DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20204086

Occurrence of possible drug related interactions in medical patients in out-patient departments of Pakistan

Hammad A. Butt, Ammara Khan, Naveed Suleman

Abstract


Background: Data regarding occurrence of drug-drug interactions in Pakistan is rare. In the current study, we have tried to find out the clinical adversity and frequency witnessed in prescriptions of a medical outpatient department.

Methods: Patient prescriptions were analyzed for potential drug-drug interactions.  A sample of 364 patients, visited outpatient department who were being prescribed at least two drugs simultaneously using a drug interaction program website.

Results: The 364 patients (72.8% male, mean age 57.9±15.2 years) were prescribed a median of six drugs (range 2-13) at OPD visit. Three hundred forty nine patients (95.8%) had at least one potentially interacting drug combination. 2636 potential interactions were seen in the visiting patients. Out of these 124 (4.7%) were of major severity, 1730 (65.6%) moderate and 515 (19.5%). Out of 124 patients with a potential DDI with major severity, no patient was re-hospitalized within 2 months after discharge due to a probable drug-related problem associated with the potential DDI.

Conclusions: A large percentage of patients were detected having one or more potential drug-drug interactions, using drug interaction detection program. However, the percentage of patients having clinically adverse consequences due to drug-drug interactions appears to be very low.


Keywords


Adverse drug interaction, Drug-related problems, Drug-drug interaction, Pharmacoepidemiology

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References


Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329:15-9.

Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652-58.

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279:1200-5.

Tulner LR, Frankfort SV, Gijsen GJ, Van-Campen JP, Koks CH, Beijnen JH. Drug-drug interactions in a geriatric outpatient cohort. Drug & Aging. 2008; 25:343-55.

Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. Expert Opin Drug Saf. 2012;11:83-94.

Pedros C, Quintana B, Rebolledo M, Porta N, Vallano A, Arnau JM. Prevalence, risk factors and main features of adverse drug reactions leading to hospital admission. Eur J Clin Pharmacol. 2014; 70:361-7.

Ismail M, Iqbal Z, Khattak MB, Khan MI, Arsalan H, Javaid A, et al. Potential drug–drug interactions in internal medicine wards in hospital setting in Pakistan. Int J Clin Pharm. 2013;35:455-62.

Carvalho RE, Reis AM, Faria LM, Zago KS, Cassiani SH. Prevalence of drug interactions in intensive care units in Brazil. Acta paul enferm. 2013;26:150-7.

Ismail M, Iqbal Z, Khan MI, Javaid A, Arsalan H, Farhadullah H, et al. Frequency, levels and predictors of potential drug-drug interactions in a pediatrics ward of a teaching hospital in Pakistan. Trop J Pharm Res. 2013;12:401-6.

Rafi MS, Naqvi SB, Khan MU, Fayyaz M, Ashraf N, Khan MA, et al. Evaluation of potential drug-drug interactions with antidepressants in two tertiary care hospitals. J Clin Diagn Res. 2015;9:FC05-8.

Vandael E, Marynissen T, Reyntens J, Spriet I, Vandenberghe J, Willems R, et al. Frequency of use of QT-interval prolonging drugs in psychiatry in Belgium. Int J Clin Pharm. 2014;36:757-65.

Van-Leeuwen RW, Brundel DH, Neef C, Van-Gelder T, Mathijssen RH, Burger DM, et al. Prevalence of potential drug–drug interactions in cancer patients treated with oral anticancer drugs. Br J Cancer. 2013;108:1071-8.

Chelkeba L, Alemseged F, Bedada W. Assessment of potential drug-drug interactions among outpatients receiving cardiovascular medications at Jimma University specialized hospital, south West Ethiopia. Int J Basic Clin Pharmacol. 2013;2:144-52.

Feinstein J, Dai D, Zhong W, Freedman J, Feudtner C. Potential drug−drug interactions in infant, child, and adolescent patients in Children’s hospitals. Pediatrics. 2015;135:e99-108.

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;5:44-8.

Chavda NB, Solanky PP, Baria H, Naik R, Bharti 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;5:236-42.

Aparasu R, Baer R, Aparasu A. Clinically important potential drug-drug interactions in outpatient settings. Research in Social and Administrative Pharmacy. 2007;3(4):426-37.

Janchawee B, Wongpoowarak W, Owatranporn T, Chongsuvivatwong V. Pharmacoepidemiologic study of potential drug interactions in outpatients of a university hospital in Thailand. J Clin Pharm Ther. 2005;30:13-20.

Saeed A, Ibrahim H. Reasons for the problems faced by patients in government hospitals: results of a survey in a government hospital in Karachi, Pakistan. J Pak Med Assoc. 2005;55:45-7.

Henriksen K, Battles JB, Keyes MA, Grady ML. Advances in patient safety: new directions and alternative approaches. Agency for Healthcare Research and Quality. Available at: https://www.academia.edu/9612902/Using_Patient_Complaints_to_Promote_Patient_Safety_Agency_for_Healthcare_Research_and_Quality_Advances_in_Patient_Safety_New_Directions_and_Alternative_Approaches_Volume_2_2008. Accessed on 20 June 2020.

Micromedex Database, Truven health analytics, Greenwood Village, Colorado, USA. Available at: https://www.micromedexsolutions.com/micromedex2/librarian. Accessed 24 June 2019.

Jazbar J, Locatelli I, Horvat N, Kos M. Clinically relevant potential drug-drug interactions among outpatients: A nationwide database study. Res Social Adm Pharm. 2018;14(6):572-80.