Advertisement

Pharmacy World & Science

, Volume 32, Issue 6, pp 815–821 | Cite as

The incidence of potential drug–drug interactions in elderly patients with arterial hypertension

  • Vesna Bacic-Vrca
  • Srecko MarusicEmail author
  • Viktorija Erdeljic
  • Slaven Falamic
  • Nives Gojo-Tomic
  • Dario Rahelic
Research Article

Abstract

Objective To assess the incidence and type of potential, clinically significant drug–drug interactions in elderly outpatients with arterial hypertension. Setting Three community pharmacies in Croatia. Method Eligible patients were aged 65 or older, treated for arterial hypertension and received 2 or more drugs. Potential interactions were identified by Lexi-Interact software. The software categorized each potential interaction according to clinical significance in five groups: (A) No known interaction; (B) Specified agents may interact, but there is little to no evidence of clinical concern; (C) Specified agents may interact in a clinically significant manner. Monitoring therapy is suggested; (D) The two medications may interact in a clinically significant manner. Modification of therapy is suggested; (X) Contraindicated combination. Interactions of level C, D and X were considered clinically significant. Main outcome measure The incidence and type of potential drug–drug interactions. Results There were 265 patients included in the study. Potential, clinically significant drug interactions were identified in 240 (90.6%) patients, out of which 97.9% had interactions with clinical significance C, 20.4% D, and 0.8% X. The median number of drug interactions per patient was 4. We identified 215 drug combinations with the potential to cause clinically significant interaction, out of which 83.3% had clinical significance C, 16.3% clinical significance D, and 0.4% clinical significance X. Conclusion Drug–drug interactions are common in elderly hypertensive patients. Computer-based screening could help pharmacists and physicians to recognize potential, clinically significant interactions.

Keywords

Arterial hypertension Croatia Drug–drug interactions Elderly Software 

Notes

Acknowledgments

The authors would like to thank Belic S., Kosovec-Hadwiger T. and Barlovic H. for their assistance with data extraction.

Funding

The study received no external funding.

Conflicts of interest

None of the authors of this manuscript had any conflict of interests in connection with this study.

References

  1. 1.
    Doucet J, Chassagne P, Trivalle C, Landrin I, Pauty MD, Kadri N, et al. Drug–drug interactions related to hospital admissions in older adults: a prospective study of 1000 patients. J Am Geriatr Soc. 1996;44:944–8.PubMedGoogle Scholar
  2. 2.
    Becker ML, Visser LE, van Gelder T, Hofman A, Stricker BH. Increasing exposure to drug-drug interactions between 1992 and 2005 in people aged > or = 55 years. Drugs Aging. 2008;25(2):145–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Stafford AC, Tenni PC, Peterson GM, Jackson SL, Hejlesen A, Villesen C, et al. Drug-related problems identified in medication reviews by Australian pharmacists. Pharm World Sci. 2009;31(2):216–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14.CrossRefPubMedGoogle Scholar
  5. 5.
    ElDesoky ES. Pharmacokinetic-pharmacodynamic crisis in the elderly. Am J Ther. 2007;14(5):488–98.CrossRefPubMedGoogle Scholar
  6. 6.
    Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16.CrossRefPubMedGoogle Scholar
  7. 7.
    Köhler GI, Bode-Böger SM, Busse R, Hoopmann M, Welte T, Böger 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(11):504–13.PubMedGoogle Scholar
  8. 8.
    Goldberg RM, Mabee J, Chan L, Wong S. Drug–drug and drug–disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med. 1996;14:447–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Republic of Croatia—Central Bureau of Statistics. Women and men in Croatia. http://www.dzs.hr/ (2009). Cited 21 Apr 2010.
  10. 10.
    Croatian National Institute of Public Health. Cardiovascular diseases in Republic of Croatia. http://www.hzjz.hr/epidemiologija/kron_mas/kvb_bilt.pdf (2004). Cited 21 Apr 2010.
  11. 11.
    Erceg M, Hrabak-Zerjavić V, Ivicević Uhernik A. Regional characteristics of arterial hypertension in adult population of Croatia. Acta Med Croatica. 2007;61(3):293–8.PubMedGoogle Scholar
  12. 12.
    Prisant LM. Now or never: optimal antihypertensive therapy in the elderly. Prev Cardiol. 2008;11(4):201–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Straubhaar B, Krähenbühl S, Schlienger RG. The prevalence of potential drug-drug interactions in patients with heart failure at hospital discharge. Drug Saf. 2006;29(1):79–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Mannheimer B, Ulfvarson J, Eklöf S, Bergqvist M, von Bahr C. A clinical evaluation of the Janus Web Application, a software screening tool for drug-drug interactions. Eur J Clin Pharmacol. 2008;64:1209–14.CrossRefPubMedGoogle Scholar
  15. 15.
    Lexi-Comp ONLINE. Lexi-Interact. http://online.lexi.com/crlsql/servlet/crlonline?a=in (2010). Cited 21 Apr 2010.
  16. 16.
    Carter BL, Lund BC, Hayase N, Chrischilles E. The extent of potential antihypertensive drug interactions in a Medicaid population. Am J Hypertens. 2002;15(11):953–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38:666–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Glintborg B, Andersen SE, Dalhoff K. Drug-drug interactions among recently hospitalised patients-frequent but mostly clinically insignificant. Eur J Clin Pharmacol. 2005;61:675–81.CrossRefPubMedGoogle Scholar
  19. 19.
    Mackenzie IS, MacDonald TM. Treatment of osteoarthritis in hypertensive patients. Expert Opin Pharmacother. 2010;11(3):393–403.CrossRefPubMedGoogle Scholar
  20. 20.
    Gyamlani G, Geraci SA. Secondary hypertension due to drugs and toxins. South Med J. 2007;100(7):692–9.PubMedGoogle Scholar
  21. 21.
    Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16(6):641–51.CrossRefPubMedGoogle Scholar
  22. 22.
    Yoon SL, Schaffer SD. Herbal, prescribed, and over-the-counter drug use in older women: prevalence of drug interactions. Geriatr Nurs. 2006;27(2):118–29.CrossRefPubMedGoogle Scholar
  23. 23.
    Pavlicević I, Kuzmanić M, Rumboldt M, Rumboldt Z. Interaction between antihypertensives and NSAIDs in primary care: a controlled trial. Can J Clin Pharmacol. 2008;15(3):E372–82.PubMedGoogle Scholar
  24. 24.
    Benson M, Marangou A, Russo MA, Durocher J, Collaku A, Starkey YY. Patient preference for sustained-release versus standard paracetamol (acetaminophen): a multicentre, randomized, open-label, two-way crossover study in subjects with knee osteoarthritis. J Int Med Res. 2009;37(5):1321–35.PubMedGoogle Scholar
  25. 25.
    Republic of Croatia—Agency for Medical Products and Medical Devices. http://www.almp.hr/?ln=hr&w=publikacije&d=promet_lijekova_2008 (2008). Cited 21 Apr 2010.
  26. 26.
    Radosević N, Gantumur M, Vlahović-Palcevski V. Potentially inappropriate prescribing to hospitalised patients. Pharmacoepidemiol Drug Saf. 2008;17(7):733–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Scheen AJ. Drug interactions of clinical importance with antihyperglycaemic agents: an update. Drug Saf. 2005;28(7):601–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Mogensen CE. New concepts in blood pressure-lowering management in diabetic patients: the case for early ACE inhibitor combination therapy with diuretics. J Hum Hypertens. 2005;19(Suppl 1):S15–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Delafuente JC. Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol. 2003;48(2):133–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Tornio A, Niemi M, Neuvonen M, Laitila J, Kalliokoski A, Neuvonen PJ, et al. The effect of gemfibrozil on repaglinide pharmacokinetics persists for at least 12 h after the dose: evidence for mechanism-based inhibition of CYP2C8 in vivo. Clin Pharmacol Ther. 2008;84(3):403–11.CrossRefPubMedGoogle Scholar
  31. 31.
    Johnell K, Fastbom J. The use of benzodiazpines and related drugs amongst older people in Sweden: associated factors and concomitant use of other psychotropics. Int J Geriatr Psychiatry. 2009;24(7):731–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Assem-Hilger E, Jungwirth S, Weissgram S, Kirchmeyr W, Fischer P, Barnas C. Benzodiazepine use in the elderly: an indicator for inappropriately treated geriatric depression? Int J Geriatr Psychiatry. 2009;24(6):563–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Barrons R. Evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm. 2004;61(4):380–5.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Vesna Bacic-Vrca
    • 1
  • Srecko Marusic
    • 2
    Email author
  • Viktorija Erdeljic
    • 3
  • Slaven Falamic
    • 4
  • Nives Gojo-Tomic
    • 2
  • Dario Rahelic
    • 5
  1. 1.Department of Clinical PharmacyUniversity Hospital DubravaZagrebCroatia
  2. 2.Department of Clinical PharmacologyUniversity Hospital DubravaZagrebCroatia
  3. 3.Division of Clinical Pharmacology, Department of MedicineUniversity Hospital ZagrebZagrebCroatia
  4. 4.Community PharmacyDonji MiholjacCroatia
  5. 5.Department of MedicineUniversity Hospital DubravaZagrebCroatia

Personalised recommendations