Objective: The objective of this study was to study the prevalence and severity of possible drug-drug interactions (DDIs) among the geriatric patients.Methods: The present study was a retrospective cross-sectional study. Case records of geriatric inpatients from the medical records department were included in the study and the case records of all the remaining age group inpatients were excluded from the study. All the collected cases were subjected to check for the DDIs using the software Micromedex 2.0 and were categorized into minor, moderate, and major based on the severity.Results: In this study, a total of 85 cases were screened for possible DDIs, and among them, 54 cases were found to be with 179 possible DDIs. The prevalence was observed to be 63.5%. Most of the possible DDIs were found to be with moderate severity (65.4%) followed by major (25.7%). Majority of the possible DDIs were observed in the Department of General Medicine (83.2%) followed by chest and tuberculosis (7.8%).Conclusion: Majorly, the severity of interactions was found to be moderate in this study. To reduce the DDIs, rationale prescriptions have to be prescribed by considering the risk-benefit ratio. Geriatrics should be prescribed very cautiously because the age-related pharmacokinetics plays a significant role. By taking all the above aspects into consideration, clinical pharmacist should play a crucial role in the prevention and management of DDIs, especially in geriatrics.Â

Kumar Sv, Suresh

N, Devanna

Ravindra Reddy, Kandula

Sripada, Ramam

English

Innovare Academic Sciences: E-Journals

Vol 11, Issue 11, 2018Online - 2455-3891 Print - 0974-2441PREVALENCE AND SEVERITY OF POSSIBLE DRUG-DRUG INTERACTIONS AMONG THE GERIATRIC PATIENTS AT AN INDIAN TERTIARY CARE TEACHING HOSPITALRAMAM SRIPADA1, SURESH KUMAR SV2*, DEVANNA N3, KANDULA RAVINDRA REDDY41Research Scholar, Department of Pharmacy Practice, CES College of Pharmacy, Kurnool, Andhra Pradesh, India. 2Department of Pharmacognosy, CES College of Pharmacy, Kurnool, Andhra Pradesh, India. 3Director-OTPRI, JNTUA, Anantapur, Andhra Pradesh, India. 4Department of Pharmaceutics, PRRM College of Pharmacy, Kadapa, Andhra Pradesh, India. Email: sureshsolleti@gmail.comReceived: 06 June 2018, Revised and Accepted: 29 June 2018ABSTRACTObjective: The objective of this study was to study the prevalence and severity of possible drug-drug interactions (DDIs) among the geriatric patients.Methods: The present study was a retrospective cross-sectional study. Case records of geriatric inpatients from the medical records department were included in the study and the case records of all the remaining age group inpatients were excluded from the study. All the collected cases were subjected to check for the DDIs using the software Micromedex 2.0 and were categorized into minor, moderate, and major based on the severity.Results: In this study, a total of 85 cases were screened for possible DDIs, and among them, 54 cases were found to be with 179 possible DDIs. The prevalence was observed to be 63.5%. Most of the possible DDIs were found to be with moderate severity (65.4%) followed by major (25.7%). Majority of the possible DDIs were observed in the Department of General Medicine (83.2%) followed by chest and tuberculosis (7.8%).Conclusion: Majorly, the severity of interactions was found to be moderate in this study. To reduce the DDIs, rationale prescriptions have to be prescribed by considering the risk-benefit ratio. Geriatrics should be prescribed very cautiously because the age-related pharmacokinetics plays a significant role. By taking all the above aspects into consideration, clinical pharmacist should play a crucial role in the prevention and management of DDIs, especially in geriatrics.Keywords: Drug-drug interactions, Geriatrics, Polypharmacy. INTRODUCTIONImproving the health-related quality of life in geriatric patients is one of the significant challenges faced by the health-care fraternity [1,2]. When compared to younger individuals, individuals over the age of 65 years are more likely to be on drug therapy. Usually, they used to be under polypharmacy due to comorbid disease conditions [3,4]. Polypharmacy is a significant risk factor in resulting the drug-drug interactions (DDIs) [5-7]. A DDI can be defined as a clinically meaningful alteration in the effect of the object drug as a result of the coadministration of the precipitant drug [8-10]. Aging associated with altered drug pharmacokinetics contributes to DDIs that represent a considerable source of preventable harm in geriatric patients [11-15]. A recent study on the incidence and preventability of adverse drug events among the older persons in the ambulatory setting revealed that about 13% of preventable prescribing errors were involved with drug interactions [16]. According to a study in Finland, about 4.8% of the residents were observed to be with significant drug interactions clinically [17]. A higher prevalence of potentially harmful drug combinations (25%) was reported by a study from Taiwan in the year of 2008 [18]. In developing countries, little information is available about the prevalence of DDIs in geriatrics [19]. Hence, in this study, we made an attempt to assess the prevalence and severity of possible DDIs among the geriatric patients.METHODSThe present study was a retrospective cross-sectional study, conducted at Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India. This study was approved by the Institutional Ethics Committee (No: 97/2015). Case records of the geriatric inpatients (≥65 years) from the medical records department were included in the study and the case records of all the remaining age group inpatients were excluded from the study. All the collected cases were subjected to check for the possible DDIs using the software Micromedex 2.0 and were categorized into minor, moderate, and major based on the severity [17-20].Statistical analysisSPSS 21.0 was used to perform the statistical analysis. Chi-square test was performed and p value was obtained by two-tailed method at 95% confidence interval.RESULTSIn our study, a total of 85 cases were screened for DDIs using the software. Among them, 54 cases were observed with 179 possible DDIs, and the prevalence was observed to be 63.5%. Table 1 represents the gender-wise categorization of the patients involved in the study and Fig. 1 represents the prevalence of drug-drug interactions.Table 2 represents the age-wise categorization of the patients observed with possible interactions. Among the 54 cases observed with possible DDIs 35 (64.8%) were observed to be in the age group of 65–69 years, 11 (20.4%) were in the age group of 70–74 years, 5 (9.3%) were in the age group of 75–79 years, and 3 (5.6%) were in the age group of 80–84 years.Fig. 2 graphically represents the type of polypharmacy observed among the prescriptions observed with possible DDIs. Among them, 38  (70.4%)  were  observed  with  major  polypharmacy  (≥9  drugs), 11 (20.4%) were observed with moderate polypharmacy (6–8 drugs), and 5 (9.2%) were observed with minor polypharmacy (3–5 drugs).© 2018 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2018.v11i11.27775Research Article122Asian J Pharm Clin Res, Vol 11, Issue 11, 2018, 121-123 Sripada et al. Table 3 represents the severity of possible DDIs involved in the study. Among the 179 possible DDIs, 16 (8.9%) were found to be minor, 117 (65.4%) were found to be moderate, and 46 (25.7%) were found to be major interactions.Fig. 3 represents the department-wise categorization of possible DDIs among the geriatric patient population. Among the total possible DDIs observed in this study, 83.2% were observed in the Department of General Medicine, 7.8% were observed in the Department of Chest and Tuberculosis (TB), 4.5% were in the Department of Gynecology and Obstetrics, and again, 4.5% were in the Department of Orthopedics. Table 4 represents some of the frequently observed possible DDIs in this study.DISCUSSIONDDIs are the significant subgroup of adverse drug events that are highly prevalent in geriatric patients. In this study, a total of 85 cases were screened for possible DDIs, and among them, 54 cases were found to be with possible DDIs. Among them, females (57.4%) were found to be with more number of possible DDIs when compared to males (42.6%). The prevalence was observed to be 63.5%. The prevalence of possible DDIs in the age group of 65–69 years (64.8%) was found to be high followed by the age group of 70–74 years (20.4%). This result was found to be differed from the study done by Rahmawati et al. as their study revealed very less prevalence (16%) of possible DDIs in the age group of 65–69 years [19].Geriatric patients would be more prone to DDIs due to the age-related physiologic changes and increased risk of developing diseases related to age when compared to younger patients. Polypharmacy can be observed in the prescriptions which were prescribed to treat the chronic diseases. In this study, the majority of the prescriptions were observed to be with major polypharmacy (70.4%) followed by moderate polypharmacy (20.4%) as geriatric patients were mainly observed with multiple disease conditions. Most of the possible DDIs were found to be with moderate severity (65.4%) followed by major (25.7%). Majority of the possible DDIs were observed in the Department of General Medicine (83.2%) followed by the chest and TB department (7.8%).CONCLUSIONIn this study, the prevalence of possible DDIs among the geriatrics was found to be 63.5%. Majority of the prescriptions were observed with major polypharmacy. Prescribing the drugs in geriatrics is a unique challenge and polypharmacy become a significant consideration. Polypharmacy became more common to manage the complex and chronic diseases in geriatrics, and thus, DDIs became a major concern in clinical practice. Majorly, the severity of interactions was found to be moderate in geriatrics in our study. To reduce the DDIs, rationale Table 1: Gender-wise categorization of patients involved in the studyGender Cases observed with interactions (%)Cases observed without interactions (%)Total (%) χ2 value p valueMale 23 (42.6) 16 (51.6) 39 (45.9) 0.645 0.42Female 31 (57.4) 15 (48.4) 46 (54.1)Total 54 (100) 31 (100) 85 (100)Table 2: Age-wise categorization of patients with drug-drug interactionsAge Male (%) Female (%) Total (%)65–69 15 (65.2) 20 (64.5) 35 (64.8)70–74 4 (17.4) 7 (22.6) 11 (20.4)75–79 2 (8.7) 3 (9.7) 5 (9.3)80–84 2 (8.7) 1 (3.2) 3 (5.6)Total 23 (100) 31 (100) 54 (100)Table 3: Severity of possible DDIs involved in the studySeverity Male (%) Female (%) Total (%) χ2 value p valueMinor 5 (6.9) 11 (10.3) 16 (8.9) 2.512 0.28Moderate 52 (72.2) 65 (60.8) 117 (65.4)Major 15 (20.9) 31 (28.9) 46 (25.7)Total 72 (100) 107 (100) 179 (100)DDIs: Drug-drug interactionsFig. 1: Prevalence of possible drug-drug interactions among the geriatric patientsFig. 2: Types of polypharmacy involved in the studyFig 3: Department-wise categorization of possible drug-drug interactions among the geriatric patient population123Asian J Pharm Clin Res, Vol 11, Issue 11, 2018, 121-123 Sripada et al. prescriptions have to be prescribed by considering the risk-benefit ratio. Geriatrics should be prescribed very cautiously because the age-related pharmacokinetics plays a significant role. By taking all the above aspects into consideration, clinical pharmacist should play a crucial role in the prevention and management of DDIs in geriatrics especially.LIMITATIONThis study with a prospective type of approach along with the involvement of other health-care professionals would show a significant impact in screening the clinically encountered DDIs for providing the better pharmaceutical care for the patients by the direct involvement of the clinical pharmacist.AUTHORS CONTRIBUTIONAll authors had equally contributed to the research work.CONFLICTS OF INTERESTThe authors declare no conflicts of interest.REFERENCES1. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014;13:57-65.2. Kim HA, Shin JY, Kim MH, Park BJ. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One 2014;9:e98043.3. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: The slone survey. JAMA 2002;287:337-44.4. Nolan L, O’Malley K. Prescribing for the elderly. Part I: Sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc 1988;36:142-9.5. Doubova Dubova SV, Reyes-Morales H, Torres-Arreola Ldel P, 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;7:147.6. Aparasu R, Baer R, Aparasu A. Clinically important potential drug-drug interactions in outpatient settings. Res Social Adm Pharm 2007;3:426-37.7. Yanti E, Kristin E, Yasmina A. Potential drug interactions in hypertensive patients in Liwa district hospital, Lampung Barat, Indonesia. Int J Pharm Pharm Sci 2017;9:134-8.8. Hines LE, Murphy JE. Potentially harmful drug-drug interactions in the elderly: A review. Am J Geriatr Pharmacother 2011;9:364-77.9. Vanitha Jyothi N, Bharathi DR, Prakruthi GM. Evaluation of drug-drug interactions in patients of general medicine, ICU and emergency departments at a tertiary care hospital. Int J Curr Pharm Res 2018;10:68-71.10. Murthy NV, Krishnaveni K, Freeda RM, Kumar RS. Assessment of potential drug–drug interaction in stroke patients. Int J Pharm Pharm Sci 2016;8:221-4.11. Seymour RM, Routledge PA. Important drug-drug interactions in the elderly. Drugs Aging 1998;12:485-94.12. Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet 2007;370:185-91.13. Hilmer SN, McLachlan AJ, Le Couteur DG. Clinical pharmacology in the geriatric patient. Fundam Clin Pharmacol 2007;21:217-30.14. Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther 2009;85:86-8.15. McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother 2002;36:1331-6.16. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC. Among older persons in the ambulatory setting incidence and preventability of adverse drug events. JAMA 2003;289:1107-16.17. Hosia-Randell HM, Muurinen SM, Pitkälä KH. Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland: A cross-sectional study. Drugs Aging 2008;25:683-92.18. Dolton MJ, Pont L, Stevens G, McLachlan AJ. Prevalence of potentially harmful drug interactions in older people in Australian aged-care facilities. J Pharm Pract Res 2012;42:33-6.19. Rahmawati F, Hidayati N, Rochmah W, Sulaiman SA. Potentiality of drug-drug interactions in hospitalized geriatric patients in a private hospital, Yogyakarta, Indonesia. Asian J Pharm Clin Res 2010;3:191-4.20. Ramam S, Kumar SV, Devanna N, Reddy KR. Prevalence and severity of possible drug-drug interactions in the inpatient department of internal medicine. Int J Pharm Clin Res 2016;8:1212-4.Table 4: Examples of interactions observed in the studyMajor interactions Moderate interactions Minor interactionsMetronidazole+Ondansetron Atorvastatin+Clopidogrel Aspirin+PhenytoinRifampicin+Phenytoin Dexamethasone+Rifampicin Bisacodyl+RanitidineCiprofloxacin+Metronidazole Ciprofloxacin+Diclofenac Isoniazid+Theophylline

PREVALENCE AND SEVERITY OF POSSIBLE DRUG-DRUG INTERACTIONS AMONG THE GERIATRIC PATIENTS AT AN INDIAN TERTIARY CARE TEACHING HOSPITAL

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PREVALENCE AND SEVERITY OF POSSIBLE DRUG-DRUG INTERACTIONS AMONG THE GERIATRIC PATIENTS AT AN INDIAN TERTIARY CARE TEACHING HOSPITAL

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