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Annual for Hospital Pharmacy

Prevalence of drug interactions in hospitalised elderly patients: a systematic review

Luciana Mello de Oliveira, Juliana do Amaral Carneiro Diel, Alessandra Nunes, Tatiane da Silva Dal Pizzol

Abstract

Background: The prevalence of drug–drug interactions (DDIs) in hospital settings is variable, and elderly patients are considered a high risk population for DDIs. There are no systematic reviews describing the prevalence of DDIs in hospitalised elderly patients.

Objectives: To assess and summarise the available data on the prevalence of DDIs in hospitalised elderly patients and to describe which drugs, drug classes and drug combinations are most commonly involved in DDIs.

Data source: A systematic electronic literature search was conducted on Medline/PubMed, Embase, Lilacs, SciElo, Web of Science, Cinahl, Scopus, Cochrane, OpenGrey, Capes Thesis Bank, OasisBR, OpenAire and abstracts from scientific events, without limitation on language or period of publication. Study selection was completed on 21 September 2018.

Study eligibility criteria, participants and interventions: Original observational studies that reported the prevalence of actual or potential DDIs during hospitalisation in patients aged 60 years or older were included. The main outcome measure was prevalence of DDIs and number of DDIs per patient. Subgroup analysis was performed in studies that reported the prevalence of DDIs in geriatric units.

Study appraisal and synthesis methods: Study quality was assessed using the Agency for Healthcare Research and Quality methodological checklist for cross sectional and prevalence studies.

Results: 34 studies were included, involving 9577 patients. The prevalence of DDIs ranged from 8.34% to 100%. In studies conducted in geriatric units, the prevalence ranged from 80.5% to 90.5%. The number of DDIs per patient ranged from 1.2 to 30.6. Single drugs most commonly involved in DDIs were furosemide, captopril, warfarin and dipyrone. Drug classes mostly involved were potassium sparing diuretics and angiotensin converting enzyme inhibitors.

Limitations: The main limitation is the heterogeneity between the included studies that precluded a metaanalysis. Several different methods were used to identify DDIs, majorly, and potential DDIs. Few studies have reported measures to control the quality of the collected data.

Conclusions and implications of key findings: The prevalence of DDIs ranged widely, and the variation may reflect differences in the conditions of the elderly patients and level of attention (or complexity of care), as well as methodological differences, especially the methods and/ or software used to identify DDIs.


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References

Askari M, Eslami S, Louws M, et al. Frequency and nature of drug-drug interactions in the intensive care unit. Pharmacoepidemiol Drug Saf 2013;22:430–7.

Montané E, Arellano AL, Sanz Y, et al. Drug-related deaths in hospital inpatients: a retrospective cohort study. Br J Clin Pharmacol 2018;84:542–52.

Juurlink DNet al. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 2003;289:1652–8.

Palleria C, Di Paolo A, Giofrè C, et al. Pharmacokinetic drugdrug interaction and their implication in clinical management. J Res Med Sci 2013;18:601–10.

Marusic S, Bacic-Vrca V, Obreli Neto PR, et al. Actual drug–drug interactions in elderly patients discharged from internal medicine clinic: a prospective observational study. Eur J Clin Pharmacol 2013;69:1717–24.

Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug–drug interactions. Expert Opin Drug Saf 2012;11:83–94.

Reis AMM, Cassiani SHDB. Adverse drug events in an intensive care unit of a university hospital. Eur J Clin Pharmacol 2011;67:625–32.

Sánchez Muñoz-Torrero JF, Barquilla P, Velasco R, et al. Adverse drug reactions in internal medicine units and associated risk factors. Eur J Clin Pharmacol 2010;66:1257–64.

Davies EC, Green CF, Taylor S, et al. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patientepisodes. PLoS One 2009;4:e4439.

Kovačević M, Vezmar Kovačević S, Miljković B, et al. The prevalence and preventability of potentially relevant drug-drug interactions in patients admitted for cardiovascular diseases: a cross-sectional study. Int J Clin Pract 2017;71:e13005.

Uijtendaal EV, van Harssel LLM, Hugenholtz GWK, et al. Analysis of potential drug-drug interactions in medical intensive care unit patients. Pharmacotherapy 2014;34:213–9.

Espinosa-Bosch M, Santos-Ramos B, Gil-Navarro MV, et al. Prevalence of drug interactions in hospital healthcare. Int J Clin Pharm 2012;34:807–17.

Zheng WY, Richardson LC, Li L, et al. Drug-drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis. Eur J Clin Pharmacol 2018;74:15–27.

Holm J, Eiermann B, Eliasson E, et al. A limited number of prescribed drugs account for the great majority of drug-drug interactions. Eur J Clin Pharmacol 2014;70:1375–83.

Doan J, Zakrzewski-Jakubiak H, Roy J, et al. Prevalence and risk of potential cytochrome P450-mediated drug-drug interactions in older hospitalized patients with polypharmacy. Ann Pharmacother 2013;47:324–32.

Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet 2007;370:185–91.

Sánchez-Fidalgo S, Guzmán-Ramos MI, Galván-Banqueri M, et al. Prevalence of drug interactions in elderly patients with multimorbidity in primary care. Int J Clin Pharm 2017;39:343–53.

Moura CS, Acurcio FA, Belo NO. Drug-drug interactions associated with length of stay and cost of hospitalization. J Pharm Sci 2009;12:266–72.

Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharmacother 2011;9:364–77.

Becker ML, Kallewaard M, Caspers PWJ, et al. Hospitalisations and emergency department visits due to drug-drug interactions: a literature review. Pharmacoepidemiol Drug Saf 2007;16:641–51.

Oliveira LM, Carneiro JAC, Dal Pizzol TS. Prevalence of drug interactions in the hospitalized elderly: a systematic review. Available: http://www.crd.york.ac.uk/ PROSPERO/display_record.php?ID=CRD42018096720 [Accessed 16 Jan 2019].

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009;6:e1000100.

WHO. World report on ageing and health, 2015. Available: http://www.who.int/ ageing/events/world-report-2015-launch/en/ [Accessed 14 Nov 2018].

Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol 2007;36:666–76.

Zeng X, Zhang Y, Kwong JSW, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med 2015;8:2–10.

Rostom A, Dubé C, Cranney A, et al. Appendix D. Quality Assessment Forms [Internet]. Agency for Healthcare Research and Quality (US), 2004. Available: https://www.ncbi. nlm.nih.gov/books/NBK35156/ [Accessed 3 Dec 2018].

Castilho ECD, Reis AMM, Borges TL, et al. Potential drugdrug interactions and polypharmacy in institutionalized elderly patients in a public hospital in Brazil. J Psychiatr Ment Health Nurs 2018;25:3–13.

Cuentro V da S. Avaliação da utilização e segurança de medicamentos em pacientes idosos internados em um hospital universitário, 2013. Available: http://repositorio. ufpa.br/jspui/ handle/2011/6213

Santos RMdos, Sette IMF, de Farias Belém L. Drug use by elderly inpatients of a philanthropic Hospital. Braz J Pharm Sci 2011;47:391–8.

Pedroso FM. Prevalência de interações medicamentosas fármaco-fármaco em um hospital de Cuiabá, 2015. Available: https://sucupira.capes.gov.br/sucupira/public/ consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_ trabalho=3600052 [Accessed 5 Jun 2018].

de Oliveira, Lillian Rodrigues. Potenciais interações medicamentosas em prescrições de pacientes idosos internados no Hospital municipal de ouro preto do oeste – Ro, 2013. Available: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/ trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=436398 [Accessed 5 Jun 2018].

Locatelli J. Interações medicamentosas em idosos hospitalizados. Einstein Säo Paulo 2007;5:343–6.

Melo D, Ribeiro E, Storpirtis S. Potential drug-drug interactions in a Brazilian teaching hospital: age-related differences? Rev Ciênc Farm Básica Apl 2015;36:435–44.

Parreira RBC. Detecção de eventos adversos a medicamentos em idosos hospitalizados, 2016. Available: http://pesquisa.bvsalud.org/portal/resource/pt/tes- 6915?lang=fr [Accessed 5 Jun 2018].

Costa, Soraya Coelho. Avaliação da prescrição de medicamentos para idosos internados em Serviço de Clínica Médica do Sistema Único de Saúde em um hospital público universitário brasileiro, 2009. Available: http://www.bibliotecadigital.ufmg.br/ dspace/handle/1843/ECJS-7YYHUA [Accessed 5 Jun 2018].

Kashyap M, D’Cruz S, Sachdev A, et al. Drug-drug interactions and their predictors: results from Indian elderly inpatients. Pharm Pract 2013;11:191–5.

Danisha P, Dilip C, Mohan PL, et al. Identification and evaluation of potentially inappropriate medications (PIMs) in hospitalized geriatric patients using beers criteria. J Basic Clin Physiol Pharmacol J2015;26:403–10.

George AS, Ramesh M, Sebastian J. Adverse drug interactions in elderly hospitalized patients: a prospective analysis. Int J Pharm Sci Res 2018;9:1913–20.

Mohammed S, Poudel S, Laloo F, et al. Assessment of drugrelated problems in a tertiary care teaching hospital, India. Asian J Pharm Clin Res 2017;10:310–3.

Devarapalli P, Soni S, T.K.N.V RK, et al. Assessment of inappropriate medication use in elderly inpatients of a tertiary care hospital in south-eastern India using the modified updated beers criteria 2003. Drugs Ther Perspect 2017;33:543–9.

Narvekar RS, Bhandare NN, Gouveia JJ, et al. Utilization pattern of potentially inappropriate medications in geriatric patients in a tertiary care hospital: a retrospective observational study. J Clin Diagn Res 2017;11:FC04–8.

Juárez-Cedillo T, Martinez-Hernández C, Hernández-Constantino A, et al. Clinical weighting of drug-drug interactions in hospitalized elderly. Basic Clin Pharmacol Toxicol 2016;118:298–305.

Rosas-Carrasco O, García-Peña C, Sánchez-García S, et al. The relationship between potential drug-drug interactions and mortality rate of elderly hospitalized patients. Rev Investig Clin 2011;63:564–73.

Radošević N, Gantumur M, Vlahović-Palčevski V. Potentially inappropriate prescribing to hospitalised patients. Pharmacoepidemiol Drug Saf 2008;17:733–7.

Matanović SM, Vlahović-Palčevski V. Potentially inappropriate prescribing to the elderly: comparison of new protocol to beers criteria with relation to hospitalizations for ADRs. Eur J Clin Pharmacol 2014;70:483–90.

Chahin RC. Drug interactions in hospitalized patients in the internal medicine hospital university “Dr. Angel Larralde”. June 2014 - December 2015. Arch Venez Farmacol Ter 2015;34:21–6.

Janković SM, Pejčić AV, Milosavljević MN, et al. Risk factors for potential drug-drug interactions in intensive care unit patients. J Crit Care 2018;43:1–6.

Sapkota S, Pudasaini N, Singh C, et al. Drug prescribing pattern and prescription error in elderly: a retrospective study of inpatient record. Asian J Pharm Clin Res 2011;4:83–6.

Rafiei H, Esmaeili Abdar M, Moghadasi J. The prevalence of potential drug interactions among critically ill elderly patients in the intensive care unit (ICU). Iran J Ageing 2012;6:14–19.

Teka F, Teklay G, Ayalew E, et al. Potential drug–drug interactions among elderly patients admitted to medical ward of Ayder Referral Hospital, Northern Ethiopia: a cross sectional study. BMC Res Notes 2016;9:431.

Senín LD. Estudio sobre la utilización inapropiada de medicamentos en pacientes de edad avanzada hospitalizados en el servicio de medicina interna de un hospital privado, 2016. Available: http://rabida.uhu.es/dspace/bitstream/handle/10272/12099/Estudio_sobre_la_utilizacion_inapropiada.pdf?sequence=2 [Accessed 5 Jun 2018].

Gutiérrez-Valencia M, Izquierdo M, Malafarina V, et al. Impact of hospitalization in an acute geriatric unit on polypharmacy and potentially inappropriate prescriptions: a retrospective study. Geriatr Gerontol Int 2017;17:2354–60.

Blix HS, Viktil KK, Reikvam A, et al. The majority of hospitalised patients have drug- related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol 2004;60:651–8.

Correia LM, Barros A, Brazão ML. Polifarmácia, Fármacos Inapropriados E Interacções Medicamentosas nas Prescrições de Doentes Nonagenários. Med Interna 2017;24:24–9.

Egger T, Dormann H, Ahne G, et al. Identification of adverse drug reactions in geriatric inpatients using a computerised drug database. Drugs Aging 2003;20:769–76.

Ghibelli S, Marengoni A, Djade CD, et al. Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck®). Drugs Aging 2013;30:821–8.

Schuler J, Dückelmann C, Beindl W, et al. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr 2008;120:733–41.

Barak-Tsafrir O, Tellem R, Cialic R. Medications reconciliation to detect drug-drug interactions (DDI) – impact on medication regimen during geriatric hospitalization. J Am Geriatr Soc 2016;64:S73–4.

Yong TY, Lau SY, Li JY, et al. Medication prescription among elderly patients admitted through an acute assessment unit. Geriatr Gerontol Int 2012;12:93–101.

Bundhun PK, Teeluck AR, Bhurtu A, et al. Is the concomitant use of clopidogrel and proton pump inhibitors still associated with increased adverse cardiovascular outcomes following coronary angioplasty?: a systematic review and meta-analysis of recently published studies (2012 - 2016). BMC Cardiovasc Disord 2017;17:3.

Johnston SC, Easton JD, Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med 2018;379:215–25.

Roblek T, Vaupotic T, Mrhar A, et al. Drug-drug interaction software in clinical practice: a systematic review. Eur J Clin Pharmacol 2015;71:131–42.

By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015;63:2227–46.

Tilson H, Hines LE, McEvoy G, et al. Recommendations for selecting drug-drug interactions for clinical decision support. Am J Health Syst Pharm 2016;73:576–85.

Roblek T, Trobec K, Mrhar A, et al. Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease. Aoms 2014;5:920–32.

Peng CC, Glassman PA, Marks IR, et al. Retrospective drug utilization review: incidence of clinically relevant potential drug-drug interactions in a large ambulatory population. J Manag Care Pharm 2003;9:513–22.

Young T, Hopewell S, Cochrane Methodology Review Group. Methods for obtaining unpublished data. Cochrane Database Syst Rev 2011;22.




DOI: http://dx.doi.org/10.14748/ahp.v7i1.8076

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