Potential drug-drug interactions in patients with cardiovascular diseases: findings from a prospective observational study

Zarka Akbar; Sundas Rehman; Asad Khan; Amjad Khan; Muhammad Atif; Nafees Ahmad

doi:10.1186/s40545-021-00348-1

Potential drug-drug interactions in patients with cardiovascular diseases: findings from a prospective observational study

J Pharm Policy Pract. 2021 Jul 26;14(1):63. doi: 10.1186/s40545-021-00348-1.

Authors

Zarka Akbar¹, Sundas Rehman¹, Asad Khan¹, Amjad Khan², Muhammad Atif³, Nafees Ahmad⁴

Affiliations

¹ Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan.
² Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
³ Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
⁴ Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan. nafeesuob@gmail.com.

Abstract

Background: Patients with cardiovascular diseases (CVD) are at high risk of experiencing drug-drug interactions (DDIs). The objective of this study was to evaluate the frequency, level and risk factors associated with potential-DDIs (pDDIs) in hospitalized CVD patients at cardiology departments of two tertiary care hospitals in Quetta, Pakistan.

Methods: In the current prospective observational study, a total of 300 eligible CVD inpatients were evaluated for pDDIs using Lexicomp Interact®. The pDDIs were classified into class A (no known interaction); B (no action needed); C (monitor therapy: it is documented that the benefits of an interaction outweigh the risk, appropriately monitor therapy in order to avoid potential adverse outcomes); D (consider therapy modification: it is documented that proper actions must be taken to reduce the toxicity resulting from an interaction); X (avoid combination: the risk of an interaction outweighs the benefits and are usually contraindicated). Multivariate binary logistic regression analysis was used to find factors associated with the presence of Class-D and/or X pDDIs. A p-value < 0.05 was considered statistically significant.

Results: With a median of 8.50 pDDIs per patient, all patients (100%) had ≥ 1 pDDIs. Out of total 2787 pDDIs observed, 74.06% (n = 2064) were of moderate and (n = 483) 17.33% of major severity. Class C pDDIs were most common (n = 1971, 70.72%) followed by D (n = 582, 20.88%), B (n = 204, 7.32%) and X (n = 30, 1.08%). Suffering from cardiovascular diseases other than myocardial infarction (OR 0.053, p-value < 0.001) and receiving > 12 drugs (OR 4.187, p-value = 0.009) had statistical significant association with the presence of class D and/or X pDDIs.

Conclusion: In the current study, pDDIs were highly prevalent. The inclusion of DDI screening tools, availability of clinical pharmacists and paying special attention to the high-risk patients may reduce the frequency of pDDIs at the study sites.

Keywords: CVD; Lexicomp; Myocardial infarction; Pakistan; Potential drug–drug interactions.