between 5 different active ingredient pairs. DDIs were mainly detected between metoprolol and aspirin. As a result, the prevalence of DDI was found to be high. The DDIs detected ranged from minor to serious, and DDI checking programs yielded varying results regarding the level of interaction.

Anahtar Kelimeler

• Antihypertensives
• community pharmacy
• drug-drug interactions
• observational study

Kaynakça

1. 1. Zhong, Y., Zheng, H., Chen, X., et al. (2023). DDI-GCN: Drug-drug interaction prediction via explainable graph convolutional networks. Artificial Intelligence in Medicine, 144, 102640. [CrossRef]
2. 2. Özdamar, E.N., Özdamar, İ. (2021). Evaluation of the potential drug-drug interactions at orthopedics and traumatology outpatient clinics of a tertiary care hospital. Cukurova Medical Journal, 46(2), 601-609. [CrossRef]
3. 3. Becker, M.L., Kallewaard, M., Caspers, P.W., et al. (2007) Hospitalisations and emergency department visits due to drug-drug interactions: A literature review. Pharmacoepidemiology and Drug Safety, 16(6), 641-651. [CrossRef]
4. 4. Akbar, Z., Rehman, S., Khan, A., et al. (2021). Potential drug-drug interactions in patients with cardiovascular diseases: Findings from a prospective observational study. Journal of Pharmaceutical Policy and Practice, 14(1), 63. [CrossRef]
5. 5. Kothari, N., Ganguly, B. (2014). Potential drug-drug interactions among medications prescribed to hypertensive patients. Journal of Clinical and Diagnostic Research, 8(11), HC01. [CrossRef]
6. 6. Alp, Ç., Karahan, I., Kalcık, M. (2018). Antihipertansif ilaçların kullanımı ile ilişkili yan etkiler: Güncel literatürler eşliğinde gözden geçirme. Turkish Journal of Clinics and Laboratory. 9(4), 342-347. [CrossRef]
7. 7. Saraswati, M.D., Ardiana, S.M., Suprapti, B., et al. (2022). Potential drug-drug interactions in ambulatory patients with hypertension: A retrospective study. Jurnal Farmasi Dan Ilmu Kefarmasian Indonesia, 9(1), 69-74. [CrossRef]
8. 8. Gürel, N., Üresin, Y., Şen, S., et al. (2024). Drug-drug interactions and their association with quality of life in patients with hypertension. Cureus, 16(3), e56526. [CrossRef]

9. 9. Abdo, M.S., Hammad, M.A., Harun, S.N., et al. (2020). Evaluation of knowledge, attitude and practice of healthcare providers towards life-threatening drug-drug interactions in Penang General Hospital, Malaysia. Clinical Epidemiology and Global Health, 8(4), 1253-1258. [CrossRef]
10. 10. Muhič, N., Mrhar, A., Brvar, M. (2017). Comparative analysis of three drug-drug interaction screening systems against probable clinically relevant drug-drug interactions: A prospective cohort study. European Journal of Clinical Pharmacology, 73, 875-882. [CrossRef]
11. 11. Aykut, B., Arslan, M. (2023). An observational study on drug interactions caused by proton pump inhibitors. European Journal of Life Sciences, 2(1), 25-30. [CrossRef]
12. 12. Demirpolat, E., Güneş, N. (2025). Comparison and analysis of 4 drug interaction databases in nephrology patients using clinical pharmacy approaches: A cross-sectional study. Istanbul Journal of Pharmacy, 55(1), 1-9. [CrossRef]
13. 13. Sancar, M., Kaşık, A., Okuyan, B., et al. (2019). Determination of potential drug-drug ınteractions by using various software programs at community pharmacy setting. Turkish Journal of Pharmaceutical Sciences, 16(1), 14–19. [CrossRef]
14. 14. Donner, A., Eliasziw, M. (1992). A goodness-of-fit approach to inference procedures for the kappa statistic: Confidence interval construction, significance-testing and sample size estimation. Statistics in Medicine, 11(11), 1511–1519. [CrossRef]
15. 15. Özkaya, Y., Özçeli̇kay, G. (2025). Yaşlılarda akılcı ilaç kullanımında eczacı sorumluluğu. Ankara Universitesi Eczacilik Fakultesi Dergisi, 49(1), 109-118. [CrossRef]
16. 16. Bundy, J.D., Li, C., Stuchlik, P., et al. (2017). Systolic blood pressure reduction and risk of cardiovascular disease and mortality: A systematic review and network meta-analysis, JAMA Cardiology, 2, 775-781. [CrossRef]
17. 17. Anfinogenova, N.D., Stepanov, V.A., Chernyavsky, A.M., et al. (2024). Clinical significance and patterns of potential drug-drug ınteractions in cardiovascular patients: Focus on low-dose aspirin and angiotensin-converting enzyme inhibitors. Journal of Clinical Medicine, 13, 4289. [CrossRef]
18. 18. Kasar, K.S., Karadakovan, A. (2017). Yaşlı bireylerde antihipertansif ilaç kullanım hatalarının incelenmesi. Journal of Cardiovascular Nursing, 8(15), 20-27. [CrossRef]
19. 19. Subramanian, A., Adhimoolam, M., Kannan, S. (2018). Study of drug-drug interactions among the hypertensive patients in a tertiary care teaching hospital. Perspectives in Clinical Research, 9(1), 9-14. [CrossRef]
20. 20. Karabağ, E. (2019). MSc Thesis. Metoprolol Kullanan Hastalarda Eş Zamanlı NSAİİ Kullanımı ve Etkileşimi. Department of Clinical Pharmacy, Faculty of Pharmacy, Medipol University, Istanbul, Türkiye.
21. 21. Rosas-Carrasco, Ó., García-Peña, C., Sánchez-García, S., et al. (2011). The relationship between potential drug-drug interactions and mortality rate of elderly hospitalized patients. Revista de Investigación Clínica, 63(6), 564-573.
22. 22. Costa, A.C., Reina-Couto, M., Albino-Teixeira, A., et al. (2017). Aspirin and blood pressure: Effects when used alone or in combination with antihypertensive drugs. Revista Portuguesa de Cardiologia (English Edition), 36(7-8), 551-567. [CrossRef]
23. 23. Chang, S.M., Granger, C.B., Johansson, P.A., et al. (2010). Efficacy and safety of angiotensin receptor blockade are not modified by aspirin in patients with chronic heart failure: A cohort study from the candesartan in heart failure-assessment of reduction in mortality and morbidity (CHARM) programme. European Journal of Heart Failure, 12(7), 738-745. [CrossRef]
24. 24. Günay, A., Demirpolat, E., Ünal, A., et al. (2022). A comparison of four drug-drug interaction databases for patients undergoing haematopoietic stem cell transplantation. Journal of Clinical Pharmacy and Therapeutics, 47(10), 1711-1719. [CrossRef]