Drug-Drug Interactions in Patients From an Internal Medicine Service

Ibáñez, A.; Alcalá, M.; García, J.; Puche, E.

doi:10.1016/S2173-5085(08)70051-0

Farmacia Hospitalaria

ISSN: 1130-6343

Farmacia Hospitalaria (Farm Hosp) is the official publication of the Spanish Society of Hospital Pharmacists (SEFH), a professional and scientific organization that currently has about 4.351 members.

The Mission of Farm Hosp is to be the support for health professionals for expanding the influence of projects, publications, and training programs, and to promote the exchange of experiences.

Vision Farm Hosp is:
- to increase the state of knowledge about the hospital pharmacy and whose actions should increase the adequate and safe use of medicines and health products.
- to be an instrument of exchange and dissemination of scientific knowledge of pharmacy practice through the best use and safe medication and health outcomes.

It is a peer-reviewed double-blind scientific journal aimed at publishing in the broad field of Hospital Pharmacy advances in Pharmacy Services. This journal included the following topics: Drug evaluation. Quality of life. Patient Reported Outcome Measures (PROMs), and Patient Reported Experience Measures (PREMs) in the use of drugs. Monitoring medication. Pharmaceutical compounding. Medication administration. Management of Pharmacy Services (logistics, quality control). Technologies and information systems in the process of using medication. Medical devices. Patient Education. Pharmacist´s role in the society and /or in the Health System in Spain, and other topics related to clinical, scientific, and institutional role of hospital pharmacists.

Farmacia Hospitalaria publishes bimonthly (6 issues yearly) originals, short originals, reviews, clinical cases, special articles, protocols, consensus documents, clinical guidelines, letters to the editor, editorials.

All the articles are published in Spanish and English language regardless of the language in which they are received.

Farmacia Hospitalaria is an Open Access journal, whose content is available free of charge to users or their institutions. Users are authorised to read, download, copy, distribute, print, search, or link to entire texts of the articles in this journal without prior permission from the editor or author, according to the BOAI definition of Open Access. The papers may be re-used under the terms of the Creative Commons 4.0 license. (CC BY-NC-ND). Such use shall be subject to authorisation from SEFH, the journal owner.

Farmacia Hospitalaria journal charges no fees for submission of papers or publication of articles.

Adherence to international ethics recommendations

Manuscripts must follow the most recent recommendations of the International Committee of Medical Journal Editors (available at http://www.icmje.org).

The articles published in Farmacia Hospitalaria are indexed in PubMed and other 17 date bases:
- Evaluation databases: MEDLINE, DOAJ, Scopus, Latindex y Scimago Journal and Country Rank (SJR). Índice H: 18, quartile 3 (Medicine, miscellaneous / Pharmacology)
- Bibliographic databases: CINHAL, EMBASE Excerpta Medica, Índice Bibliográfico Español en Ciencias de la Salud (IBECS), Índice Español de Ciencia Y Tecnología (ICyT), Índice Médico Español (IME), International Pharmaceutical Abstracts (IPA).
- Journal collections: Dialnet, Medes, Scientific Electronic Library Online (SciELO), REDIB, ScienceDirect, ClinicalKey.

Indexed in:

Medline, Emerging Sources Citation Index (ESCI), Directory of Open Access Journals (DOAJ)

Drug interactions are the cause of serious adverse reactions, the incidence and morbi-mortality of which are not yet well established. The aim of this study is to carry out an initial estimate of drug interactions in an internal medicine service and to look at any factors associated with their appearance.

Method

A prospective study was carried out with 120 patients randomly selected from a total of 376 patients admitted to an internal medicine service over a period of 3 months (February-April 2007). A protocol was designed on an ad-hoc basis to record the interactions.

Results

It was observed that 43% of the patients had at least one potential adverse drug interaction and 14% showed associated adverse interactions. The drug with the highest implications in pharmacokinetic interactions was omeprazole when prescribed with acenocoumarol, phenytoin, and digoxin. The most significant pharmacodynamic interactions were with associations between NSAID and salureticdiuretics, insulin and beta-blockers, and aspirin and prednisone. The number of interactions did relate to the number of prescriptions (P<.001), however this was not the case for gender, age, and comorbidity.

Conclusions

Drug interaction is a serious clinical problem which requires the availability of more in depth information and medical attention.

Key words:

Drug interactions

Patients

Internal Medicine

Hospital

Objetivo

El objetivo de este ensayo fue poder realizar una primera estimación de las interacciones medicamentosas en un servicio de medicina interna y los factores asociados a su aparición.

Método

Se diseñó un estudio prospectivo en 120 pacientes elegidos al azar de un total de 376 ingresos durante un período de 3 meses (febrero-abril de 2007) en un servicio de medicina interna. Las interacciones se recogieron en un protocolo diseñado ad hoc.

Resultados

El 43% de pacientes tuvo al menos una interacción potencial no deseable y un 14% de las interacciones se asoció con reacciones adversas. El omeprazol fue el fármaco más implicado en las interacciones farmacocinéticas, al prescribirse conjuntamente con acenocumarol, fenitoína y digoxina. Las asociaciones de antiinflamatorios no esteroideos con diuréticos saluréticos, insulina con bloqueadores beta y aspirina con prednisona fueron las interacciones farmacodinámicas más importantes. El número de interacciones estuvo relacionado con el de prescripciones (p<0,001), no siendo así para el sexo, edad y comorbilidad.

Conclusiones

Las interacciones medicamentosas son un problema clínico importante que requiere una mayor información y atención médicas.

Palabras clave:

Interacciones farmacológicas

Pacientes

Medicina interna

Hospital

Full text is only available in PDF

References

[1.]

C.A. Crespo, E. Guerrero, P. Sanmartín, B. Castro, J.L. Vila.

Interacciones entre medicamentos: Detección precoz mediante un sistema computarizado.

Farm Hosp, 16 (1992), pp. 38-44

[2.]

D. Comet, J. Casajuana, J.M. Bodas, M.A. Fuentes, J.A. Arnaiz, B. Núñez, et al.

Interacciones farmacológicas en la prescripción crónica.

Aten Prim, 20 (1997), pp. 71-74

[3.]

L. Bjerrum, M. Andersen, G. Petersen, J. Kragstrup.

Exposure to potential drug interactions in primary health care.

Scand J Prim Health Care, 21 (2003), pp. 153-158

Medline

[4.]

E. Vargas, M.I. Navarro, L. Laredo, M. García-Arenillas, M. García-Mateos, A. Moreno.

Effect of drug interactions on the development of adverse drug reactions.

Clin Drug Invest, 13 (1997), pp. 282-289

[5.]

P. López, C. Rodríguez, C. Durán, F. Tato, I. Rodríguez, F.L. Lado.

Interacciones entre medicamentos prescritos al alta en un servicio de medicina interna.

An Med Interna (Madrid), 22 (2005), pp. 69-75

[6.]

J. Peral, U. Lertxundi, M.J. Martínez, O. Mora, E. Franco, I. Gabilondo.

Evaluación prospectiva de interacciones entre medicamentos en pacientes ingresados mediante aplicación informática.

Farm Hosp, 31 (2007), pp. 93-100

Medline

[7.]

L. Guédon-Moreau, D. Ducrocq, M.F. Duc, Y. Quieureux, L. Hote, J. Deligne, et al.

Absolute contraindications in relation to potential drug intractions in outpatient prescriptions: analysis of the first five million prescriptions in 1999.

Eur J Clin Pharmacol, 59 (2003), pp. 689-695

[8.]

C. Jankel, L. Fitterman.

Epidemiology of drug-drug interactions as a cause of hospital admissions.

Drug Safety, 09 (1993), pp. 51-59

[9.]

R. Seymur, P. Routledge.

Important drug-drug interactions in the elderly.

Drugs Aging, 12 (1998), pp. 485-494

Medline

[10.]

D. Juurlink, M. Mamdani, A. Kopp, A. Laupacis, D. Redelmeier.