Evaluation and Management of Drug-Drug Interactions in Patients Hospitalized in Nephrology and Post-Transplant Wards in a Teaching Hospital

  • Mojtaba Shafiekhani Shiraz University of Medical Sciences
  • Sara Tarighati Shiraz University of Medical Sciences
  • Ehsan Mirzaei Shiraz University of Medical Sciences
  • Soha Namazi Tehran University of Medical Sciences
Keywords: Adverse drug events, Clinical pharmacist, Drug-Drug interaction, Immunosuppressant, kidney transplant


Background: Kidney transplant patients usually take a combination of medications after transplantation; hence medication safety becomes an important issue in order to maintain the new organ working properly.

Objective: To evaluate the incidence and risk factors associated with potential drug-drug interactions (pDDIs) in hospitalized patients in Nephrology and Post-transplant wards to improve clinical management of pDDIs by a clinical pharmacist.

Methods: Patients in Nephrology and Post-transplant wards were screened for pDDIs, using the interaction screening program Lexi-comp resource®. After evaluating the detected pDDIs for clinical relevance, intervention was implemented through physicians or nurses for type D and X drug interactions. Intervention feedback, implemented recommendations and any probable adverse drug reactions were documented.

Results: During the study, 399 patients (239 in nephrology and 160 in post-transplant wards) plus 6105 drug orders were evaluated, and a total of 3263 DDIs were identified of which 827 (23.5%) were determined to be D and X classifications, and a total of 89.97 % of all hospitalized cases had at least 1 pDDIs. Factors that had the greatest influence on pDDI incidence included number of drugs and the admitted wards. Patients in post-transplant ward experienced 2.3 times more DDIs than patients in nephrology ward. In total, 78% of class X and D DDIs required intervention of which 75% were accepted and implemented by the physicians and nurses.

Conclusion: Clinically relevant pDDIs are common in patients in Nephrology and Post-transplant wards, and pharmacists play a critical role in detecting and managing this medical problem in hospitalized patients.

Author Biographies

Mojtaba Shafiekhani, Shiraz University of Medical Sciences

Department of clinical pharmacy

Ehsan Mirzaei, Shiraz University of Medical Sciences

Department of clinical pharmacy

Soha Namazi, Tehran University of Medical Sciences

Department of clinical pharmacy


1. van den Bemt PM, Fijn R, van der Voort PH, Gossen AA, Egberts TC, Brouwers JR. Frequency and determinants of drug administration errors in the intensive care unit. Crit Care Med. 2002;30(4):846-50.
2. 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(7456):15-9.
3. Wheeler AJ, Scahill S, Hopcroft D, Stapleton H. Reducing medication errors at transitions of care is everyone's business. Australian prescriber. 2018;41(3):73-7. doi:10.18773/austprescr.2018.021.
4. McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother. 2002;36(9):1331-6.
5. Espinosa-Bosch M, Santos-Ramos B, Gil-Navarro MV, Santos-Rubio MD, Marín-Gil R, Villacorta-Linaza P. Prevalence of drug interactions in hospital healthcare. Int J Clin Pharm. 2012;34(6):807-17.
6. Verbeeck RK, Musuamba FT. Pharmacokinetics and dosage adjustment in patients with renal dysfunction. Eur J Clin Pharmacol. 2009;65(8):757-73.
7. Wang H-Y, Chan AL, Chen M, Liao C, Tian Y, editors. Effects of pharmaceutical care intervention by clinical pharmacists in renal transplant clinics. Transplantation proceedings; 2008: Elsevier.
8. Peter WLS. Improving medication safety in chronic kidney disease patients on dialysis through medication reconciliation. Adv Chronic Kidney Dis. 2010;17(5):413-9.
9. Kaplan B, Mason NA, Shimp LA, Ascione FJ. Chronic hemodialysis patients. Part I: Characterization and drug-related problems. SAGE Publications; 1994.
10. Mirkov S. Implementation of a pharmacist medication review clinic for haemodialysis patients. N Z Med J. 2009;122(1297).
11. Mason NA, Bakus JL, editors. Strategies for reducing polypharmacy and other medication‐related problems in chronic kidney disease. Seminars in dialysis; 2010: Wiley Online Library.
12. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890-6.
13. Ghods AJ. The history of organ donation and transplantation in Iran. Exp Clin Transplant. 2014;12(suppl 1):38-41.
14. Saidi RF, Broumand B. Current Challenges of Kidney Transplantation in Iran: Moving Beyond The “Iranian Model”. Transplantation. 2018;102(8):1195-7.
15. Manitpisitkul W, McCann E, Lee S, Weir MR. Drug interactions in transplant patients: what everyone should know. Curr Opin Nephrol Hypertens. 2009;18(5):404-11.
16. Qiu C, Huang Y, Wang Q, Tian D, Zhang W, Hu Y et al. Boosting heterosubtypic neutralization antibodies in recipients of 2009 pandemic H1N1 influenza vaccine. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2012;54(1):17-24. doi:10.1093/cid/cir753.
17. Rama M, Viswanathan G, Acharya LD, Attur RP, Reddy PN, Raghavan SV. Assessment of Drug-Drug Interactions among Renal Failure Patients of Nephrology Ward in a South Indian Tertiary Care Hospital. Indian J Pharm Sci. 2012;74(1):63-8. doi:10.4103/0250-474x.102545.
18. Fulton MM, Riley Allen E. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005;17(4):123-32.
19. MacKinnon NJ, Hepler CD. Preventable Drug-related Morbidity in Older Adults-1. Indicator Development (Part 1 of a 2-part series). J Manag Care Spec Pharm. 2002;8(5):365-71.
20. Manley HJ, Cannella CA, Bailie GR, Peter WLS. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2005;46(4):669-80.
21. Joshua L, Devi PD, Guido S. Adverse drug reactions in nephrology ward inpatients of a tertiary care hospital. Indian J Med Sci. 2007;61(10):562-9.
22. Pranabjyoti M, DM M. Profile of Adverse Drug Reaction in Patients with Renal Disorders. IJHRMLP. 2017;3(1):51-4.
23. Dopour A, Hosseini F, Kanki K, Davoodpour S, Srinivas C, Shekar H. Prospective study on identification and assessment of potential drug-drug interactions in emergency medicine department at KIMS hospital and research centre. Int J Pharm Sci Rev Res 2016(1).
24. Reimche L, Forster AJ, Walraven C. Incidence and contributors to potential drug‐drug interactions in hospitalized patients. J Clin Pharmacol. 2011;51(7):1043-50.
25. Mannesse CK, Derkx F, De Ridder M, Man In't Veld A, Van Der Cammen T. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing. 2000;29(1):35-9.
26. Namazi S, Pourhatami S, Borhani-Haghighi A, Roosta S. Incidence of potential drug-drug interaction and related factors in hospitalized neurological patients in two Iranian teaching hospitals. ran J Med Sci. 2014;39(6):515.
27. Moura CS, Acurcio FA, Belo NO. Drug-drug interactions associated with length of stay and cost of hospitalization. Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques. 2009;12(3):266-72.
28. Shafiekhani M, Karimi S, Davarpanah Ma, Vazin A. Evaluating drug interactions, adverse drug reactions, and level of adherence to highly active antiretroviral therapy regimen amongst HIV-positive patients who referred to an AIDS healthcare center in Fars, southern Iran: the first multifaceted study from Iran. HIV & AIDS Review International Journal of HIV-Related Problems. 2017;16(1):24-31. doi:10.5114/hivar.2017.65334.
29. Jankovic SM, Pejcic AV, Milosavljevic MN, Opancina VD, Pesic NV, Nedeljkovic TT et al. Risk factors for potential drug-drug interactions in intensive care unit patients. J Crit Care. 2018;43:1-6. doi:10.1016/j.jcrc.2017.08.021.
30. Köhler G, Bode-Böger S, Busse R, Hoopmann M, Welte T, Böger R. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. INT J CLIN PHARM TH. 2000;38(11):504-13.
31. Riechelmann RP, Moreira F, Smaletz Ò, Saad ED. Potential for drug interactions in hospitalized cancer patients. Cancer Chemother Pharmacol. 2005;56(3):286-90.
32. 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(2):152-6. doi:10.4103/0253-7613.129303.
33. 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(6):413-20.
How to Cite
Shafiekhani M, Tarighati S, Mirzaei E, Namazi S. Evaluation and Management of Drug-Drug Interactions in Patients Hospitalized in Nephrology and Post-Transplant Wards in a Teaching Hospital. J Pharm Care. 8(1):16-22.
Original Article(s)