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 PP  Vol.5 No.4 , April 2014
Possibility of Drug-Drug Interaction in Prescription Dispensed by Community and Hospital Pharmacy
Abstract: Objective: To analyze the use of all subsidized prescription drugs including their use of drug combination generally accepted as carrying a risk of severe interactions. Methodology: In a cross sectional study, we analyzed all prescriptions (n = 1014) involving two or more drugs dispensed to the population (age range 4-85 years) from all pharmacies, clinics and hospitals. Data were stratified by age and sex, and frequency of common interacting drugs. Potential drug interactions were classified according to clinical relevance as significance of severity (types A: major, B: moderate, and C: minor) and documented evidence (types 1, 2, 3, and 4). Result and Discussion: The growing use of pharmacological agents means that drug interactions are of increasing interest for public health. Monitoring of potential drug interactions may improve the quality of drug prescribing and dispensing, and it might form a basis for education focused on appropriate prescribing. To make the manifestation of adverse interaction subside, management strategies must be exercised if two interacting drugs have to be taken with each other, involving: adjusting the dose of the object drug; spacing dosing times to avoid the interaction. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action they should take. Conclusion: It is unrealistic to expect clinicians to memorize the thousands of drug-drug interactions and their clinical significance, especially considering the rate of introduction of novel drugs and the escalating appreciation of the importance of pharmacogenomics. Reliable regularly updated decision support systems and information technology are necessary to help avert dangerous drug combinations.
Cite this paper: Kafeel, H. , Rukh, R. , Qamar, H. , Bawany, J. , Jamshed, M. , Sheikh, R. , Hanif, T. , Bokhari, U. , Jawaid, W. , Javed, Y. and Saleem, Y. (2014) Possibility of Drug-Drug Interaction in Prescription Dispensed by Community and Hospital Pharmacy. Pharmacology & Pharmacy, 5, 401-407. doi: 10.4236/pp.2014.54048.
References

[1]   Farkas, D., Shader, R.I., von Moltke, L.L. and Greenblatt, D.J. (2008) Mechanisms and Consequences of Drug-Drug Interactions. In: Gad, S.C., Ed., Preclinical Development Handbook: ADME and Biopharmaceutical Properties, John Wiley & Sons, Inc., Hoboken, 879-917. http://dx.doi.org/10.1002/9780470249031.ch25

[2]   Helms, R.A. and Quan, D.J. (2006) Text Books of Therapeutics Drug and Disease Management. Lippincott Williams and Wilkins, Philadelphia.

[3]   Ibrahim, Q.A. (2011) Hand Book of Drug Interaction and Mechanism of Interaction. Xilbris Corporation, Bloomington, 2-3.

[4]   Piscitellu, S.C., Rodvold, K.A. and Pai, M.P. (2011) Drug Interaction in Infectious Disease. 3rd Edition, Springerscience + Business Media, Berlin, 1-11.

[5]   Doubova, S.V., Reyes-Morales, H., del Pilar Torres-Arreola, L. and Suárez-Ortega, M. (2007) 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 Services Research, 7, 147. http://dx.doi.org/10.1186/1472-6963-7-147

[6]   Gagne, J.J., Maio, V. and Rabinowitz, C. (2008) Prevalence and Predictors of Potential Drug-Drug Interactions in Regione Emilia-Romagna, Italy. Journal of Clinical Pharmacy and Therapeutics, 33, 141-151.
http://dx.doi.org/10.1111/j.1365-2710.2007.00891.x

[7]   Glintborg, B., Andersen, S.E. and Dalhoff, K. (2005) Drug-Drug Interactions among Recently Hospitalised Patients— Frequent but Mostly Clinically Insignificant. European Journal of Clinical Pharmacology, 61, 675-681.
http://dx.doi.org/10.1007/s00228-005-0978-6

[8]   Vonbach, P., Dubied, A., Krähenbühl, S. and Beer, J.H. (2008) Prevalence of Drug-Drug Interactions at Hospital Entry and during Hospital Stay of Patients in Internal Medicine. European Journal of Internal Medicine, 19, 413-420.
http://dx.doi.org/10.1016/j.ejim.2007.12.002

[9]   Jyrkkä, J., Enlund, H., Lavikainen, P., Sulkava, R. and Hartikainen, S. (2011) Association of Polypharmacy with Nutritional Status, Functional Ability and Cognitive Capacity over a Three-Year Period in an Elderly Population. Pharmacoepidemiology and Drug Safety, 20, 514-522. http://dx.doi.org/10.1002/pds.2116

[10]   Rosholm, J.U., Bjerrum, L., Hallas, J., Worm, J. and Gram, L.F. (1998) Polypharmacy and the Risk of Drug-Drug Interactions among Danish Elderly. A Prescription Database Study. Danish Medical Bulletin, 45, 210-213.

[11]   Bjerrum, L., Søgaard, J., Hallas, J. and Kragstrup, J. (1998) Polypharmacy: Correlations with Sex, Age and Drug Regimen A Prescription Database Study. European Journal of Clinical Pharmacology, 54, 197-202.
http://dx.doi.org/10.1007/s002280050445

[12]   Haider, S.I., Johnell, K., Thorslund, M. and Fastbom, J. (2007) Trends in Polypharmacy and Potential Drug-Drug Interactions across Educational Groups in Elderly Patients in Sweden for the Period 1992-2002. International Journal of Clinical Pharmacology and Therapeutics, 45, 643-653. http://dx.doi.org/10.5414/CPP45643

[13]   Bjerrum, L., Lopez-Valcarcel B, G. and Petersen, G. (2008) Risk Factors for Potential Drug Interactions in General Practice. European Journal of General Practice, 14, 23-29. http://dx.doi.org/10.1080/13814780701815116

[14]   Egger, S.S., Drewe, J. and Schlienger, R.G. (2003) Potential Drug-Drug Interactions in the Medication of Medical Patients at Hospital Discharge. European Journal of Clinical Pharmacology, 58, 773-778.

[15]   Janchawee, B., Wongpoowarak, W., Owatranporn, T. and Chongsuvivatwong, V. (2005) Pharmacoepidemiologic Study of Potential Drug Interactions in Outpatients of a University Hospital in Thailand. Journal of Clinical Pharmacy and Therapeutics, 30, 13-20. http://dx.doi.org/10.1111/j.1365-2710.2004.00598.x

[16]   Merlo, J., Liedholm, H., Lindblad, U., Björck-Linné, A., Fält, J., Lindberg, G. and Melander, A. (2001) Prescriptions with Potential Drug Interactions Dispensed at Swedish Pharmacies in January 1999: Cross Sectional Study. British Medical Journal, 323, 427. http://dx.doi.org/10.1136/bmj.323.7310.427

[17]   Chen, Y.F., Avery, A.J., Neil, K.E., Johnson, C., Dewey, M.E. and Stockley, I.H. (2005) Incidence and Possible Causes of Prescribing Potentially Hazardous/Contraindicated Drug Combinations in General Practice. Drug Safety, 28, 67-80. http://dx.doi.org/10.2165/00002018-200528010-00005

[18]   Becker, M.L., Kallewaard, M., Caspers, P.W., Schalekamp, T. and Stricker, B.H. (2005) Potential Determinants of Drug-Drug Interaction Associated Dispensing in Community Pharmacies. Drug Safety, 28, 371-378.
http://dx.doi.org/10.2165/00002018-200528050-00001

[19]   Jagarlapudi, S.A. and Kishan, K.R. (2009) Database Systems for Knowledge-Based Discovery. In: Chemogenomics, Humana Press, New York, 159-172. http://dx.doi.org/10.1007/978-1-60761-274-2_6

[20]   Duda, S., Aliferis, C., Miller, R., Statnikov, A. and Johnson, K. (2005) Extracting Drug-Drug Interaction Articles from MEDLINE to Improve the Content of Drug Databases. AMIA Annual Symposium Proceedings Archive, 216-220.

[21]   Kuhlmann, J. and Mück, W. (2001) Clinical-Pharmacological Strategies to Assess Drug Interaction Potential during Drug Development. Drug Safety, 24, 715-725.

[22]   Trumic, E., Pranjic, N., Begic, L. and Becic, F. (2012) Prevalence of Polypharmacy and Drug Interaction among Hospitalized Patients: Opportunities and Responsibilities in Pharmaceutical Care. Materia Socio Medica, 24, 68-72.

[23]   Koh, Y., Kutty, F.B.M. and Li, S.C. (2005) Drug-Related Problems in Hospitalized Patients on Polypharmacy: The Influence of Age and Gender. Therapeutics and Clinical Risk Management, 1, 39-48.

[24]   Rosholm, J.U., Bjerrum, L., Hallas, J., Worm, J. and Gram, L.F. (1998) Polypharmacy and the Risk of Drug-Drug Interactions among Danish Elderly. A Prescription Database Study. Danish Medical Bulletin, 45, 210-213.

[25]   Seymour, R.M. and Routledge, P.A. (1998) Important Drug-Drug Interactions in the Elderly. Drugs & Aging, 12, 485-494. http://dx.doi.org/10.2165/00002512-199812060-00006

[26]   Cooney, D. and Pascuzzi, K. (2009) Polypharmacy in the Elderly: Focus on Drug Interactions and Adherence in Hypertension. Clinics in Geriatric Medicine, 25, 221-233. http://dx.doi.org/10.1016/j.cger.2009.01.005

[27]   Prybys, K., Melville, K., Hanna, J., Gee, A. and Chyka, P. (2002) Polypharmacy in the Elderly: Clinical Challenges in Emergency Practice: Part 1: Overview, Etiology, and Drug Interactions. Emergency Medicine Reports, 23, 145-153.

[28]   Rochon, P.A. (2013) Drug Prescribing for Older Adults.

[29]   Johnston, R.T., de Bono, D.P. and Nyman, C.R. (1992) Preventable Sudden Death in Patients Receiving Angiotensin Converting Enzyme Inhibitors and Loop/Potassium Sparing Diuretic Combinations. International Journal of Cardiology, 34, 213-215.

[30]   Wiltink, E.H. (1998) Medication Control in Hospitals: A Practical Approach to the Problem of Drug-Drug Interactions. Pharmacy World & Science, 20, 173-177.

[31]   Bonetti, P.O., Hartmann, K., Kuhn, M., Reinhart, W.H. and Wieland, T. (2000) Potential Drug Interactions and Number of Prescription Drugs with Special Instructions at Hospital Discharge. Praxis (Bern 1994), 89, 182-189.

[32]   Matthews Jr., M.K. (1998) Association of Ginkgo Biloba with Intracerebral Hemorrhage. Neurology, 50, 1933-1934.

 
 
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