Kashyap Mandavi, D'Cruz Sanjay, Sachdev Atul, Tiwari Pramil
Research Centre, Montreal University . Montreal ( Canada ).
Department of General Medicine, Government Medical College & Hospital. Chandigarh ( India ).
Pharm Pract (Granada). 2013 Oct;11(4):191-5. doi: 10.4321/s1886-36552013000400003. Epub 2013 Dec 20.
In view of the multiple co-morbidities, the elderly patients receiving drugs are prone to suffer with drug interactions since they receive a greater number of drugs.
The study was undertaken to determine the prevalence of drug interactions, as well as their predictors.
The prescriptions of a total of 1510 inpatients were collected prospectively for 1.5 years from inpatients wards of public tertiary care teaching hospital. All the prescriptions were checked for drug interactions using the Micromedex® Drug-Reax database-2010 and Stockley's Drug Interactions. Regression analyses sought to determine predictors for the drug interaction.
The patients, with the average age of 67.2 ±0.2 years, were prescribed an average of 9.15 ±0.03 medications. It was found that out of 1510 prescriptions of inpatients, 126 (8.3%) prescriptions had one or more than one drug interaction. All the identified interactions were severe in nature. The top most interacting drugs were acetylsalicylic acid and anticoagulant (n=59). The second top most interacting drug combination was clopidogrel and proton pump inhibitors (n=51). The most commonly involved drugs in interactions were C (cardiovascular system) and A (alimentary tract and metabolism). Using multivariate binary logistic regression, multiple drugs (Odds Ratio=4.5; 95% Confidence Interval: - 2.38 -9.47) and multiple diagnoses (Odds Ratio=2.6; 95%CI: -1.40 -5.57) were found to be significant predictors for drug interaction.
The results of this study substantiate the occurrence of severe drug interactions among Indian elderly inpatients. In order to provide safer pharmaceutical care, the active involvement of clinical pharmacists is a potential option.
鉴于多种合并症，老年患者因用药数量较多，容易发生药物相互作用。
开展本研究以确定药物相互作用的发生率及其预测因素。
前瞻性收集了一家公立三级护理教学医院住院病房1.5年期间共1510例住院患者的处方。使用Micromedex® Drug-Reax数据库-2010和《斯托克利药物相互作用》对所有处方进行药物相互作用检查。回归分析旨在确定药物相互作用的预测因素。
患者平均年龄为67.2±0.2岁，平均用药9.15±0.03种。结果发现，在1510例住院患者处方中，126例（8.3%）处方存在一种或多种药物相互作用。所有已识别的相互作用均为严重相互作用。相互作用最多的药物是乙酰水杨酸和抗凝剂（n=59）。第二多的相互作用药物组合是氯吡格雷和质子泵抑制剂（n=51）。相互作用中最常涉及的药物是C（心血管系统）和A（消化道及代谢）。使用多变量二元逻辑回归分析发现，多种药物（比值比=4.5；95%置信区间：-2.38至-9.47）和多种诊断（比值比=2.6；95%置信区间：-1.40至-5.57）是药物相互作用的显著预测因素。
本研究结果证实了印度老年住院患者中存在严重药物相互作用。为了提供更安全的药学服务，临床药师的积极参与是一个潜在选择。
