Potential for drug interactions in hospitalized cancer patients
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To quantify the frequency of potential drug interactions unrelated to chemotherapy in cancer patients admitted to our institution, and to define risk factors for such interactions.
Charts of 100 consecutive hospitalized cancer patients were reviewed. Patients receiving chemotherapy and/or hormone therapy were excluded, as were patients admitted for intensive care. Drug–drug interactions were screened with Drug Interaction Facts software, and manually by the authors. Potential interactions were graded by levels of severity (severe, moderate, minor) and significance (one to five, with one representing the highest level of evidence).
The median age of the patients was 67 years, and the length of hospital stay and the number of drugs per patient were 6 days and eight drugs, respectively. In 63 patients 180 potential interactions were detected. Of the potential interactions, 18.3% were severe, 56.7% were moderate, and 25% were minor. Approximately 7%, 18% and 13% of potential interactions were graded as level 1, 2 and 3, respectively. In multivariate analysis, prescriptions with eight or more drugs (P=0.0004) and six or more days of hospital stay (P=0.014) were independent risk factors for potential interactions.
Potential drug interactions are common among hospitalized cancer patients. Length of hospital stay and number of prescribed drugs are risk factors.
KeywordsDrug interactions Drug therapy Combination Adverse effects Neoplasms
We thank Dr. Ian Tannock for his editorial help and thoughtful review of the manuscript.
- 1.Barrons R (2004) Evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm 61:380–385Google Scholar
- 2.Beers MH, Storrie M, Lee G (1990) Potential adverse drug interactions in the emergency room. An issue in the quality of care. Ann Intern Med 112:61–64Google Scholar
- 3.Bernard S, Bruera E (2000) Drug interactions in palliative care. J Clin Oncol 18:1780–1799Google Scholar
- 5.Buajordet I, Ebbesen J, Erikssen J, Brors O, Hilberg T (2001) Fatal adverse drug events: the paradox of drug treatment. J Intern Med 250:327–341Google Scholar
- 7.Ciummo PE, Katz NL (1995) Interactions and drug-metabolizing enzymes. Am Pharm NS35:41–51; quiz 51–53Google Scholar
- 8.Corcoran ME (1997) Polypharmacy in the older patient with cancer. Cancer Control 4:419–428Google Scholar
- 9.Craig C, Stiztel R (1997) Modern pharmacology with clinical application, 5th edn. Little Brown and Company, New YorkGoogle Scholar
- 10.Daly MP, Lamy PP, Richardson JP (1994) Avoiding polypharmacy and iatrogenesis in the nursing home. Md Med J 43:139–144Google Scholar
- 11.Davidson KW, Kahn A, Price RD (1987) Reduction of adverse drug reactions by computerized drug interaction screening. J Fam Pract 25:371–375Google Scholar
- 12.Delafuente JC (2003) Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol 48:133–143Google Scholar
- 13.eFacts Online (accessed 2003 May through October) Drug interaction facts. Wolters Kluwer Health. http://www.factsandcomparisons.com
- 15.Fauno P, Petersen KD, Husted SE (1993) Increased blood loss after preoperative NSAID. Retrospective study of 186 hip arthroplasties. Acta Orthop Scand 64:522–524Google Scholar
- 16.Gear RW, Miaskowski C, Heller PH, Paul SM, Gordon NC, Levine JD (1997) Benzodiazepine mediated antagonism of opioid analgesia. Pain 71:25–29Google Scholar
- 17.Geppert U, Beindl W, Hawranek T, Hintner H (2003) Drug interactions in clinical practice. A pilot project for quality assurance in prescribing. Hautarzt 54:53–57Google Scholar
- 18.Gerson LB, Triadafilopoulos G (2001) Proton pump inhibitors and their drug interactions: an evidence-based approach. Eur J Gastroenterol Hepatol 13:611–616Google Scholar
- 20.Goldberg RM, Mabee J, Mammone M, Chan L, Tarleton G, Broderick S, Robinson DC, Hurst AK, Whelan GP (1994) A comparison of drug interaction software programs: applicability to the emergency department. Ann Emerg Med 24:619–625Google Scholar
- 21.Goldberg RM, Mabee J, Chan L, Wong S (1996) Drug–drug and drug–disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med 14:447–450Google Scholar
- 22.Hancock D, Kennington JM, Beckner RR, Quick G (1992) Emergency department medication and drug interaction evaluation. Hosp Pharm 27:129–132Google Scholar
- 23.Heininger-Rothbucher D, Bischinger S, Ulmer H, Pechlaner C, Speer G, Wiedermann CJ (2001) Incidence and risk of potential adverse drug interactions in the emergency room. Resuscitation 49:283–288Google Scholar
- 24.Herr RD, Caravati EM, Tyler LS, Iorg E, Linscott MS (1992) Prospective evaluation of adverse drug interactions in the emergency department. Ann Emerg Med 21:1331–1336Google Scholar
- 25.Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New YorkGoogle Scholar
- 26.Jankel CA, Martin BC (1992) Evaluation of six computerized drug interaction screening programs. Am J Hosp Pharm 49:1430–1435Google Scholar
- 27.Karas S Jr (1981) The potential for drug interactions. Ann Emerg Med 10:627–630Google Scholar
- 28.Lackner TE (1991) Interaction of dexamethasone with phenytoin. Pharmacotherapy 11:344–347Google Scholar
- 29.McLeod HL (1998) Clinically relevant drug–drug interactions in oncology. Br J Clin Pharmacol 45:539–544Google Scholar
- 30.Michocki RJ, Lamy PP, Hooper FJ, Richardson JP (1993) Drug prescribing for the elderly. Arch Fam Med 2:441–444Google Scholar
- 31.Pick CG (1997) Antinociceptive interaction between alprazolam and opioids. Brain Res Bull 42:239–243Google Scholar
- 32.Poirier TI, Giudici R (1995) Evaluation of drug interaction microcomputer software: an updated comparison. Hosp Pharm 30:888–890, 893–894Google Scholar
- 33.Sternbach H (1991) The serotonin syndrome. Am J Psychiatry 148:705–713Google Scholar
- 34.Tatro DS (ed) (1997) Drug interaction facts, 4th edn. Facts and Comparisons, St. Louis, MOGoogle Scholar
- 35.Weale AE, Warwick DJ, Durant N, Prothero D (1995) Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement? Ann R Coll Surg Engl 77:35–37Google Scholar