Study of Potential Drug-Drug Interactions in Prescriptions of University- Based Pharmacies
-
Sarah Mousavi
,
Molood Norouzi
,
Asieh Ashouri
,
Mohammad Reza Javadi
,
Kheirollah Gholami
,
Molouk Hadjibabaie
Abstract
Background: Drug-Drug Interactions (DDIs) are adverse reactions caused by a combination of drugs; they are often predictable and therefore avoidable or manageable. The objective of this study was to evaluate the nature, type and prevalence of potential DDIs in prescriptions dispensed in university-based community pharmacies in Tehran, Iran.
Methods: From July 2012 to February 2014, sample of 1260 prescriptions were collected from community and outpatient hospital pharmacies affiliated to Tehran University of Medical Sciences (TUMS), Iran. The prescriptions were assessed using the reference text “drug interaction facts”. The identified DDIs were categorized according to their level of significance into three classes (minor, moderate, major).
Results: At least one drug-drug interaction was present in 339 (26.9%) of prescriptions and a total of 751 cases of interactions were found in prescriptions. Major DDIs represented 7.3% of all DDIs detected, whereas moderate DDIs were 75% of all DDIs. The mean number of drugs per prescriptions was 3.2, with a median of 4 (range, 2-10).There was a positive association between number of prescribed drugs and occurrence of DDIs (OR: 2.14, 95% CI: 1.9-2.4). The prescriptions of medical specialist had greater risk of occurrence of moderate severity DDIs than general practitioners (OR: 1.52, 95%CI: 1.08-2.15).
Conclusion: Despite the prescriptions were collected from university-based pharmacies, but the overall prevalence of potential DDIs were high among patients. Physicians should be aware of potentially harmful DDIs. Meanwhile Pharmacists can contribute to the detection and prevention of drug-related injuries. Appropriate education, collaborating drug selection and pharmaceutical care are strongly recommended for physicians and pharmacists.
Mannheimer B, Ulfvarson J, Eklöf S, et al. Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic. Eur J Clin Pharmacol 2006;62(12):1075-81.
Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279(15):1200-5.
Chyka PA. How many deaths occur annually from adverse drug reactions in the United States? Am J Med 2000;109(2):122-30.
Hajebi G, Mortazavi SA. An investigation of drug interactions in hospital pharmacy prescriptions. IJPR 2002;1:15-9.
Moore N, Lecointre D, Noblet C, Mabille M. Frequency and cost of serious adverse drug reactions in a department of general medicine. British J Clin Pharmacol 1998;45(3):301-8.
Montamat S, Cusack B. Overcoming problems with polypharmacy and drug misuse in the elderly. Clinics Geriatr Med 1992;8(1):143-58.
Ahmadizar F, Soleymani F, Abdollahi M. Study of drug-drug interactions in prescriptions of general practitioners and specialists in Iran 2007-2009. IJPR 2011;10(4):921-31.
Ebrahimzadeh MA GK. Evaluation of drug interactions of Non steroidal Anti inflammatory drugs in prescriptions of Sari city. Mazandaran University of Medical Sciences. [Thesis]. 2000.
MortezaSemnani K, Saeedi M, Qari Pour U. Evaluation of drug interactions of Cardiovascular drugs in insurance prescriptions of Sari city - 1998-99 . Mazandaran University of Medical Sciences Journal 2000; 11(32): 93-87.
Nabavizadeh SH, Khoshnevisan F. Drug interactions in prescriptions of general practitioners in yasuj city. Armaghan Danesh 2003;7(28): 53-9.
Rafieii H, Arab M, Ranjbar H, et al. The prevalence of potential drug interactions in Intensive Care Units. Int J Crit Care Nurs 2012;4(4):191-6.
Rashidi K, Senobar Tahaee S. Assessment of drug interactions in medical insurance prescriptions in Kurdistan province in 2000. Scientific Journal of Kurdistan University of Medical Sciences 2005;10(3):78-84.
Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS one 2009;4(2):e4439.
Fokter N, Možina M, Brvar M. Potential drug-drug interactions and admissions due to drug-drug interactions in patients treated in medical departments. Wiener klinische Wochenschrift 2010;122(3-4):81-8.
Pasina L, Djade CD, Nobili A, et al. Drug–drug interactions in a cohort of hospitalized elderly patients. Pharmacoepidemiol Drug Saf 2013;22(10):1054-60.
Doubova SV, Reyes-Morales H, del Pilar Torres-Arreola L, 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(1):147.
Lopez-Picazo JJ, Ruiz JC, Sanchez JF, et al. Prevalence and typology of potential drug interactions occurring in primary care patients. Eur J Gen Pract 2010;16(2):92-9.
Abarca J, Malone DC, Armstrong EP, et al. Concordance of severity ratings provided in four drug interaction compendia. Journal of the American Pharmacists Association: JAPhA 2003;44(2):136-41.
Jankel C, Speedie S. Detecting drug interactions: a review of the literature. Ann Pharmacother 1990;24(10):982-9.
Soleymani F, Valadkhani M, Dinarvand R. Challenges and achievements of promoting rational use of drugs in Iran. Iranian J Publ Health. 2009;38(Suppl. 1):166-8.
Mohanty B, Aswini M, Hasamnis A, Patil S, Murty K, Jena S. Prescription pattern in the department of medicine of a tertiary care hospital in South India. J Clin Diagnos Res 2010;3:2047-51.
Williams D, Bennett K, Feely J. The application of prescribing indicators to a primary care prescription database in Ireland. Eur J Clin Pharmacol 2005;61(2):127-33.
Zou J, Li L, Zhang C, Yan Y, Gao F, Zhang H. Analysis of outpatient prescription indicators and trends in Chinese Jingzhou Area between September 1 and 10, 2006-2009. African J Pharm Pharmacol 2011;5(2): 270-5.
Nobili A, Pasina L, Tettamanti M, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther 2009;34(4):377-86.
Gagne J, Maio V, Rabinowitz C. Prevalence and predictors of potential drug–drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther 2008;33(2):141-51.
Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly. Drug Saf 2007;30(10):911-8.
Åstrand B, Åstrand E, Antonov K, Petersson G. Detection of potential drug interactions–a model for a national pharmacy register. Eur J Clin Pharmacol 2006;62(9):749-56.
Schuler J, Dückelmann C, Beindl W, Prinz E, Michalski T, Pichler M.Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wiener klinische Wochenschrift 2008;120(23-24): 733-41.
Weideman RA, Bernstein IH, McKinney WP. Pharmacist recognition of potential drug interactions. Am J Health Sys Pharm 1999;56(15):1524-9.
Blix HS, Viktil KK, Reikvam Å, et al. The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin pharmacol 2004;60(9):651-8.
Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother 2008;42(7-8):1017-25.
Krähenbühl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krähenbühl S. Drug-related problems in hospitals. Drug Saf 2007;30(5):379- 407.
Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag 2005;1(1):39-48.
Guédon-Moreau L, Ducrocq D, Duc M-F, et al. Absolute contraindications in relation to potential drug interactions in outpatient prescriptions: analysis of the first five million prescriptions in 1999. Eur J Clin Pharmacol 2003;59(8-9):689-95.
Sproule BA, Naranjo CA, Bremner KE, Hassan PC. Selective serotonin reuptake inhibitors and CNS drug interactions. Clin Pharmacokinetics 1997;33(6):454-71.
Izzo AA, Di Carlo G, Borrelli F, Ernst E. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardiol 2005;98(1):1- 14.
Hodsman GP, Johnston CI. Angiotensin converting enzyme inhibitors: drug interactions. J Hypertens 1987;5(1):1-6.
Wells PS, Holbrook AM, Crowther NR, Hirsh J. Interactions of warfarin with drugs and food. Ann Intern Med 1994;121(9):676-83.
| Files | ||
| Issue | Vol 2, No 2 (Spring 2014) | |
| Section | Original Article(s) | |
| Keywords | ||
| Drug Interactions Community Pharmacy Services Hospital Pharmacy Services Prescriptions Iran | ||
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