Drug Res (Stuttg) 2014; 64(12): 633-637
DOI: 10.1055/s-0033-1363965
Review
© Georg Thieme Verlag KG Stuttgart · New York

Polypharmacy-induced Drug-Drug Interactions; Threats to Patient Safety

H. Sharifi
1   Clinical Pharmacologist MD-PhD, Urmia University of Medical Sciences
,
M. A. V. Hasanloei
2   Anesthesiologist-Fellowship of Intensive care Medicine – Assistant Professor of Urmia University of Medical Sciences
,
J. Mahmoudi
3   Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
› Author Affiliations
Further Information

Publication History

received 20 September 2013

accepted 07 December 2013

Publication Date:
05 February 2014 (online)

Abstract

Background:

Patient safety is an increasingly recognized challenge and opportunity for stakeholders in improving health care delivery. Because of extensive use of medicines, life expectancy is increasing and elderly as well as comorbidities need polypharmacy, and therefore the risk of drug-drug interactions (DDIs) increases.

Methods:

We searched PubMed and ScienseDirect for epidemiology of articles describing the frequency of potential DDIs published up to 2011 in title, abstract, keywords and text.

Results:

Studies show that the rate of DDIs both in outpatients and hospitalized patients is high. The elderly, <5 year-old children and women are at higher risks for it. Also, the rate of DDIs in patients who suffer from chronic kidney disease (CKD), cardiovascular disease (CVD) such as heart failure (HF) and hypertension (HTN) and cancers is significant.

Discussion and Conclusions:

Physicians, for lowering the risk of DDIs, should take precise drug history, prescribe appropriate and lowest drugs and ultimately counsel with clinical pharmacologist as a key strategy in order to insure the patient safety. This article reviews the existing data concerning this problem to provide an aid for choosing the appropriate drugs and prescribe the most effective with the lowest DDIs for providing patient safety.

 
  • References

  • 1 Taylor LK, Kawasumi Y, Bartlett G et al. Inappropriate prescribing practices: the challenge and opportunity for patient safety. Healthcare Quartery 2005; 8: 81-85
  • 2 Council of Europe, Expert Group on Safe Medication Practices (P-SP-PH/SAFE) (2006). Creation of a better medication safety culture in Europe: building up safe medication practices. Available at: http://www.coe.int/t/e/social_cohesion/soc-sp/Medication%20safety%20culture%20report%20E.pdf 2006 Accessed 11.03.10. ician has intentionally prescribed an overdose
  • 3 Kohn LT, Corrigan JM, Donaldson MS. eds. (Institute of Medicine).ToErr Is Human: Building a Safer Health System. Washington, DC: National Academy Press;
  • 4 Teinila T, Kaunisvesi K, Airaksinen M. Primary care physicians’ perceptions of medication errors and error prevention in cooperation with community pharmacists. Res Social Adm Pharm 2011; 7: 162-179
  • 5 National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) (2006) What is a medication error? Available at: http://www.nccmerp.org/aboutMedErrors.html 2006 Accessed 11.03.10
  • 6 Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug – drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther 2008; 33: 141-151
  • 7 Tatro DS. Drug interaction facts – the authority on drug interactions. Facts and Comparisons. St. Louis, MO: 2006
  • 8 Gizzi LA, Slain D, Hare JT et al. Assessment of a Safety Enhancement to the Hospital Medication Reconciliation Process for Elderly Patients. Am J Geriatr Pharmacother 2010; 8: 127-135
  • 9 Grattagliano I, Portincasa P, D’Ambrosio G et al. Avoiding drug interactions: Here’s help. J Fam Pract 2010; 59: 322-329
  • 10 Juurlink DN, Mamdani M, Kopp A et al. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 2003; 289: 1652-1658
  • 11 Egger SS, Drewe J, Schlienger RG. Potential drug-drug interactions in the medication of medical patients at hospital discharge. Eur J Clin Pharmacol 2003; 58: 773-778
  • 12 Ahmadizar F, Soleymani F, Abdollahi M. Study of drug-drug interactions in prescriptions of general practitioners and specialists in Iran between the years of 2007–2009 2009;
  • 13 Brown NA, Zenilman ME. The Impact of Frailty in the Elderly on the Outcome of Surgery in the Aged. Adv Surg 2010; 44: 229-249
  • 14 Magro L, Conforti A, Zotti FD et al. Identification of severe potential drug-drug interactions using an Italian general-practitioner database. Eur J Clin Pharmacol. Springer-Verlag 2007;
  • 15 Indermitte J, Beutler M, Bruppacher R et al. Management of drug-interaction alerts in community pharmacies. J Clin Pharm Ther 2007; 32: 132-142
  • 16 Aparasu R, Baer R, Aparasu A. Clinically important potential drug-drug interactions in outpatient settings. Res Social Adm Pharm 2007; 3: 426-437
  • 17 Riechelmann RP, Giglio AD. Drug interactions in oncology: how common are they?. Annals of Oncology 2009; 20: 1907-1912
  • 18 Girre V, Arkoub HL, Puts MTE et al. Potential drug interactions in elderly cancer patients. Crit Rev Oncol Hematol 2011; 78: 220-226
  • 19 Shapiro LE, Shear NH. Drug interactions: proteins, pumps, and P-450s. J Am Acad Dermatol. 2002; 47: 467-484
  • 20 Sitar DS. Aging issues in drug disposition and efficacy. Proc West Pharmacol Soc 2007; 50: 16-20
  • 21 Tulner LR, Frankfort SV, Gijsen GJ et al. Drug-drug interactions in a geriatric outpatient cohort: prevalence and relevance. Drugs Aging 2008; 25: 343-355
  • 22 Rifkin DE, Winkelmayer WC. Medication Issues in Older Individuals With CKD. Adv Chronic Kidney Dis 2010; 17: 320-328
  • 23 Fick DM, Cooper JW, Wade WE et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Arch Intern Med 2003; 163: 2716-2724
  • 24 Riechelmann RP, Krzyzanowska MK, O’Carroll A et al. Symptom and medication profiles among cancer patients attending a palliative care clinic. Support Care Cancer 2007; 15: 1407-1412
  • 25 Flesch M, Erdmann E. The Problem of Polypharmacy in Heart Failure. Curr Cardiol Rep 2006; 8: 217-225
  • 26 Cleland JG, Findlay I, Jafri S et al. The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. Am Heart J 2004; 148: 157-164
  • 27 Stys T, Lawson WE, Smaldone GC et al. Does Aspirin Attenuate the Beneficial Effects of Angiotensin-Converting Enzyme Inhibition in Heart Failure?. Arch Intern Med 2000; 160: 1409-1413
  • 28 Page J, Henry D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an underrecognized public health problem. Arch Intern Med 2000; 160: 777-784
  • 29 Isnard R, Baroin JP, Drobinski G et al. Influence of aspirin on long-term prognosis of patients with left ventricular systolic dysfunction [abstract]. Circulation 1998; 17: 300
  • 30 Amabile CM, Spencer AP. Keeping your patient with heart failure safe: a review of potentially dangerous medications. Arch Intern Med 2004; 164: 709-720
  • 31 Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 2002; 347: 1403-1411
  • 32 Gill SS, Mamdani M, Naglie G et al. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med 2005; 165: 808-813
  • 33 Arnstein P. Balancing Analgesic Efficacy with Safety Concerns in the Older Patient Pain Management Nursing. 2010; 11: S11-S22
  • 34 Pauwels O. Factors contributing to carbamazepine-macrolide interactions. Pharmacol Res 2002; 45: 291-298
  • 35 Duke JD, Li X, Grannis SJ. Data visualization speeds review of potential adverse drug events in patients on multiple medications. J Biomed Inform 2010; 43: 326-331