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      Drug–Drug Interactions and Prescription Appropriateness at Hospital Discharge: Experience with COVID-19 Patients

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          Abstract

          Background

          Patients with coronavirus disease 2019 (COVID-19) are often elderly, with comorbidities, and receiving polypharmacy, all of which are known factors for potentially severe drug–drug interactions (DDIs) and the prescription of potentially inappropriate medications (PIMs).

          Objective

          The aim of this study was to assess the risk of DDIs and PIMs in COVID-19 patients at hospital discharge.

          Method

          Patients with a proven diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were hospitalized between 21 February and 30 April 2020, treated with at least two drugs, and with available information regarding pharmacological treatments upon admission and at discharge were considered. The appropriateness of drug prescriptions was assessed using INTERcheck ®.

          Results

          A significant increase in the prescription of proton pump inhibitors and heparins was found when comparing admission with hospital discharge (from 24 to 33% [ p < 0.05] and from 1 to 17% [ p < 0.01], respectively). The increased prescription of heparins at discharge resulted in a highly significant increase in the potentially severe DDIs mediated by this class of drugs. 51% of COVID-19 patients aged > 65 years had at least one PIM upon admission, with an insignificant increment at discharge (58%).

          Conclusion

          An increased number of prescribed drugs was observed in COVID-19 patients discharged from our hospital. The addition of heparins is appropriate according to the current literature, while the use of proton pump inhibitors is more controversial. Particular attention should be paid to the risk of bleeding complications linked to heparin-based DDIs.

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          Most cited references20

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          Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

          Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.
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            Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial

            Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) is associated with substantial mortality and use of health care resources. Dexamethasone use might attenuate lung injury in these patients.
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              • Record: found
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              Aging in COVID-19: Vulnerability, immunity and intervention

              The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic was first reported in Wuhan, China in December 2019, moved across the globe at an unprecedented speed, and has caused a profound and yet still unfolding health and socioeconomic impacts. SARS-CoV-2, a β-coronavirus, is a highly contagious respiratory pathogen that causes a disease that has been termed the 2019 coronavirus disease (COVID-19). Clinical experience thus far indicates that COVID-19 is highly heterogeneous, ranging from being asymptomatic and mild to severe and causing death. Host factors including age, sex, and comorbid conditions are key determinants of disease severity and progression. Aging itself is a prominent risk factor for severe disease and death from COVID-19. We hypothesize that age-related decline and dysregulation of immune function, i.e., immunosenescence and inflammaging play a major role in contributing to heightened vulnerability to severe COVID-19 outcomes in older adults. Much remains to be learned about the immune responses to SARS-CoV-2 infection. We need to begin partitioning all immunological outcome data by age to better understand disease heterogeneity and aging. Such knowledge is critical not only for understanding of COVID-19 pathogenesis but also for COVID-19 vaccine development.
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                Author and article information

                Contributors
                cristina.gervasoni@unimi.it
                Journal
                Drugs Aging
                Drugs Aging
                Drugs & Aging
                Springer International Publishing (Cham )
                1170-229X
                1179-1969
                1 March 2021
                1 March 2021
                : 1-6
                Affiliations
                [1 ]GRID grid.144767.7, ISNI 0000 0004 4682 2907, Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli-Sacco University Hospital, ; Milan, Italy
                [2 ]GRID grid.507997.5, ISNI 0000 0004 5984 6051, Unit of Clinical Pharmacology, , ASST Fatebenefratelli-Sacco University Hospital, ; Milan, Italy
                [3 ]Department of Neurosciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
                [4 ]GRID grid.476007.2, ISNI 0000 0000 9583 0138, ANMCO Research Center, ; Florence, Italy
                [5 ]GRID grid.417010.3, ISNI 0000 0004 1785 1274, Maria Cecilia Hospital, GVM Care and Research, ; Cotignola, Italy
                [6 ]GRID grid.507997.5, ISNI 0000 0004 5984 6051, Department of Infectious Diseases, , ASST Fatebenefratelli-Sacco University Hospital, ; Via GB Grassi 74, 20157 Milan, Italy
                Author information
                http://orcid.org/0000-0002-4922-6495
                Article
                840
                10.1007/s40266-021-00840-y
                7917961
                33646509
                d927ecb8-a5df-41c6-8015-f4b59535ed4d
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 28 January 2021
                Funding
                Funded by: Università degli Studi di Milano
                Categories
                Original Research Article

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