Out-patients Prescriptions are Safe from Drug Interactions or Not: A Pilot Study Report

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Abstract

The objective of the research work was to analysis the out patients drug interactions and alerts the healthcare professionals to prevent the future complications. The study was done in three pharmacies within a 200 meters distance of each other. The doctors involved were made aware of the study but data were collected without their knowledge. All prescriptions presented to the three pharmacies were analyzed during the five-month study period. A total of 500 prescriptions were analyzed and 64 drug-drug interactions were detected giving a drug-drug interaction rate of 12.8 percent but 436 (87.2%) prescriptions are free from drug interactions. Moderate drug interactions were found in 10.2%, Severe were 2.6% and contraindicated were 0% and also disease wise drug interaction analysis were carried out during the study results, more number of drug interactions reported in central nerves system followed by diabetes mellitus. Outpatient visits resulted in minimal numbers of clinically important drug-drug interactions, these interactions can have significant implications due to medication-related morbidity and mortality. Pharmacists can play a critical role in managing the medication therapy of patients at risk for clinically important drug-drug interactions.

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Drug-drug interactions among elderly patients hospitalized for drug toxicity.

David Juurlink, Muhammad Mamdani, Alexander Kopp … (2003)

Drug-drug interactions are a preventable cause of morbidity and mortality, yet their consequences in the community are not well characterized. To determine whether elderly patients admitted to hospital with specific drug toxicities were likely to have been prescribed an interacting drug in the week prior to admission. Three population-based, nested case-control studies. Ontario, Canada, from January 1, 1994, to December 31, 2000. All Ontario residents aged 66 years or older treated with glyburide, digoxin, or an angiotensin-converting enzyme (ACE) inhibitor. Case patients were those admitted to hospital for drug-related toxicity. Prescription records of cases were compared with those of controls (matched on age, sex, use of the same medication, and presence or absence of renal disease) for receipt of interacting medications (co-trimoxazole with glyburide, clarithromycin with digoxin, and potassium-sparing diuretics with ACE inhibitors). Odds ratio for association between hospital admission for drug toxicity (hypoglycemia, digoxin toxicity, or hyperkalemia, respectively) and use of an interacting medication in the preceding week, adjusted for diagnoses, receipt of other medications, the number of prescription drugs, and the number of hospital admissions in the year preceding the index date. During the 7-year study period, 909 elderly patients receiving glyburide were admitted with a diagnosis of hypoglycemia. In the primary analysis, those patients admitted for hypoglycemia were more than 6 times as likely to have been treated with co-trimoxazole in the previous week (adjusted odds ratio, 6.6; 95% confidence interval, 4.5-9.7). Patients admitted with digoxin toxicity (n = 1051) were about 12 times more likely to have been treated with clarithromycin (adjusted odds ratio, 11.7; 95% confidence interval, 7.5-18.2) in the previous week, and patients treated with ACE inhibitors admitted with a diagnosis of hyperkalemia (n = 523) were about 20 times more likely to have been treated with a potassium-sparing diuretic (adjusted odds ratio, 20.3; 95% confidence interval, 13.4-30.7) in the previous week. No increased risk of drug toxicity was found for drugs with similar indications but no known interactions (amoxicillin, cefuroxime, and indapamide, respectively). Many hospital admissions of elderly patients for drug toxicity occur after administration of a drug known to cause drug-drug interactions. Many of these interactions could have been avoided.

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Assessment of potential drug-drug interactions with a prescription claims database.

Michelle B Gerke-Duncan, Elizabeth Hutchins, Kiliaan van Wees … (2005)

The prevalence of 25 clinically important potential drug-drug interactions (DDIs) in a population represented by the drug claims database of a pharmacy benefit management company (PBM) was studied. A retrospective cross-sectional analysis of pharmaceutical claims for almost 46 million participants in a PBM was conducted to determine the frequency of 25 DDIs previously identified as clinically important. A DDI was counted when drugs in potentially interacting combinations were dispensed within 30 days of each other during a 25-month period between April 2000 and June 2002. The number of DDIs ranged from 37 for pimozide and an azole antifungal to 127,684 for warfarin and a nonsteroidal antiinflammatory drug (NSAID). The highest prevalence (278.56 per 100,000 persons) and highest case-exposure rate (242.7 per 1,000 warfarin recipients) occurred with the warfarin-NSAID combination. The combination with the lowest overall prevalence (cyclosporine and a rifamycin, 0.10/100,000) differed from the combination with the lowest case-exposure rate (pimozide and an azole antifungal, 0.028 per 1,000 azole antifungal recipients). Number of cases, prevalence, and case-exposure rates for both sexes generally increased with age. An estimated 374,000 plan participants were exposed to a clinically important DDI during a 25-month period. Between 20% and 46% of prescription drug claims were reversed (canceled) for a medication with a drug interaction when a warning about the interaction was sent to the pharmacy. Analysis of prescription claims data from a major PBM found that 374,000 of 46 million plan participants had been exposed to a potential DDI of clinical importance.

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Suboptimal prescribing in elderly outpatients: potentially harmful drug-drug and drug-disease combinations.

Chunliu Zhan, Rosaly Correa-de-Araujo, Michael R. Miller … (2005)

To assess the prevalence and correlates of potentially harmful drug-drug combinations and drug-disease combinations prescribed for elderly patients at outpatient settings. Retrospective analysis of the 1995-2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). Physician offices and hospital outpatient departments. Outpatient visits by patients aged 65 and older in the NAMCS and NHAMCS (n=70,203). Incidences of six drug-drug combinations and 50 drug-disease combinations that can place elderly patients at risk for adverse events according to expert consensus panels. Overall, 0.74% (95% confidence interval (CI)=0.65-0.83) of visits with two or more prescriptions had at least one inappropriate drug-drug combination, and 2.58% (95% CI=2.44-2.72) of visits with at least one prescription had one or more inappropriate drug-disease combinations. Of visits with a prescription of warfarin, 6.60% (95% CI=5.46-7.74) were prescribed a drug with potentially harmful interaction. Of patients with benign prostatic hypertrophy, 4.06% (95% CI=3.06-5.06) had at least one of six drugs that should be avoided. The number of drugs prescribed is most predictive of inappropriate drug-drug and drug-disease combinations. Potentially harmful drug-drug and drug-disease combinations occur in various degrees in outpatient care in the elderly population. Targeting combinations such as those involving warfarin that are high in prevalence and potential harm offers a practical approach to improving prescribing and patient safety.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Pharm Sci

Journal ID (iso-abbrev): Indian J Pharm Sci

Journal ID (publisher-id): IJPhS

Title: Indian Journal of Pharmaceutical Sciences

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0250-474X

ISSN (Electronic): 1998-3743

Publication date (Print): Sep-Oct 2011

Volume: 73

Issue: 5

Pages: 590-592

Affiliations

[1]Department of Pharmacology, M.P. Patel College of Pharmacy, Kapadwanj, Kheda-387 620, India

[1 ]Department of Clinical Pharmacy, A.R College of Pharmacy, Vallabh Vidya Nagar, Anand-388 120, India

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[* ] Address for correspondence E-mail: asathish1981@ 123456yahoo.co.in

Article

Publisher ID: IJPhS-73-590

DOI: 10.4103/0250-474X.99024

PMC ID: 3425076

PubMed ID: 22923877

SO-VID: 626e8b25-9a2d-43f4-b959-f698ca39cc5b

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 21 June 2010

Date revision received : 01 October 2011

Date accepted : 15 October 2011

Out-patients Prescriptions are Safe from Drug Interactions or Not: A Pilot Study Report

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Most cited references 11

Drug-drug interactions among elderly patients hospitalized for drug toxicity.

Assessment of potential drug-drug interactions with a prescription claims database.

Suboptimal prescribing in elderly outpatients: potentially harmful drug-drug and drug-disease combinations.

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