Potential drug interactions in drug therapy prescribed for older adults at hospital discharge
cross-sectional study
Keywords:
Drug interactions, Frail elderly, Patient discharge, Drug therapyAbstract
BACKGROUND: Older adults with a range of comorbidities are often prescribed multiple medications, which favors drug interactions. OBJECTIVES: To establish the frequency of potential drug interactions in prescriptions at hospital dis-charge among older adults and to identify the associated factors. DESIGN AND SETTING: Cross-sectional study conducted in a public hospital. METHODS: An initial face-to-face interview, data collection from the electronic medical records (covering sociodemographic, clinical, functional and drug therapy-related variables) and telephone follow-up after discharge were conducted to confirm the medication prescribed at discharge. Drug interactions were iden-tified through the Micromedex DrugReax software, along with interactions that should be avoided among the elderly, as per the 2015 American Geriatric Society/Beers criteria. Multivariable logistic regression was performed. RESULTS: Potential for drug interactions was identified in the discharge drug therapy of 67.8% of the 255 old-er adults evaluated (n = 172), and 54.5% (n = 145) of the drug interactions were major. Among the drug in-teractions that should be avoided among older adults, those that increase the risk of falls were the most fre-quent. The drug interactions thus identified were independently associated with polypharmacy (odds ratio, OR = 12.62; 95% confidence interval, CI 6.25-25.50; P = 0.00), diabetes mellitus (OR = 2.16; 95% CI 1.05-4.44; P = 0.04), hypothyroidism (OR = 7.29; 95% CI 2.03-26.10; P = 0.00), chronic kidney disease (OR = 3.41; 95% CI 1.09-10.64; P = 0.03) and hospitalization in geriatric units (OR = 0.45; 95% CI 0.22-0.89; P = 0.02). CONCLUSION: The frequency of potential drug interactions in drug therapy prescribed at discharge for these older adults was high. Polypharmacy, diabetes mellitus, hypothyroidism and chronic kidney disease were positively associated with occurrences of drug interactions, while hospitalization in geriatric units showed an inverse association.
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Melo DO, Ribeiro E, Storpirtis S. Potential drug-drug interaction in a Brazilian teaching hospital: age-related differences? Rev Ciên Farm Básica Apl. 2015;36(3):435-44.
Veras RP, Oliveira M. Aging in Brazil: the building of a healthcare model. Ciênc Saúde Coletiva. 2018;23(6):1929-36. PMID: 29972500; doi: 10.1590/1413-81232018236.04722018.
Olsson IN, Runnamo R, Engfeldt P. Medication quality and quality of life in the elderly, a cohort study. Health and Quality of Life Outcomes. 2011;9(95). PMID: 22054205; doi: 10.1186/1477-7525-9-95.
Rodrigues MCS, Oliveira C. Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review. Rev Latino-Am Enfermagem. 2016;24:e2800. PMID: 27598380; doi: 10.1590/1518-8345.1316.2800.
Roblek T, Deticek A, Leskovar B, et al. Clinical-pharmacist intervention reduces clinically relevant drug-drug interactions in patients with heart failure: a randomized, double-blind, controlled trial. Int J Cardiol. 2016;203:647-52. PMID: 26580349; doi: 10.1016/j. ijcard.2015.10.206.
Hines LE, Murphy JE. Potentially harmful drug-drug interactions in the elderly: a review. Am J Geriatr Pharmacother. 2011;9(6):364-77. PMID: 22078863; doi: 10.1016/j.amjopharm.2011.10.004.
Lucas C, Byles J, Martin JH. Medicines optimisation in older people: taking age and sex into account. Maturitas. 2016;93:114-20. PMID: 27506133; doi: 10.1016/j.maturitas.2016.06.021.
Cortejoso L, Dietz RA, Hoffman G, Gosch M, Sattler A. Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany. Clin Interv Aging. 2016;11:1343-50. PMID: 27713625; doi: 10.2147/CIA.S109048.
IBM Micromedex® DRUGREAX® (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. Available from: https:// www.micromedexsolutions.com/micromedex2/librarian/ssl/true Accessed in 2019 (Aug 28).
Guedes TM, Reis AMM. Performance of three brands of drug interaction programs for use in geriatrics. Pharmacoepidemiology Drug Saf. 2013;22:489.
American Geriatrics Society. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Society. 2015;63(11):2227-46. PMID: 26446832; doi: 10.1111/jgs.13702.
Busca por Codigo. [CID10 – Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde, 10a edição.] Available from: https://www.cid10.com.br/. Accessed in 2019 (Sep 4).
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. PMID: 3558716.
Melchiors AC, Correr CJ, Fernández-Llimos F. Tradução e validação para o português do Medication Regimen Complexity Index. Arq Bras Cardiol. 2007;89(4):210-8. PMID: 17992376.
Pantuzza LLN, Ceccato MCB, Silveira MR, Pinto IV, Reis AMM. Validation and standardization of the Brazilian version of the Medication Regimen Complexity Index for older adults in primary care. Geriatr Gerontol Int. 2018;18(6):853-9. PMID: 29380500; doi: 10.1111/ggi.13261.
Luz LL, Santiago LM, Silva JF, Mattos IE. Psychometric properties of the Brazilian version of the Vulnerable Elders Survey-13 (VES-13). Cad Saúde Pública. 2015;31(3):507-15. PMID: 25859718.
Abolhassani N, Castioni J, Santschi V, Waeber G, Marques-Vidal P. Trends and Determinants of Polypharmacy and Potential Drug-Drug Interactions at Discharge from Hospital Between 2009-2015. J Patient Saf. 2018. PMID: 29557932; doi: 10.1097/PTS.0000000000000482.
Marusic S, Bacic-Vrca V, Neto PR, et al. Actual drug-drug interactions in elderly patients discharged from internal medical clinic: a prospective observational study. Eur J Clin Pharmacol. 2013;69:1717-24. PMID: 23739998; doi: 10.1007/s00228-013-1531-7.
Bertoli R, Bissig M, Caronzolo D, et al. Assessment of potential drug-drug interactions at hospital discharge. Swiss Med Wkly. 2010;15,140:w13043. PMID: 20373176; doi: 10.4414/smw.2010.13043.
Chatzizisis YS, Koskinas KC, Misirli G, et al. Risk factors and drug interactions predisposing to statin-induced myopathy: implications for risk assessment, prevention and treatment. Drug Saf. 2010;33(3):171‑87. PMID: 20158283; doi: 10.2165/11319380-000000000-00000.
Wiggins BS, Saseen JJ, Page RL 2nd, et al. Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2016; 134:e468-95. PMID: 27754879; doi: 10.1161/ CIR.0000000000000456.
Thai M, Reeve E, Hilmer SN, et al. Prevalence of statin-drug interactions in older people: a systematic review. Eur J Clin Pharmacol. 2017;72(5):513-21. PMID: 26790666; doi: 10.1007/s00228-016-2011-7.
Novello MF, Rosa ML, Ferreira RT, et al. Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care. Arq Bras Cardiol. 2017;108(2):135-42. PMID: 28327875 ; doi: 10.5935/ abc.20170009.
Luppen LS, Sampaio FH, Zandoná B, et al. Prevalência do uso de anti-hipertensivos em pacientes acompanhados em Unidade Básica de Saúde, Canoas, RS, Brasil. Rev AMRIGS. 2011;55(1):42-7.
Day RO, Snowden L, McLachlan AJ. Life-threatening drug interactions: what the physician needs to know. Intern Med J. 2017;47(5):501-12. PMID: 28503886; doi: 10.1111/imj.13404.
Amaral DMD, Perassolo MS. Possíveis interações medicamentosas entre os anti-hipertensivos e antidiabéticos em participantes do Grupo HIPERDIA de Parobé, RS (Uma análise teórica). Rev Ciên Farm Básica Apl. 2012;33(1):99-105. Available at: http://serv-bib.fcfar.unesp.br/seer/index.php/Cien_Farm/article/view/1703/1703. Accessed in 2019 (Aug 18).
Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140-9. PMID: 25538310; doi: 10.2337/dc14-2441.
Maia BC, Viana PS, Arantes PMM, Alencar MA. Consequências das quedas em idosos vivendo na comunidade. Rev Bras Geriatr Gerontol. 2011;14(2):381-93.
Abreu DROM, Novaes ES, Oliveira RR, Mathias TAF, Marcon SS. Fall-related admission and mortality in older adults in Brazil: trend analysis. Ciênc Saúde Colet. 2018;23(4):1131-41. PMID: 29694573; doi: 10.1590/1413-81232018234.09962016.
Ahmad A, Mast MR, Nijpels G, et al. Identification of drug-related problems of elderly patients discharged from hospital. Patient Prefer Adherence. 2014;8:155-65. PMID: 24523581; doi: 10.2147/PPA.S48357.
Pinto NBF, Vieira LB, Pereira FMV, Reis AMM, Cassiani SHB. Interações medicamentosas em prescrições de idosos hipertensos: prevalência e significância clínica [Drug interactions in prescriptions for elderly hypertensive patients: prevalence and clinical significance.] Rev Enfermagem UERJ. 2014;22(6):735-41. doi: https://doi.org/10.12957/reuerj.2014.7111. Available at: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/7111. Accessed in 2019 (Aug 18).
Prado MA, Francisco PM, Barros MB. Diabetes in the elderly: drug use and the risk of drug interaction. Ciênc Saúde Colet. 2016;21(11):3447‑58. PMID: 27828578; doi: 10.1590/1413-812320152111.24462015.
Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012;7:97-111. PMID: 22573936; doi: 10.2147/CIA.S23966.
Liwanpo L, Hershman JM. Conditions and drugs interfering with thyroxine absorption. Best Pract Research Clin Endocrinol Metab. 2009;23(6):781-92. PMID: 19942153; doi: 10.1016/j.beem.2009.06.006.
Lassiter J, Bennett WM, Olyaei AJ. Drug dosing in elderly patients with chronic kidney disease. Clin Geriatr Med. 2013;29(3):657-705. PMID: 23849014; doi: 10.1016/j.cger.2013.05.008. Petrovic M, Sommers A, Onder G. Optimization of Geriatric Pharmacotherapy: Role of Multifaceted Cooperation in the Hospital Setting. Drugs Aging. 2016;33(3):179-88. PMID: 26884392; doi: 10.1007/ s40266-016-0352-7.
