Zhao Mei, Liu Chuan-Fen, Feng Yu-Fei, Chen Hong
Department of Pharmacy, Peking University People's Hospital, Beijing, China.
Department of Cardiology, Peking University People's Hospital, Beijing, China.
Front Pharmacol. 2022 Aug 24;13:946415. doi: 10.3389/fphar.2022.946415. eCollection 2022.
Polypharmacy are commonly observed among older adults with cardiovascular disease. However, multiple medications lead to increased risk of drug-drug interactions (DDIs). Therefore, identification and prevention actions related to harmful DDIs are expected in older adults. The study aimed to describe the prevalence of potential DDIs (pDDIs) in discharge prescriptions among older adults with chronic coronary syndrome (CCS). A single-center cross-sectional study was performed in a tertiary public hospital in Beijing, China. CCS patients aged 65 years and above who were admitted to cardiology wards over a 3-month period and alive at discharge were included. Electronic medical records and discharge prescriptions were reviewed. pDDIs were evaluated through the Lexi-Interact online. pDDIs were identified in 72.9% of the 402 individuals ( = 293). A total of 864 pDDIs were obtained. 72.1% of patients were found with C DDIs ( = 290) and 20.3% were categorized in D and X DDIs ( = 82). The only X DDI was between cyclosporine and atorvastatin. Under category D, glycemia alterations within antidiabetics and increased chances of bleeding with antithrombotic were the most common. Concomitant use of clopidogrel and calcium channel blockers was a frequent situation within category C, followed by synergic blood pressure lowering agents and increased rosuvastatin concentration induced by clopidogrel. DDIs exposure was common in older CCS. DDIs screening tools should be introduced to alert potential adverse effects. Prescribers need to rigorously review or modulate therapies to prevent DDI-related adverse outcomes. Clinical pharmacists should be more involved in complex drug regimen management.
多重用药在患有心血管疾病的老年人中很常见。然而,多种药物会增加药物相互作用(DDIs)的风险。因此,预计需要针对老年人中有害的药物相互作用采取识别和预防措施。本研究旨在描述慢性冠状动脉综合征(CCS)老年患者出院处方中潜在药物相互作用(pDDIs)的发生率。在中国北京的一家三级公立医院进行了一项单中心横断面研究。纳入年龄在65岁及以上、在3个月内入住心内科病房且出院时存活的CCS患者。回顾电子病历和出院处方。通过Lexi-Interact在线评估pDDIs。在402名个体中的72.9%(n = 293)中识别出pDDIs。共获得864种pDDIs。发现72.1%的患者存在C类药物相互作用(n = 290),20.3%被归类为D类和X类药物相互作用(n = 82)。唯一的X类药物相互作用是环孢素和阿托伐他汀之间的相互作用。在D类中,抗糖尿病药物引起的血糖变化和抗血栓药物导致的出血几率增加最为常见。氯吡格雷与钙通道阻滞剂的联合使用是C类中常见的情况,其次是协同降压药物以及氯吡格雷引起的瑞舒伐他汀浓度升高。药物相互作用暴露在老年CCS患者中很常见。应引入药物相互作用筛查工具以警示潜在的不良反应。开处方者需要严格审查或调整治疗方案以预防与药物相互作用相关的不良后果。临床药师应更多地参与复杂药物治疗方案的管理。