Kovačević Milena, Vezmar Kovačević Sandra, Miljković Branislava, Radovanović Slavica, Stevanović Predrag
Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
Faculty of Medicine, University Clinical Hospital Center Bežanijska Kosa, University of Belgrade, Belgrade, Serbia.
Int J Clin Pract. 2017 Oct;71(10). doi: 10.1111/ijcp.13005. Epub 2017 Sep 4.
The aim was to describe the type and prevalence of potentially relevant drug-drug interactions (pDDIs) in a population of patients admitted for cardiovascular diseases (CVD), and management strategies for reducing the occurrence of pDDIs.
A retrospective cross-sectional study was performed on Cardiology ward of University Clinical Hospital Center in Belgrade, Serbia. A total of 527 patients, with more than one prescription during hospital stay, were enrolled in this study. Data were obtained from medical records. LexiInteract was used as the screening tool.
At least one potentially relevant pDDI was identified in 83.9% of patients. Occurrence was significantly more prevalent in patients with higher number of drugs, multimorbidity, longer length of stay, arrhythmia, heart failure, infectious and respiratory disease. About 13% of pDDIs exposures were accompanied with concurrent renal or liver disease, as an additional risk for DDI manifestation. Among CVD, patients with a history of myocardial infarction possessed the highest additional risk. The most common potential clinical outcome was the effect on cardiovascular system 48.5%, renal function and/or potassium 22.3%, bleeding 9.5%, impaired glucose control 6.8% and digoxin toxicity 4.6%. Main management strategies to avoid X or D class included using paracetamol instead of NSAID or alternative NSAID (38%), alternative antibiotic or antifungal (20.4%), H receptor antagonist instead of PPI (8.3%), avoiding therapeutic duplication (7.3%), and alternative HMG-CoA reductase inhibitor (7%). Heart rate, blood pressure, electrolytes/potassium and blood glucose could have been employed in monitoring for potential consequence of 72.2% C class pDDIs.
Use of drug interaction screening tools can be beneficial risk mitigation strategy for potentially relevant pDDIs in CVD patients. DDI screening software could be linked to the patient's laboratory results or clinical data regarding renal or liver function, as an approach to reinforce DDIs alert quality.
本研究旨在描述因心血管疾病（CVD）入院患者中潜在相关药物相互作用（pDDIs）的类型和患病率，以及降低pDDIs发生率的管理策略。
在塞尔维亚贝尔格莱德大学临床医院中心的心脏病科病房进行了一项回顾性横断面研究。本研究共纳入了527例在住院期间有不止一张处方的患者。数据来自病历记录。使用LexiInteract作为筛查工具。
83.9%的患者至少被识别出一种潜在相关的pDDI。在用药数量较多、患有多种疾病、住院时间较长、患有心律失常、心力衰竭、感染性疾病和呼吸系统疾病的患者中，pDDI的发生率显著更高。约13%的pDDI暴露伴有并发的肾脏或肝脏疾病，这是药物相互作用表现的额外风险。在心血管疾病患者中，有心肌梗死病史的患者额外风险最高。最常见的潜在临床结果是对心血管系统的影响（48.5%）、肾功能和/或钾（22.3%）、出血（9.5%）、血糖控制受损（6.8%）和地高辛中毒（4.6%）。避免X类或D类药物相互作用的主要管理策略包括使用对乙酰氨基酚代替非甾体抗炎药或替代非甾体抗炎药（38%）、替代抗生素或抗真菌药（20.4%）、用H受体拮抗剂代替质子泵抑制剂（8.3%）、避免治疗重复（7.3%）以及替代HMG-CoA还原酶抑制剂（7%）。心率、血压、电解质/钾和血糖可用于监测72.2%的C类pDDI的潜在后果。
使用药物相互作用筛查工具可能是降低CVD患者潜在相关pDDI风险的有益策略。药物相互作用筛查软件可与患者的实验室结果或有关肾功能或肝功能的临床数据相链接，作为提高药物相互作用警报质量的一种方法。
