Drug-Drug Interactions and Prescription Appropriateness in COVID-19 ICU Patients in a Tertiary Care Hospital
Abstract
Severe Coronavirus disease 2019 (COVID-19) management has been challenging due to varying treatment protocol. Additionally, co-morbidities and older age group receiving polypharmacy increases the risk for drug-drug interactions (DDIs). With limited DDI research studies in Indian setup, we aimed to assess the frequency and severity of potential DDIs in COVID-19 ICU patients. This was a retrospective, observational study conducted in a tertiary care hospital, Karnataka, India. Case record of all patients aged ≥18 years with COVID-19 disease admitted to the COVID-19 ICU during March 2021 to July 2021 and treated with two drugs at least were included. A total of one hundred ninety one medical records of COVID-19 patients confirmed by RTPCR were reviewed from medical record department. DDIs were assessed by validated INTERCheck® web system and prescription appropriateness by Beers criteria. Among 191 COVID-19 treated patients, a total of 1049 pDDIs were recorded. Thirty nine percent of the total interactions were classified as potentially severe (class C + class D). Severe pDDIs increased significantly (140 to 274; p < 0.001) during hospitalization. Consistently, a significant increase in drug interactions trend was observed during hospitalization (432 to 617; p < 0.001). Hence, this study concludes that the severe pDDIs increased significantly during hospitalization and consistent increase in overall (Class A, B, C D) drug interactions trend was observed during hospitalization largely because of the drugs managed to treat comorbidities. Therefore, web based system with multidisciplinary team of expertise may be adopted in hospitals for regulating the dosage of interacting drugs and selecting substitute for over all optimizing the therapy.
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Ministry of Health and Family Welfare [Internet]. Government of India; c2021- [cited 2022 Feb 06]. Available at: https://www.mohfw.gov.in/.
Chary A, Nguyen NN, Maiton K, Holodniy M. A review of drug-drug interactions in older HIV-infected patients. Expert Rev Clin Pharmacol. 2017;10(12):1329-1352.
Pasqualetti G, Tognini S, Calsolaro V, Polini A, Monzani F. Potential drug-drug interactions in Alzheimer patients with behavioral symptoms. Clin Interv Aging. 2015;10:1457-1466.
Petrini E, Caviglia GP, Pellicano R, Saracco GM, Morino M, Ribaldone DG. Risk of drug interactions and prescription appropriateness in elderly patients. Ir J Med Sci. 2019;189:953-959.
Cahir C, Wallace E, Cummins A, Teljeur C, Byrne C, Bennett K et al. Identifying Adverse Drug Events in Older Community-Dwelling Patients. Ann Fam Med. 2019;17(2):133-140.
American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;(67):674-694.
Marengoni A, Pasina L, Concoreggi C, Martini G, Brognoli F, Nobili A et al. Understanding adverse drug reactions in older adults through drug-drug interactions. Eur J Intern Med. 2014;25(9):843-846.
Back D, Marzolini C, Hodge C, Marra F, Boyle A, Gibbons S et al. COVID-19 treatment in patients with comorbidities: Awareness of drug-drug interactions. Br J Clin Pharmacol. 2021;87(1):212-213.
Ministry of Health and Family Welfare. Clinical Management Protocol: COVID-19 2020.Availableat:https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19dated27062020.pdf [accessed on February 2022]
Martocchia A, Spuntarelli V, Aiello F, Meccariello AL, Proietta M, Del Porto F, et al. Using INTERCheck® to evaluate the incidence of adverse events and drug-drug interactions in out-and inpatients exposed to polypharmacy. Drugs Real World Outcomes. 2020;7(3):243-249.
Ghibelli S, Marengoni A, Djade CD, Nobili A, Tettamanti M, Franchi C, et al. Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck(®)). Drugs Aging. 2013;30(10):821-828.
Cattaneo D, Pasina L, Maggioni AP, Giacomelli A, Oreni L, Covizzi A et al. Drug-Drug Interactions and Prescription Appropriateness in Patients with COVID-19: A Retrospective Analysis from a Reference Hospital in Northern Italy. Drugs Aging. 2020;37(12):925-933.
Hovstadius B, Petersson G. Factors leading to excessive polypharmacy. Clin Geriatr Med 2012;28(2):159-172.
Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007;63(2):187-195.
Haider SI, Johnell K, Weitoft GR, Thorslund M, Fastbom J. The influence of educational level on polypharmacy and inappropriate drug use: a register-based study of more than 600,000 older people. J Am Geriatr Soc. 2009;57(1):62-69.
Liang C, Tian L, Liu Y, Hui N, Qiao G, Li H et al. A promising antiviral candidate drug for the COVID-19 pandemic: A mini-review of remdesivir. Eur J Med Chem. 2020;201:112527.
Pereyra D, Heber S, Schrottmaier WC, Santol J, Pirabe A, Schmuckenschlager A, et al. Low-molecular-weight heparin use in coronavirus disease 2019 is associated with curtailed viral persistence: a retrospective multicentre observational study. Cardiovasc Res. 2021;117(14):2807-2820.
Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56(1):105949.
Aggarwal G, Henry BM, Aggarwal S, Bangalore S. Cardiovascular safety of potential drugs for the treatment of coronavirus disease 2019. Am J Cardiol. 2020;128:147-150.
Aggarwal G, Cheruiyot I, Aggarwal S, Wong J, Lippi G, Lavie CJ et al. Association of Cardiovascular Disease With Coronavirus Disease 2019 (COVID-19) Severity: A Meta-Analysis. Curr Probl Cardiol. 2020;45(8):100617.
Gérard A, Romani S, Fresse A, Viard D, Parassol N, Granvuillemin A et al; French Network of Pharmacovigilance Centers. "Off-label" use of hydroxychloroquine, azithromycin, lopinavir-ritonavir and chloroquine in COVID-19: A survey of cardiac adverse drug reactions by the French Network of Pharmacovigilance Centers. Therapie. 2020;75(4):371-379.
Jankelson L, Karam G, Becker ML, Chinitz LA, Tsai MC. QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: A systematic review. Heart Rhythm. 2020;17(9):1472-1479.
Woosley RL, Heise CW , Gallo T, Woosley D and Romero KA, www.CredibleMeds.org, QTdrugs List, [15th June 2023], AZCERT, Inc. 1457 E. Desert Garden Dr., Tucson, AZ 85718.
Haider SI, Johnell K, Weitoft GR, et al. The influence of educational level on polypharmacy and inappropriate drug use: A register-based study of more than 600,000 older people. J Am Geriatr Soc. 2009;57(1):62 69.
Bjerrum L, Gonzalez Lopez Valcarcel B, Petersen G. Risk factors for potential drug interactions in general practice. Eur J Gen Pract. 2008;14(1):23-29.
Schnoll-Sussman F, Niec R, Katz PO. Proton pump inhibitors: the good, bad, and ugly. Gastrointest Endosc Clin N Am. 2020;30(2):239-251.
Wang X, Song Y, Wang J, He J, Liu R, Li X, et al. Effect of proton pump inhibitors on high-dose methotrexate elimination: a systematic review and meta-analysis. Int J Clin Pharm. 2020;42(1):23-33.
Kanno T, Moayyedi P. Proton pump inhibitors in the elderly, balancing risk and benefit: an age-old problem. Curr Gastroenterol Rep. 2019;21(12):65.
Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and followup: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23): 2950-2973.
Vranckx P, Valgimigli M, Heidbuchel H. The significance of drug-drug and drug-food interactions of oral anticoagulation. Arrhythmia Electrophysiol Rev. 2018;7(1):55-61.
Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug-drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ (Can Med Assoc J) 2007;177(4): 347-51.
Amir Ali Mahboobipour, Shadi Baniasadi. Clinically important drug–drug interactions in patients admitted to hospital with COVID-19: drug pairs, risk factors, and management. Drug Metabol Pers Ther 2020;20200145.
DOI: https://doi.org/10.15416/pcpr.v9i2.52189
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