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Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil

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Abstract

The aim of this study is to investigate the prevalence of potential drug-drug interactions (PDDIs), as well as classifying them in relation to level of severity, scientific evidence, time of onset, and potential clinical impact in adult and older adult patients with diabetes mellitus 2 (DM2). This cross-sectional study was conducted in a tertiary care outpatient center. The consecutive sample was made up of 140 patients with DM2. The Anatomical-Therapeutic-Chemical Classification was used for classifying the classes of medications. The PDDIs were analyzed using the DRUG-REAX® system. The relationships between PDDI and the associated factors were ascertained using a multiple logistic regression model. The prevalence of total PDDI was 75 %, and the prevalence of major severity PDDI was 20.7 %. Simvastatin (30.8 %), captopril/enalapril (12.8 %), and oral anti-diabetics/insulin (12.8 %) were the medications which were most involved in the major PDDI, bringing relevant potential clinical impacts such as rhabdomyolysis, hyperkalemia, and important glycemic alterations. Polypharmacy was associated with PDDI (adjusted odds ratio = 10.46, 95 % confidence interval = 4.10–26.71). Diabetics were highly exposed to clinically significant PDDI. It is important that health professionals should be aware of the risks related to PDDI, so that measures may be implemented in order to assure safe care for the patient.

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References

  1. World Health Organization. Global Status Report on Non-Communicable Diseases 2010 (2011). http://www.who.int/nmh/publications/ncd_report2010/en/. Accessed 09 Feb 2014.

  2. Feng P, Wang X, Hu Z, Ma Y, Tang W, et al. Distribution and determinants of non communicable diseases among elderly Uyghur ethnic group in Xinjiang, China. PLoS One. 2014;9:e105536.

    Article  PubMed  PubMed Central  Google Scholar 

  3. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35:S64–71.

    Article  Google Scholar 

  4. American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36:S11–66.

    Article  Google Scholar 

  5. American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37:S14–80.

    Article  Google Scholar 

  6. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Freeman JS, Gross B. Potential drug interactions associated with treatments for type 2 diabetes and its comorbidities: a clinical pharmacology review. Expert Rev Clin Pharmacol. 2012;5:31–42.

    Article  PubMed  Google Scholar 

  8. Secoli SR, Figueras A, Lebrao ML, de Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly: a population-based, cross-sectional study. Drugs Aging. 2010;27:759–70.

    Article  PubMed  Google Scholar 

  9. JJV T, MTL C, Dos Santos CA, Romano-Lieber NS. Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, Southern Brazil. PLoS One. 2012;7:e47062.

    Article  Google Scholar 

  10. Bachmann KA. Drug interactions handbook.Hudson,: Lexi-Comp; 2003.

  11. Tatro DS. Drug interactions facts. St Louis: Wolters Kluwer Health/Facts & Comparisons; 2011.

  12. Van Leeuwen RWF, Brundel DHS, Neef C, van Gelder T, Mathijssen RHJ, Burger DM, et al. Prevalence of potential drug–drug interactions in cancer patients treated with oral anticancer drugs. Br J Cancer. 2013; 108:1071–108.

  13. Bergk V, Gasse C, Rothenbacher D, Loew M, Brenner H, Haefeli WE. Drug interactions in primary care: impact of a new algorithm on risk determination. Clin Pharmacol Ther. 2004;76:85–96.

    Article  CAS  PubMed  Google Scholar 

  14. Bjerrum L, Andersen M, Petersen G, Kragstrup J. Exposure to potential drug interactions in primary health care. Scand J Prim Health Care. 2003;21:153–8.

    Article  PubMed  Google Scholar 

  15. Codagnone Neto V, Garcia VP, Santa Helena ET. Possible pharmacological interactions in hypertensive and/or diabetic elderly in family health units at Blumenau (SC). Braz J Pharm Sci. 2010;46:795–804.

    Article  Google Scholar 

  16. Trevisan DD, Silva JB, Oliveira HC, Secoli SR, Lima MH. Prevalence and clinical significance of potential drug-drug interaction in hematopoietic stem cell transplantation. Cancer Chemother Pharmacol. 2015;75:393–400.

    Article  CAS  PubMed  Google Scholar 

  17. Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther. 2008;33:141–51.

    Article  CAS  PubMed  Google Scholar 

  18. Kohler GI, Bode-Boger SM, Busse R, Hoopmann M, Welte T, Boger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther. 2000;38:504–13.

    Article  CAS  PubMed  Google Scholar 

  19. Dinesh KU, Subish P, Pranaya M, Shankar PR, Anil SK, Durga B. Pattern of potential drug-drug interactions in diabetic out-patients in a tertiary care teaching hospital in Nepal. Med J Malays. 2007;62:294–8.

    CAS  Google Scholar 

  20. World Health Organization. Collaborating Center for Drug Statistics Methodology – ATC/DDD Index (2012). http://www.whocc.no/atcddd/index. Accessed 06 Feb 2014.

  21. Thomson Reuters Inc. (2012–2015). Micromedex® Healthcare Series. [Database]. http://www.micromedexsolutions.com/home/dispatch. Accessed 17 Feb 2014.

  22. Hosmer Jr DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: John Willey & Sons; 2000.

    Book  Google Scholar 

  23. Chiang HH, Tseng FY, Wang CY, Chen CL, Chen YC, See TT, et al. All-cause mortality in patients with type 2 diabetes in association with achieved hemoglobin A(1c), systolic blood pressure, and low-density lipoprotein cholesterol levels. PLoS One, 2014; 9:e109501.

  24. Secoli SR, Danzi NJ, Ferreira de Lima FF, Lorenzi Filho G, Cesar LAM. Drug interactions in patients with coronary artery disease. Rev Bras Cartogr. 2012;25:11–8.

    Google Scholar 

  25. Doubova SV, Reyes-Morales H, Torres-Arreola LP, Suarez-Ortega M Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City. BMC Health Serv Res. 2007;7:147.

    Article  Google Scholar 

  26. Marquito AB, Fernandes NMS, Basile Colugnati FA, de Paula RB. Identifying potential drug interactions in chronic kidney disease patients. J Bras Nefrol. 2014;36:26–34.

    Article  PubMed  Google Scholar 

  27. Patel PS, Rana DA, Suthar JV, Malhotra SD, Patel VJ. A study of potential adverse drug-drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital. J Basic Clin Pharm. 2014;5:44–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. De Araújo MF, Dos Santos Alves PJ, Veras VS, de Araújo TM, Zanetti ML, Damasceno MM. Drug interactions in Brazilian type 2 diabetes patients. Int J Nurs Pract. 2013;19:423–30.

    Article  PubMed  Google Scholar 

  29. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81.

    Article  Google Scholar 

  30. Borders-Hemphill V. Concurrent use of statins and amiodarone. Consult Pharm. 2009;24:372–9.

    Article  PubMed  Google Scholar 

  31. Tuchscherer RM, Nair K, Ghushchyan V, Saseen JJ. Simvastatin prescribing patterns before and after FDA dosing restrictions: a retrospective analysis of a large healthcare claims database. Am J Cardiovasc Drugs. 2015;15:27–34.

    Article  CAS  PubMed  Google Scholar 

  32. Chatzizisis YS, Koskinas KC, Misirli G, Vaklavas C, Hatzitolios A, Giannoglou GD. Risk factors and drug interactions predisposing to statin-induced myopathy: implications for risk assessment, prevention and treatment. Drug Saf. 2010;33:171–87.

    Article  CAS  PubMed  Google Scholar 

  33. Schepkens H, Vanholder R, Billiouw JM, Lameire N. Life-threatening Hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases. Am J Med. 2001;110:438–41.

    Article  CAS  PubMed  Google Scholar 

  34. Eschmann E, Beeler PE, Kaplan V, Schneemann M, Zünd G, Blaser J. Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug-drug interactions. Eur J Clin Pharmacol. 2014;70:215–23.

    Article  CAS  PubMed  Google Scholar 

  35. Schelleman H, Bilker WB, Brensinger CM, Wan F, Hennessy S. Anti-infectives and the risk of severe hypoglycemia in users of glipizide or glyburide. Clin Pharmacol Ther. 2010;88:214–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Micheli L, Sbrilli M, Nencini C. Severe hypoglycemia associated with levofloxacin in type 2 diabetic patients receiving polytherapy: two case reports. Int J Clin Pharmacol Ther. 2012;50:302–6.

    Article  CAS  PubMed  Google Scholar 

  37. Paris B, Yerino P, Ogilvie B, Parkinson A. Abstract 130: the proton pump inhibitors (PPIs) omeprazole and rabeprazole but not lansoprazole and pantoprazole are in vitro time-dependent inhibitors of CYP2C19. Drug Metab Rev. 2008;40:89–90.

    Google Scholar 

  38. Gremmel T, Steiner S, Seidinger D, Koppensteiner R, Panzer S, Kopp CW. Calcium channel blockers decrease clopidogrel-mediated platelet inhibition. Heart. 2010;96:186–9.

    Article  CAS  PubMed  Google Scholar 

  39. Siller-Matula JM, Lang I, Christ G, Jilma B. Calcium-channel blockers reduce the antiplatelet effect of clopidogrel. J Am Coll Cardiol. 2008;52:1557–63.

    Article  CAS  PubMed  Google Scholar 

  40. Good CW, Steinhubl SR, Brennan DM, Lincoff AM, Topol EJ, Berger PB. Is there a clinically significant interaction between calcium channel antagonists and clopidogrel?: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Circ Cardiovasc Interv. 2012;5:77–81.

    Article  CAS  PubMed  Google Scholar 

  41. Olesen JB, Gislason GH, Charlot MG, Fosbøl EL, Andersson C, Weeke P, et al. Calcium-channel blockers do not alter the clinical efficacy of clopidogrel after myocardial infarction: a nationwide cohort study. J Am Coll Cardiol. 2011;57:409–17.

    Article  CAS  PubMed  Google Scholar 

  42. Paterno MD, Maviglia SM, Gorman PN, Seger DL, Yoshida E, Seger AC, et al. Tiering drug-drug interaction alerts by severity increases compliance rates. J Am Med Inform Assoc. 2009;16:40–6.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Danilo D. Trevisan.

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Trevisan, D.D., Silva, J.B., Póvoa, V.C. et al. Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil. Int J Diabetes Dev Ctries 36, 283–289 (2016). https://doi.org/10.1007/s13410-015-0428-7

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