Potential drug interactions related to antimicrobials use in hospitalized patients on hemodialysis
DOI:
https://doi.org/10.30968/rbfhss.2022.134.0856Abstract
Objective: to evaluate the prevalence, severity and main clinical consequences of potential drug interactions (DIs) related to antimicrobials in hemodialysis patients admitted to a university hospital. Methods: This is an observational and retrospective study, conducted in a university hospital in the Midwest region, the sample consisted of adult patients using antimicrobial therapy and undergoing renal replacement therapy. DIs were verified in medical prescriptions, during a period of 7 days, using the Micromedex® database. Results: 85 patients were included in the study and 595 prescriptions were analyzed. As for kidney disease, 30 (35.3%) of the patients underwent hemodialysis for acute kidney injury, 45 (53%) for chronic kidney disease and in 10 (11.7%) it was not possible to verify the type of kidney disease due to lack of information in the charts. At least one DI were identified in 29.6% of prescriptions. In all, 499 interactions were found, of which 301 (60.3%) were important, 149 (29.9%) were moderate and 49 (9.8%) were contraindications. Regarding possible adverse events related to contraindicated interactions, 25 (51.0%) were related to an increase in hypertensive events and 8 (16.3%) to cardiotoxicity. The antimicrobials most involved in possible DI were fluconazole (98.76% of antifungals), ciprofloxacin (79.4% of quinolones) and linezolid (oxazolidones). The most frequent interactions were: linezolid and norepinephrine (contraindicated), ciprofloxacin and insulin (important), fluconazole and fentanyl (important), fluconazole and omeprazole (moderate). Conclusion: Most of the potential DIs identified were serious and there was a high percentage of contraindicated DIs. The main potential adverse events were related to the cardiovascular system. These findings reinforce the importance of knowing the possible antimicrobial-related DIs in hemodialysis patients, their possible adverse events and corresponding management.
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Njeri LW, Ogallo WO, Nyamu DG, et al. Medication-related problems among adult chronic kidney disease patients in a sub-Saharan tertiary hospital. Int J Clin Pharm. 2018;40(5):1217-7. DOI: 10.1007/s11096-018-0651-7.
Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharmacother. 2011; 9(6), 364–377.
World Health Organization (WHO). International drug monitoring: the 11. Conclusion role of national centres. Technical Report Series. 1972; 498:1-48.
Aronson JK, Ralph E. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000; 356: 1255–59.
Shakeel F, Aamir M, Khan AF, et al. Epidemiology of potential drug-drug interactions in elderly population admitted to critical care units of Peshawar, Pakistan. BMC Pharmacol Toxicol. 2018; 19(1):85. DOI: 10.1186/s40360-018-0276-4.
Oliveira AM, Rodrigues VAV, Passerini JP, et al. Technical complaints and adverse drug reactions reported in a regional hospital in Brazil: a cross-sectional study. ABCS Health Sci. 2018; 43(1):25-29. DOI: 10.7322/abcshs.v43i1.1015
Akbulut M, Urun Y. Onco-cardiology: Drug-drug interactions of antineoplastic and cardiovascular drugs. Crit Ver Oncol Hematol. 2020;145 :102822. DOI: 10.1016/j.critrevonc.2019.102822.
Kidney International Suplements. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Official Journal of the International Society of Nephrology. 2013; 3(1):1-163.
Kidney International Suplements. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Official Journal of the International Society of Nephrology. 2012; 2(1):1-141.
Formica M, Politano P, Marazzi F, et al. Acute kidney injury and chronic kidney disease in the elderly and polypharmacy. Blood Purif. 2018;46(4):332-336. DOI: 10.1159/000492149
Xu H, Gasparini A, Ishigami J, Mzayen M, et al. EGFR and the risk of community-acquired infections. CJASN. 2017, 12 (9) 1399-1408. DOI: 10.2215/CJN.00250117.
Chakraborty S, Ghosh S, Banerjea A, et al. Prescribing patterns of medicines in chronic kidney disease patients on maintenance hemodialysis. Indian J Pharmacol. 2016;48(5):586-590. DOI: 10.4103/0253-7613.190760.
Pavanello, L, Farhat, FG, Carvalho, RP, et al. Clinically relevant drug interactions involving antimicrobials in a general hospital: a cross-sectional study. Rev Bras Farm Hosp Serv Saude. 2021;12(2):0573. DOI: 10.30968/rbfhss.2021.122.0573
Bello AK, Johnson D, Eckardt K, et al. Global Kidney Health Atlas: A report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe. Available in: https://www.theisn.org/focus/ckd#health-atlas. Accessed on: 1st Fev 2020.
Thomé FS, Sesso RC, Lopes AA, et al. Inquérito Brasileiro de Diálise Crônica 2019. J Bras Nefrol. 2021;43(2):217-227. Available in: https://www.bjnephrology.org/wp-content/uploads/articles_xml/2175-8239-jbn-2020-0161/2175-8239-jbn-2020-0161-pt.pdf.
MICROMEDEX® 2.0 Healthcare Series. Thomson Reuters: 1974-2011. Available from: http://www.periodicos. capes.gov.br. Accessed on: 02 nd mar 2019.
Marquito AB, Fernandes NM, Colugnati FA, et al. Identifying potential drug interactions in chronic kidney disease patients. J Bras Nefrol. 2014;36(1):26-34. DOI: 10.5935/0101-2800.20140006.
Fasipe OJ, Akhideno PE, Ibiyemi-Fasipe OB, Idowu AA. The burden of polypharmacy and pattern of comorbidities among chronic kidney disease patients in clinical practice. Arch Med Health Sci. 2018;6(1):40-47. DOI: 10.4103/amhs.amhs_11_18.
Saleem A, Masood I, Khan TM. Clinical relevancy and determinants of potential drug–drug interactions in chronic kidney disease patients: results from a retrospective analysis. Integr Pharm Res Pract. 2017 Feb 17;2017(6): 71-77. DOI: 10.2147/IPRP.S128816. eCollection 2017.
Olumuyiwa JF, Akinwumi AA, Ademola OA, et al. Prevalence Prevalence and pattern of potential drug-drug interactions among chronic kidney disease patients in south-western Nigeria. Niger Postgrad Med J. 2017; 24;24(2): 88-92. DOI: 10.4103/npmj.npmj_64_17.
Sgnaolin V, Engroff P, Figueiredo A, et al. Assessment of used medications and drug-drug interactions among chronic renal failure patients. Sci Med. 2014; 24(4):329-335.
Fernandes FM, Paulino AM, Sedda BC, Silva EP,et al. Assessment of the risk of QT-interval prolongation associated with potential drug-drug interactions in patients admitted to Intensive Care Units. Saudi Pharm J. 2019;27(2):229–234. DOI: 10.1016/j.jsps.2018.11.003.
Hosseinpoor Z, Farzanegan B, Seyyedi SR, Rajabi M, et al. Drug interactions and creatinine levels are associated with QTc prolongation in intensive care units: a prospective, observational study. Drug Metab Pers Ther. 2019; 34(4). DOI: 10.1515/dmpt-2019-0022.
Dookeeram D, Bidaisee S, Paul JF, et al. Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean. Int J Clin Pharm. 2017;39(5):1119-1127. DOI: 10.1007/s11096-017-0520-9.
Vanham D, Spinewine A, Hantson P, et al. Drug-drug interactions in the intensive care unit: Do they really matter? J Crit Care. 2017; 38:97-103. DOI: 10.1016/j.jcrc.2016.09.014.
Wagh BR, Godbole DD, Deshmukh SS, et al. Identification and Assessment of Potential Drug-Drug Interactions in Intensive Care Unit Patients. Indian J Crit Care Med. 2019;23(4):170-174. DOI: 10.5005/jp-journals-10071-23147.
Moreira MB, Mesquita MGDR, Stipp MAC, et al. Potential intravenous drug interactions in intensive care. Rev Esc Enferm USP. 2017 Jul 20;51. DOI: 1590/S1980-220X2016034803233.
Carvalho REFL, Reis AMM, Faria LMP, et al. Prevalence of drug interactions in intensive care units in Brazil. Acta Paul Enferm. 2013; 26(2):150-157. DOI: 10.1590/S0103-21002013000200008.
Sivva D, Mateti UV, Neerati VM, et al. Assessment of drug-drug interactions in hypertensive patients at a superspeciality hospital. Avicenna J Med. 2015; 5(2):29-35. DOI: 10.4103/2231-0770.154194.
Chou HW, Wang JL, Chang CH, et al. Risk of severe dysglycemia among diabetic patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Taiwan. Clin Infect Dis. 2013; 57(7):971-980. DOI: 10.1093/cid/cit439.
Hegde S, Udaykumar P, Manjuprasad MS. Potential drug interactions in chronic kidney disease patients - A cross sectional study. International Journal of Recent Trends in Science and Technology. 2015;16(1):56-60.
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