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Title: Potential Drug-Drug interactions in Selected Chronic Diseases at Tertiary Care Hospitals of Peshawar, Paksitan
Authors: Khadim, Faiza
Keywords: Biological & Medical Sciences
Issue Date: 2020
Publisher: University of Peshawar, Peshawar.
Abstract: Chronic diseases are the leading causes of mortality and morbidity worldwide. Some chronic diseases like hypertension, stroke, diabetes mellitus, depression, and chronic obstructive pulmonary disease (COPD) are amongst the major causes of hospitalization. Polypharmacy is a commonly observed practice in patients suffering from chronic diseases because they require multiple drug treatment comprising anti-diabetics, anti-hypertensives, anti-depressants, anti-platelets, antibiotics, and corticosteroids. Most of these drugs have a high probability of causing drug-drug interactions (DDIs). Therefore, patients with chronic diseases have a greater tendency for exposure to drug-interactions. The present study was conducted in patients with selected chronic diseases to investigate the drugs’ prescribing pattern; prevalence/levels of potential DDIs (pDDIs) and their risk factors; and devise management/monitoring recommendations. In this study, a high prevalence of pDDIs was reported in five selected chronic diseases i.e., stroke (83.2%), hypertension(72.8%), diabetes mellitus (70%), depression (82.5%), and COPD (72.8%). Based on severity-wise prevalence, patients with stroke, hypertension, diabetes mellitus, and COPD were the most frequently exposed to moderate-pDDIs, while patients with depression were frequently exposed to major-pDDIs. Polypharmacy was commonly observed in all five chronic diseases that also increased the risk of pDDIs in each disease. Besides polypharmacy, odds ratios were significant in patients with stroke comorbid with diabetes mellitus (p = 0.001) & chronic kidney disease (p = 0.001); ≥6 drugs prescribed (p<0.001) in patients with hypertension; ≥31 years of age (p = 0.04) and ≥6 prescribed medicines (p<0.001) in patients with diabetes mellitus; ≥7 days of hospitalization (p = 0.07) in patients with depression; and ≥7 prescribed medicines (p<0.001) in patients with COPD. The most frequent prescribed drugs in patients with stroke were aspirin (n=310), rosuvastatin (268), ceftriaxone (180), and omeprazole (106); in patients with hypertension were furosemide (114), rosuvastatin (105), amlodipine (95), omeprazole (144), ceftriaxone (132), insulin (123), and aspirin (123); in patients with diabetes mellitus were insulin (278), ceftriaxone (145) and aspirin (181); in patients with depression were olanzapine (187), procyclidine (171), lorazepam (106), esomeprazole (99), and haloperidol (98); and in patients with COPD were ipratropium (276), albuterol (259), dexamethasone (226), and beclomethasone (196). Various drug-interactions resulted in adverse outcomes such as electrolyte disturbances and abnormalities in renal function tests were found with the concomitant use of non-steroidal anti-inflammatory drugs, angiotensin converting enzyme inhibitors, diuretics, and angiotensin receptor blockers. Hypoglycemia was reported with the combination of insulin with oral anti-diabetics or angiotensin receptor blockers or angiotensin converting enzyme inhibitors. Reduced efficacy and abnormal renal function were reported in patients with aspirin and angiotensin converting enzymes. Abnormalities in bleeding indicators were observed with combination of antiplatelet agents and anticoagulants. It is concluded that patients with hypertension, stroke, diabetes mellitusdepression and COPD are at higher risk to pDDIs. Polypharmacy, prolonged hospital stay, and comorbidities/complications are the most frequent predictors of pDDIs. Patient safety can be enhanced by careful monitoring of drug interactions associated adverse outcomes. This research will contribute to patients’ safety and optimization of drug therapy by general and specific management guidelines in clinical practices for minimization of DDIs related adverse outcomes.
Gov't Doc #: 20216
Appears in Collections:PhD Thesis of All Public / Private Sector Universities / DAIs.

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