Drug drug Interactions in Hospitalized Cardiac Patients

Pharmacy Practice Drug drug Interactions in Hospitalized Cardiac Patients Mateti UV, Rajakannan T, Nekkanti H, Rajesh V, Mallaysamy SR, Ramachandran P 1 Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, 1 Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, India Address for correspondence: Dr. Thiyagu R; E-mail: rthiyagu82@gmail.com ABSTRACT Key words: INTRODUCTION a i o in mo om l ma in a o ia d i ion on d a in a in l all n in in a ion a mo im o an in i on and o andlin o d d in a ion ma n a m l n a d n d Quick Response Code: Access this article online Website: DOI: o o mo d in a in in a mann a i n o o i i o on o mo d i al d in a i n i in m l id a i a ma o on n in a ion ma l ad o an in a d i o o i ali a ion and i al a o in id n o a al o n o d in a ion a n o d o m mall an in om o 3 om di a o nd a o o a i n i n m om a o ia d i and a a on i l o o o o i al admi ion a a al o o n a a a o ia d i in a d al a A o din o a n l li d d o all o i al admi ion a a d and m n d a m n i i o o i al admi ion and o Journal of Young Pharmacists Vol 3 / No 4 329

o i ali a ion a a d ad d a ion A d o 3 in id n o a dio a la di a a in a d in n d ad a n ima d a a mo ommon a o d a in ndia and a a l a dio a la d a mo d o ond la amon all d la i d in o n a i n i a dio a la di a a a i la l ln a l o d o i ad an d a ol a ma and in n o a di a on d m a oli m o n ial o a a i la a dio a la d a i i indi id al di a in a d and n o o o o d o n ial o d in a ion i i i a dia d and a o on o n ial in a diolo d a m n om ndia a no di o in a al in id n o in ndian in n n d a d i n d o a in id n and a n o in o i ali d a dia a i n in a ia a o i al i a m n o a ion a a i i o om and a ali MATERIALS AND METHODS Study design, population and data collection A o i o a ional d a a i d o o a iod o 3 mon A il l in a ia a a in o i al i al a o al a o ain d om n i ional i ommi io o ini ia ion o d a i n o admi d on i l o a diolo ni in l d d in d i ion i o o mo d i d d in o i ali a ion onl l d o d d o la ion om i d all a i n a d a o old admi d o o i al and ad a l n o a a an o a i n d o a diolo ni o al a ion a i n i i in on o a i n a i and a i n o di d d in o i al a l d d om d mo a i in o ma ion a and nd n m o d a n l n o o i al a main dia no i and n m o addi ional dia no and la o a o in i a ion mad o ain d om lini al o d All i ion o d o la ion n d o in om i d da a a m o d minin A o m di a ion add d and a ll a di on in d on id d All d la i i d a Ana omi al a i mi al la i a ion A od l l on ain d mo a i a a i i di d o nd o di o o a a i n a a i i nd a mo an a old on n mo idi i and l n o a d a a i i n m o d and la o a o in i a ion n na ional o mali d a io l din im m a inin and m o a i m l l a i n m di al o d n d o n o A and n m o al la d om o al n m o o la i a ali o o i al admi ion o d a an o al o i m a d a an o al o i m o a an o al i a ionnai d i n d a an o et al o d minin li li ood o an A i a all d o d a an l o o a o o a ili i a i n d ia a o m d d ni o a l o i l o do l al o ain d om i al o i m a om im d in i o i alidi o a o on l ion a din A in a ion o d la i d in o mild mod a and a o din o i and nd i a l da a on i a o ain d om da a o d da a a Statistical analysis n i i n a d o mma i dia no i n m o d di n d n o d in ol d in and i o an i on d n in al a d o mma i a and l n o a i a a d o nd a o ia ion n n m o d and a man o la ion a d o nd o la ion n n m o d l n o a i A P al o a on id d a i i all i ni an All anal o m d in RESULTS Patients, drug characteristics and DDIs A o al o i ion anal d d in d iod and i a o nd a a i n on m d i minim m o on A i ni an o o ion o a i n i a mal n m in ollo d mal 3 3 a o o mo an a ad and a ollo d o a o a i n o ad a n mo an d d lo d i n m o a i n a a i i and a i i al i ni an o l a mma i d in a l a i n o a d 330 Journal of Young Pharmacists Vol 3 / No 4

o da d lo d mo n l an o o n an a a a a i n ad 3 od d dia no i in i an io all m o a dial in a ion a mo ommon ondi ion ollo d in io all m o a dial in a ion a ial illa ion 3 n ion and o mo ommon d la in ol d in A an i la l 3 and an i oa lan d a in and a i in mo ommon d on i l o lini all im o an amon i d d a mma i d in a l Bl din a ommon lini al on n in 3 a lini al on n o a mma i d in a l 3 da a al a d o i m a d a mma i d in a l Causality and severity of DDIs All o a d o a o a l a ali in a an o al o i m in a in d i d a n in a and do a al d in a 3 3 i a i n im o d a i d a al o in a in d all n a o m d in a i n and n o m om o d in a i n on a ali a m n ma o i o o a d a o a l ollo d o i l a in o o a d o i in i a 3 la i d a mod a ollo d 33 a 3 and mild a DISCUSSION i d al d o all in id n o lini all im o an in a diolo d a m n o in id n om a d i ano d li d om am in on o n ial i o d an in id n o a o 3 i d o d on Table 1: Patient c aracteristics Patient Number (%) characteristics of ADRs Gender group Male Female Age (years o o drugs ta en 1 1 3 ( 3 1 ( 2 1 (11 3 2 (3 1 ( 9 1 (1 1 29 (32 9 ( 91 P value 2 =12 9 d =3 P 2 =1 23 d =3 P 2 =11 9 d =3 P in id n o a al om a d o o d d on o n ial i a a o o i l i ma a i o o i n om ina ion indin Table 2: linically important s amon t e prescribe r s Objective drug Precipitant drug (n, %) Clinical consequences Heparin C BA 3 Aspirin ar arin B 1AA 3 Clopidogrel - decrease - increase Aspirin (33 3 trepto inase (3 3 B 1A 1 ar arin ( 9 9 B 1AA 3 iltiazam (3 3 C B 1 pti batide (1 1 13 B 1AC1 Insulin (1 1 13 A1 A 1 Captopril (1 1 13 C 9AA 1 Furosemide (1 1 13 C 3CA 1 Clopidogrel (2 2 2 Amoxicillin (1 1 13 1CR 2 Aspirin (1 1 13 Atenolol (1 1 13 C AB 3 Phenytoin (1 1 13 3AB 2 Heparin (11 12 C BA 3 Torsemide (11 12 C 3CA noxaparin ( 9 9 B 1AB Aspirin (1 1 13 Hypoglycemia Captopril e ect Furosemide e ect Torsemide toxicity Table 3: linical conse ences of s Clinical consequences No. of DDIs (%) Torsemide toxicity Hypoglycemia Furosemide e ect Captopril e ect - decrease I - rug drug interactions ( 3 11 (12 Table 4: r an systems affecte by t e s Organ system Documented Number (%) complications of DDIs Platelet bleeding and ( 3 clotting disorders Body as a whole Therapeutic e ect 11 (12 General disorders increased (drug toxicity Heart rate and rhythm Bradycardia 9 (2 31 disorders rinary system Acute renal ailure (1 2 disorders Central and peripheral nervous system disorder Headache 2 ( 1 Journal of Young Pharmacists Vol 3 / No 4 331

o n d o d a a n o in id n o a o i i l a o ia d i a i n a nd n m o d i d and l n o o i al a A i a o a n in om n and a i n o mo an a o a i o ond o l o o di o in a a ommon in ld l o l o a on m l i l d im n l o d a i a o n in ld l a i n a d o in a d n m o m di a ion i d o i o la ion l a in a o dan i o a ion o o d di 3 o i i a o ia ion a o d n n m o d i d and l n o a i n a om o d om ina ion a d o a i n in lini al a i and o a in od d in na ionall d i in a d i o om o mo ommon d la in ol d in an i la l 3 and an i oa lan Amon d la a in and a i in 3 lo ido l and a in lo ido l and o mid and a in and a a in mo ommonl o d d ai l in in and l din a mo ommon lini al on n o d in n d i l o la i l o imila di n A i a m n o an i oa la ion a i li d o i in o non oidal an i in lamma o d A and o in a in m di in in an i oa la d a i n a on o i i i in a i o n ial on n o i in a i a an in a in i o l din om li a ion i a n o d o a n and o a a ini d a i n ann all l d o d o mino ma o and a al a ion m i d in om a in a a o a main ainin no mal an o a i a d a ial om o la in im a and al a n li in a o d a in la ma d on n a ion an a o o nd lini al n o and o i am a on a i n in a in and a a in a o n o i o o moni o in o a o and do mi ad d a o din o la o o d om a diolo d a m n on n o man d and n addi ion o n d ma i o o a i n ln a l o i all i i a n d o in a a a n o o i l in all o i al d a m n a a i a l n m o a n o d d in all o m a nd n m o d a n and m l i l di a a id n i d a i a o o d lo in P a an m l i ni an lin a la ion i r P n n m o d i d and in a i n imila l a i ni an lin a la ion i r P a o d n l n o a and l a in a o dan i io o a aila l in li a on i n i io a i a o d in i d a o m l i l m di a ion a a o ia d i i ni i an l in a d i o in i d o n iall a m l d d om ina ion in a odd o in i d o n iall in a in d mo an do l d o a addi ional m di a ion i d a on ollin o o a o 3 i a d o mana m n a oa o d i d a al o do d ion i all o m lo d o mana m n o n n d in a d d a i d a n and in 3 3 a do o d d a al d i d a al and do al a ion o d d a n o d in li a n a ali a m n o in a an o al o i m on m d o a o a l a ali on id in i a m n o a ion ma o i o a ion a o i d a mod a in na ollo d and mild i and ndin a di n n om a d i o o on an o o in di 3 ln o om i d nin d nd on ali in l din o alida ion o da a ld in o a mo da in m i no l d d m n and on in o o iali main ainin d in a ion da a a 3 imi a ion o i d i i o d a ion i o an in n ion om on n on oll d d o al a ood lini al mana m n o an d d la d mo idi o mo ali i n d d in in i di i lin CONCLUSION i d o in id n o in a diolo d a m n in a o i al om ndian in i d al o amin d a i n d a a i i a ali and 332 Journal of Young Pharmacists Vol 3 / No 4

i o i d o a a n amon o i ali d a dia a i n a o in n in a a nd n m o i d d and l n o o i al a and o d lo m n and im l m n a ion o a iona id lin and om a d nin mi l o n o n iall a m l d in a ion REFERENCES Bli i il o A i am A d n i i a ion o d in a ion in o i al om i d nin d id o din lin a ma a 33 3 a o n A and oo o d in a ion amil on linoi n lli n li a ion 3 3 on Ba n a l m di a ion o d n i in and limina in io d in a ion Am a ma A o a A a di a a im l all in m al om in and i o dd n d a om a dia a n l d 3 on on A i a o on a al a mo a ind d a a in in n o d d in a ion a ma o a 3 amil on A B i land And i n o o i ali a ion a o o no n d d in a ion in a m di al o la ion a ma o a o on in a ion in ld l am a o an in in d d in a ion in m di a ion o l o ia i in a i n A o a a oa o mo an d A o mon i n o A i a Ao i on om a o ia d o i al admi ion in old m di al a i n Am ia o 3 an l A di in d in a ion A i o li a an l A illan A a in B o d in a ion on o om o a i n i in a a in o o llin Am o a m i mo am d am a in n o A all et al Ad d a ion a a o admi ion o o i al o i anal i o a i n B 3 3 B ml all aa d a i n i B o i ali a ion and m n d a m n i i d o d d in a ion A li a i a ma o a i a d n in ndia ima ion and a al anal i A aila l om oindia o in il ommi ion on a o onomi and al B B d n o i a ima ion and a al anal i d a d on o a l an i Ad d a ion in a i n i a dio a la di a o l a diol 33 3 olan a a dio a la d in ld l Am ia a diol a l A a a a a annan alla a am dd adma ma o n ial d in a ion in a i n admi d o a diolo a d o a o ndian a in o i al A om on mi om d m A aila l om mi om d om od d d a d on an Ana omi al a i mi al la i a ion m A aila l om o no a ddd ind i d on an a d on an a an o A B o ll ando i o o A A m od o ima in o a ili o ad d a ion lin a ma ol 3 3 B o man a om mid B n n B d in a ion in ld l Ann a ma o 3 o l Bod Bo B oo mann l Bo d in a ion in m di al a i n o in o i al a m n and la ion o m l i l d n lin a ma ol 3 3 3 nai A im on a o n ial o in a ion n a a in and o i d m di a ion A o i d in ima a Am a dio a na ional a i n a a n i a m n o an i oa lan a A aila l om n a n i m dia do o m n 3 an i oa lan o d i d on an a d on a ala i ali o i Bl din om li a ion o o al an i oa lan a m n An in ion o o o i olla o a i d A alian d on om li a ion o o al an i oa la ion a an 3 3 i ma i A Blann Ad i AB o an i om o i a B 3 3 A a a Ba A a a A lini all im o an o n ial d d in a ion in o a i n in o ial Adm a m 3 3 an o a A a o Bi man A an al o imal i in in ld l o a i n o n iall a m l d d and d di a om ina ion Am ia o 3 alon in a an n n an B an B n et al A m n o o n ial d d in a ion i a i ion laim da a a Am a a m 3 3 o ao a n o ad d a ion no i d on an o o in in an ndian ia a a in o i al a ma 33 3 i in l Ad i a d m l m n a ion o l a d om i d d id i in and admini a ion n n ion d B 3 3 How to cite this article: Source of Support: None declared. Journal of Young Pharmacists Vol 3 / No 4 333