Potential drug–drug interactions in the medication of medical patients at hospital discharge

ObjectiveInformation on the frequency of drug combinations with the potential to induce dangerous drug–drug interactions (DDIs) in patients discharged from the hospital is scarce. With the present study, we assessed the frequency and potential clinical significance of DDIs in the prescriptions of discharged medical patients.MethodsWe retrospectively screened the medication for potential DDIs of 500 patients consecutively discharged with at least two prescriptions using a computerised drug-interaction program.ResultsThe 500 patients (56.6% male, mean age 67.0±15.9 years, median length of stay 13 days) were prescribed a median of six drugs (range 2–18) at discharge. Three hundred patients (60.0%; 95% confidence interval 55.7–64.3%) had at least one potentially interacting drug combination. Of 747 potential DDIs at discharge overall, 402 (53.8%) were new at the time of discharge due to a change of the medication during the hospital stay. Of these, 72 (17.9%) were of potentially minor, 281 (69.9%) of moderate and 49 (12.2%) of major severity. Of 44 patients with a potential DDI with major severity, 1 patient was re-hospitalised within 2 months after discharge due to a probable drug-related problem associated with the potential DDI.ConclusionsUsing a computerised drug-interaction program, a high proportion of patients was detected with at least one potential DDI in the medication prescribed at discharge. However, the proportion of DDIs associated with potentially relevant clinical consequences appeared to be relatively low.

[1]  R. Raschetti,et al.  Suspected adverse drug events requiring emergency department visits or hospital admissions , 1999, European Journal of Clinical Pharmacology.

[2]  H. Ulmer,et al.  Incidence and risk of potential adverse drug interactions in the emergency room. , 2001, Resuscitation.

[3]  A. Lever,et al.  CAPTOPRIL IN A HYPONATRÆMIC HYPERTENSIVE: NEED FOR CAUTION IN INITIATING THERAPY , 1979, The Lancet.

[4]  F. Reubi,et al.  Long-term effects of captopril on renal function in hypertensive patients , 2004, European Journal of Clinical Pharmacology.

[5]  W. Stanaszek,et al.  Documenting drug-drug interactions in ambulatory patients. , 1979, American journal of hospital pharmacy.

[6]  P. Williams,et al.  Pharmacokinetics and effects on renal function following cilazapril and hydrochlorothiazide alone and in combination in healthy subjects and hypertensive patients. , 1989, British journal of clinical pharmacology.

[7]  M. Diemer,et al.  Interaction between Aspirin and ACE Inhibitors in Patients with Heart Failure , 2001, Drug safety.

[8]  T Welte,et al.  Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. , 2000, International journal of clinical pharmacology and therapeutics.

[9]  J S Roberts,et al.  Quantifying the Clinical Significance of Drug—Drug Interactions: Scaling Pharmacists' Perceptions of a Common Interaction Classification Scheme , 1996, The Annals of pharmacotherapy.

[10]  G. Santambrogio,et al.  Antihypertensive efficacy of angiotensin converting enzyme inhibition and aspirin counteraction , 1998, Clinical pharmacology and therapy.

[11]  H. Chrystyn,et al.  An investigation of hospital generated pharmaceutical care when patients are discharged home from hospital. , 2003, British journal of clinical pharmacology.

[12]  Sklar Sh.  Letter: Herpes simplex. , 1975, Lancet.

[13]  J. Puschett,et al.  Life-threatening hyperkalemia associated with captopril administration. , 1993, Southern medical journal (Birmingham, Ala. Print).

[14]  A. F. Shinn,et al.  Development of a Computerized Drug Interaction Database (Medicomsm) for Use in a Patient Specific Environment , 1983, Drug information journal.

[15]  R. Tallis,et al.  PRESCRIPTION OF CONTRAINDICATED AND INTERACTING DRUGS IN ELDERLY PATIENTS ADMITTED TO HOSPITAL , 1984, The Lancet.

[16]  H. Scheinin,et al.  A medication database – a tool for detecting drug interactions in hospital , 1997, European Journal of Clinical Pharmacology.

[17]  J. Rowin,et al.  Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion , 1996, Neurology.

[18]  Robert S Van Hare.  Potential adverse drug interactions in the emergency room (An issue in the quality of care) , 1990 .

[19]  F. Frey,et al.  [Dangerous hyperkalemia as sequelae of new treatment strategies of heart failure]. , 2000, Praxis.

[20]  J. Rowin,et al.  Association of Ginkgo biloba with intracerebral hemorrhage , 1998, Neurology.

[21]  L. Tyler,et al.  Prospective evaluation of adverse drug interactions in the emergency department. , 1992, Annals of emergency medicine.

[22]  C. A. Jankel,et al.  Epidemiology of Drug-Drug Interactions as a Cause of Hospital Admissions , 1993, Drug safety.

[23]  A. J. Costa.  Potential drug interactions in an ambulatory geriatric population. , 1991, Family practice.

[24]  L C Mion,et al.  Adverse drug reactions in an elderly outpatient population. , 1992, American journal of hospital pharmacy.

[25]  J. Dupond,et al.  Le hoquet: à la (re)découverte d'un signe souvent négligé , 1989 .

[26]  P. Chassagne,et al.  Fréquence et gravité des interactions médicamenteuses dans une population âgée: étude prospective concernant 639 malades , 1989 .

[27]  C. Nyman,et al.  Preventable sudden death in patients receiving angiotensin converting enzyme inhibitors and loop/potassium sparing diuretic combinations. , 1992, International journal of cardiology.

[28]  A. Glynn,et al.  ANTIGONOCOCCAL IgA IN GONORRHŒA , 1978, The Lancet.

[29]  E. Wiltink.  Medication control in hospitals. A practical approach to the problem of drug‐drug interactions. , 1998, Pharmacy World and Science.

[30]  S. Vale.  Subarachnoid haemorrhage associated with Ginkgo biloba , 1998, The Lancet.