Potential drug-drug interactions among hospitalized cardiac patients
Keywords:DDIs, MEDSCAPE, Cardiac in-patients
Background: Drug-drug interactions (DDIs) are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. The objective of our study was to identify potential drug-drug interactions among hospitalized cardiac patients and to identify the risk factors associated with these interactions.
Methods: After obtaining approval from Institutional Ethical Committee, a prospective observational study was carried out among 367 hospitalized cardiac patients in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru. Cardiac patients prescribed at least 2 drugs and having hospital stay of more than 24 hour duration were enrolled into the study. The prescriptions were analysed for potential DDIs using MEDSCAPE multidrug interaction checker tool. Descriptive statistics, Student ‘t’ test, ANOVA and Pearson correlation coefficient were used to analyse the results.
Results: The incidence of potential DDIs was 98% with 360 prescriptions having at least one potential DDI. A total of 38 potentially interacting drug pairs were identified among which majority were of significant grade while only 3 were serious. Majority of interactions were pharmacodynamic (76.3%) in nature. Aspirin/clopidogrel (71.1%) and pantoprazole/clopidogrel (69.8%) were the most common interacting pairs. Drugs most commonly involved were aspirin, clopidogrel, heparin, pantoprazole and ramipril. Age, female gender, polypharmacy, prolonged hospital stay, stay in ICU and diabetes mellitus were the risk factors found associated with the potential DDIs.
Conclusions: Proper therapeutic planning, routine monitoring of cardiac in-patients and usage of online DDI database will avoid potentially hazardous consequences in cardiac in-patients.
Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharmaceut Sci. 2006;9(3):427-33.
Roblek T, Trobec K, Mrhar A, Lainscak M. Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease. Arch Med Sci. 2014;10(5):920-32.
Kulkarni V, Bora SS, Sirisha S, Saji M, Sundaran S. A study on drug-drug interactions through prescription analysis in a South Indian teaching hospital. Ther Adv Drug Saf. 2013;4(4):141-6.
Murtaza G, Khan MYG, 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;24:220-5.
Sivva D, Mateti UV, Neerati VM, Thiruthopu NS, Martha S. Assessment of drug-drug interactions in hypertensive patients at a superspeciality hospital. Avicenna J Med. 2015;5:29-35.
Mateti UV, Rajakannan T, Nekkanti H, Rajesh V, Mallaysamy SR, Ramachandran P. Drug-drug interactions in hospitalized cardiac patients. J Young Pharmacists. 2011;3:329-33.
Sharma S, Chhetri HP, Alam K. A study of potential drug-drug interactions among hospitalized cardiac patients in a teaching hospital in Western Nepal. Indian J Pharmacol. 2014;46:152-6.
Chauhan S, Aeri BT. Prevalence of cardiovascular disease in India and its economic impact - a review. International Journal of Scientific and Research Publications. 2013;10(3):1-5.
Chauhan S, Aeri BT. The rising incidence of cardiovascular diseases in India: assessing its economic impact. J Preventive Cardiology. 2015;4(4):735-40.
Snyder BD, Polasek TM, Doogue MP. Drug interactions: principles and practice. Aust Prescr. 2012;35(3):85-8.
Patel VK, Acharya LD, Rajakannan T, Surulivelrajan M, Guddattu V, Padmakumar R. Potential drug interactions in patients admitted to cardiology wards of a south Indian teaching hospital. Australas Med J. 2011;4:9-14.
Kashyap M, D’Cruz S, Sachdev A, Tiwari P. Drug-drug interactions and their predictors: results from Indian elderly inpatients. Pharmacy Practice. 2013;11(4):191-5.
Vonbach P, Dubied A, Krähenbühl S, Beer JH. Prevalence of drug drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med. 2008;19:413-20.
Aparasu R, Baer R, Aparasu A. Clinically important potential drug-drug interactions in outpatient settings. Res Social Adm Pharm. 2007;3:426-37.
Smithburger PL, Kane Gill SL, Seybert AL. Drug-drug interactions in cardiac and cardiothoracic intensive care units: an analysis of patients in an academic medical centre in the US. Drug Saf. 2010;33:879-88.
Rodrigues AT, Stahlschmidt R, Granja S, Falcao ALE, Moriel P, Mazzola PG. Clinical relevancy and risks of potential drug-drug interactions in intensive therapy. Saudi Pharm J. 2015;23:366-70.
Moura C, Acurcio F, Belo N. Drug-drug interactions associated with length of stay and cost of hospitalization. J Pharm Pharmaceut Sci. 2009;12(3):266-72.
Dubova SV, Reyes Morales H, Torres Arreola Ldel P, Suárez Ortega M. Potential drug-drug and drug disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City. BMC Health Serv Res. 2007;7:147.
Taegtmeyer A, Kullak-Ublick G, Widmer N, Falk V, Jetter, A. Clinical usefulness of electronic drug–drug interaction checking in the care of cardiovascular surgery inpatients. Cardiology. 2012;123:219-22.