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Published in: International Journal of Diabetes in Developing Countries 3/2016

01-09-2016 | Original Article

Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil

Authors: Danilo D. Trevisan, Juliana B. Silva, Valéria C. Póvoa, Carla P. Araujo, Henrique C. Oliveira, Eliana P Araújo, Silvia R. Secoli, Maria Helena M. Lima

Published in: International Journal of Diabetes in Developing Countries | Issue 3/2016

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Abstract

The aim of this study is to investigate the prevalence of potential drug-drug interactions (PDDIs), as well as classifying them in relation to level of severity, scientific evidence, time of onset, and potential clinical impact in adult and older adult patients with diabetes mellitus 2 (DM2). This cross-sectional study was conducted in a tertiary care outpatient center. The consecutive sample was made up of 140 patients with DM2. The Anatomical-Therapeutic-Chemical Classification was used for classifying the classes of medications. The PDDIs were analyzed using the DRUG-REAX® system. The relationships between PDDI and the associated factors were ascertained using a multiple logistic regression model. The prevalence of total PDDI was 75 %, and the prevalence of major severity PDDI was 20.7 %. Simvastatin (30.8 %), captopril/enalapril (12.8 %), and oral anti-diabetics/insulin (12.8 %) were the medications which were most involved in the major PDDI, bringing relevant potential clinical impacts such as rhabdomyolysis, hyperkalemia, and important glycemic alterations. Polypharmacy was associated with PDDI (adjusted odds ratio = 10.46, 95 % confidence interval = 4.10–26.71). Diabetics were highly exposed to clinically significant PDDI. It is important that health professionals should be aware of the risks related to PDDI, so that measures may be implemented in order to assure safe care for the patient.
Literature
2.
go back to reference Feng P, Wang X, Hu Z, Ma Y, Tang W, et al. Distribution and determinants of non communicable diseases among elderly Uyghur ethnic group in Xinjiang, China. PLoS One. 2014;9:e105536.CrossRefPubMedPubMedCentral Feng P, Wang X, Hu Z, Ma Y, Tang W, et al. Distribution and determinants of non communicable diseases among elderly Uyghur ethnic group in Xinjiang, China. PLoS One. 2014;9:e105536.CrossRefPubMedPubMedCentral
3.
go back to reference American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35:S64–71.CrossRef American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35:S64–71.CrossRef
4.
go back to reference American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36:S11–66.CrossRef American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36:S11–66.CrossRef
5.
go back to reference American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37:S14–80.CrossRef American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37:S14–80.CrossRef
6.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79.CrossRefPubMedPubMedCentral Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79.CrossRefPubMedPubMedCentral
7.
go back to reference Freeman JS, Gross B. Potential drug interactions associated with treatments for type 2 diabetes and its comorbidities: a clinical pharmacology review. Expert Rev Clin Pharmacol. 2012;5:31–42.CrossRefPubMed Freeman JS, Gross B. Potential drug interactions associated with treatments for type 2 diabetes and its comorbidities: a clinical pharmacology review. Expert Rev Clin Pharmacol. 2012;5:31–42.CrossRefPubMed
8.
go back to reference Secoli SR, Figueras A, Lebrao ML, de Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly: a population-based, cross-sectional study. Drugs Aging. 2010;27:759–70.CrossRefPubMed Secoli SR, Figueras A, Lebrao ML, de Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly: a population-based, cross-sectional study. Drugs Aging. 2010;27:759–70.CrossRefPubMed
9.
go back to reference JJV T, MTL C, Dos Santos CA, Romano-Lieber NS. Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, Southern Brazil. PLoS One. 2012;7:e47062.CrossRef JJV T, MTL C, Dos Santos CA, Romano-Lieber NS. Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, Southern Brazil. PLoS One. 2012;7:e47062.CrossRef
10.
go back to reference Bachmann KA. Drug interactions handbook.Hudson,: Lexi-Comp; 2003. Bachmann KA. Drug interactions handbook.Hudson,: Lexi-Comp; 2003.
11.
go back to reference Tatro DS. Drug interactions facts. St Louis: Wolters Kluwer Health/Facts & Comparisons; 2011. Tatro DS. Drug interactions facts. St Louis: Wolters Kluwer Health/Facts & Comparisons; 2011.
12.
go back to reference Van Leeuwen RWF, Brundel DHS, Neef C, van Gelder T, Mathijssen RHJ, Burger DM, et al. Prevalence of potential drug–drug interactions in cancer patients treated with oral anticancer drugs. Br J Cancer. 2013; 108:1071–108. Van Leeuwen RWF, Brundel DHS, Neef C, van Gelder T, Mathijssen RHJ, Burger DM, et al. Prevalence of potential drug–drug interactions in cancer patients treated with oral anticancer drugs. Br J Cancer. 2013; 108:1071–108.
13.
go back to reference Bergk V, Gasse C, Rothenbacher D, Loew M, Brenner H, Haefeli WE. Drug interactions in primary care: impact of a new algorithm on risk determination. Clin Pharmacol Ther. 2004;76:85–96.CrossRefPubMed Bergk V, Gasse C, Rothenbacher D, Loew M, Brenner H, Haefeli WE. Drug interactions in primary care: impact of a new algorithm on risk determination. Clin Pharmacol Ther. 2004;76:85–96.CrossRefPubMed
14.
go back to reference Bjerrum L, Andersen M, Petersen G, Kragstrup J. Exposure to potential drug interactions in primary health care. Scand J Prim Health Care. 2003;21:153–8.CrossRefPubMed Bjerrum L, Andersen M, Petersen G, Kragstrup J. Exposure to potential drug interactions in primary health care. Scand J Prim Health Care. 2003;21:153–8.CrossRefPubMed
15.
go back to reference Codagnone Neto V, Garcia VP, Santa Helena ET. Possible pharmacological interactions in hypertensive and/or diabetic elderly in family health units at Blumenau (SC). Braz J Pharm Sci. 2010;46:795–804.CrossRef Codagnone Neto V, Garcia VP, Santa Helena ET. Possible pharmacological interactions in hypertensive and/or diabetic elderly in family health units at Blumenau (SC). Braz J Pharm Sci. 2010;46:795–804.CrossRef
16.
go back to reference Trevisan DD, Silva JB, Oliveira HC, Secoli SR, Lima MH. Prevalence and clinical significance of potential drug-drug interaction in hematopoietic stem cell transplantation. Cancer Chemother Pharmacol. 2015;75:393–400.CrossRefPubMed Trevisan DD, Silva JB, Oliveira HC, Secoli SR, Lima MH. Prevalence and clinical significance of potential drug-drug interaction in hematopoietic stem cell transplantation. Cancer Chemother Pharmacol. 2015;75:393–400.CrossRefPubMed
17.
go back to reference Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther. 2008;33:141–51.CrossRefPubMed Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther. 2008;33:141–51.CrossRefPubMed
18.
go back to reference Kohler GI, Bode-Boger SM, Busse R, Hoopmann M, Welte T, Boger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther. 2000;38:504–13.CrossRefPubMed Kohler GI, Bode-Boger SM, Busse R, Hoopmann M, Welte T, Boger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther. 2000;38:504–13.CrossRefPubMed
19.
go back to reference Dinesh KU, Subish P, Pranaya M, Shankar PR, Anil SK, Durga B. Pattern of potential drug-drug interactions in diabetic out-patients in a tertiary care teaching hospital in Nepal. Med J Malays. 2007;62:294–8. Dinesh KU, Subish P, Pranaya M, Shankar PR, Anil SK, Durga B. Pattern of potential drug-drug interactions in diabetic out-patients in a tertiary care teaching hospital in Nepal. Med J Malays. 2007;62:294–8.
22.
go back to reference Hosmer Jr DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: John Willey & Sons; 2000.CrossRef Hosmer Jr DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: John Willey & Sons; 2000.CrossRef
23.
go back to reference Chiang HH, Tseng FY, Wang CY, Chen CL, Chen YC, See TT, et al. All-cause mortality in patients with type 2 diabetes in association with achieved hemoglobin A(1c), systolic blood pressure, and low-density lipoprotein cholesterol levels. PLoS One, 2014; 9:e109501. Chiang HH, Tseng FY, Wang CY, Chen CL, Chen YC, See TT, et al. All-cause mortality in patients with type 2 diabetes in association with achieved hemoglobin A(1c), systolic blood pressure, and low-density lipoprotein cholesterol levels. PLoS One, 2014; 9:e109501.
24.
go back to reference Secoli SR, Danzi NJ, Ferreira de Lima FF, Lorenzi Filho G, Cesar LAM. Drug interactions in patients with coronary artery disease. Rev Bras Cartogr. 2012;25:11–8. Secoli SR, Danzi NJ, Ferreira de Lima FF, Lorenzi Filho G, Cesar LAM. Drug interactions in patients with coronary artery disease. Rev Bras Cartogr. 2012;25:11–8.
25.
go back to reference Doubova SV, Reyes-Morales H, Torres-Arreola LP, Suarez-Ortega M Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City. BMC Health Serv Res. 2007;7:147.CrossRef Doubova SV, Reyes-Morales H, Torres-Arreola LP, Suarez-Ortega M Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City. BMC Health Serv Res. 2007;7:147.CrossRef
26.
go back to reference Marquito AB, Fernandes NMS, Basile Colugnati FA, de Paula RB. Identifying potential drug interactions in chronic kidney disease patients. J Bras Nefrol. 2014;36:26–34.CrossRefPubMed Marquito AB, Fernandes NMS, Basile Colugnati FA, de Paula RB. Identifying potential drug interactions in chronic kidney disease patients. J Bras Nefrol. 2014;36:26–34.CrossRefPubMed
27.
go back to reference Patel PS, Rana DA, Suthar JV, Malhotra SD, Patel VJ. A study of potential adverse drug-drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital. J Basic Clin Pharm. 2014;5:44–8.CrossRefPubMedPubMedCentral Patel PS, Rana DA, Suthar JV, Malhotra SD, Patel VJ. A study of potential adverse drug-drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital. J Basic Clin Pharm. 2014;5:44–8.CrossRefPubMedPubMedCentral
28.
go back to reference De Araújo MF, Dos Santos Alves PJ, Veras VS, de Araújo TM, Zanetti ML, Damasceno MM. Drug interactions in Brazilian type 2 diabetes patients. Int J Nurs Pract. 2013;19:423–30.CrossRefPubMed De Araújo MF, Dos Santos Alves PJ, Veras VS, de Araújo TM, Zanetti ML, Damasceno MM. Drug interactions in Brazilian type 2 diabetes patients. Int J Nurs Pract. 2013;19:423–30.CrossRefPubMed
29.
go back to reference Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81.CrossRef Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81.CrossRef
30.
31.
go back to reference Tuchscherer RM, Nair K, Ghushchyan V, Saseen JJ. Simvastatin prescribing patterns before and after FDA dosing restrictions: a retrospective analysis of a large healthcare claims database. Am J Cardiovasc Drugs. 2015;15:27–34.CrossRefPubMed Tuchscherer RM, Nair K, Ghushchyan V, Saseen JJ. Simvastatin prescribing patterns before and after FDA dosing restrictions: a retrospective analysis of a large healthcare claims database. Am J Cardiovasc Drugs. 2015;15:27–34.CrossRefPubMed
32.
go back to reference Chatzizisis YS, Koskinas KC, Misirli G, Vaklavas C, Hatzitolios A, Giannoglou GD. Risk factors and drug interactions predisposing to statin-induced myopathy: implications for risk assessment, prevention and treatment. Drug Saf. 2010;33:171–87.CrossRefPubMed Chatzizisis YS, Koskinas KC, Misirli G, Vaklavas C, Hatzitolios A, Giannoglou GD. Risk factors and drug interactions predisposing to statin-induced myopathy: implications for risk assessment, prevention and treatment. Drug Saf. 2010;33:171–87.CrossRefPubMed
33.
go back to reference Schepkens H, Vanholder R, Billiouw JM, Lameire N. Life-threatening Hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases. Am J Med. 2001;110:438–41.CrossRefPubMed Schepkens H, Vanholder R, Billiouw JM, Lameire N. Life-threatening Hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases. Am J Med. 2001;110:438–41.CrossRefPubMed
34.
go back to reference Eschmann E, Beeler PE, Kaplan V, Schneemann M, Zünd G, Blaser J. Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug-drug interactions. Eur J Clin Pharmacol. 2014;70:215–23.CrossRefPubMed Eschmann E, Beeler PE, Kaplan V, Schneemann M, Zünd G, Blaser J. Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug-drug interactions. Eur J Clin Pharmacol. 2014;70:215–23.CrossRefPubMed
35.
go back to reference Schelleman H, Bilker WB, Brensinger CM, Wan F, Hennessy S. Anti-infectives and the risk of severe hypoglycemia in users of glipizide or glyburide. Clin Pharmacol Ther. 2010;88:214–22.CrossRefPubMedPubMedCentral Schelleman H, Bilker WB, Brensinger CM, Wan F, Hennessy S. Anti-infectives and the risk of severe hypoglycemia in users of glipizide or glyburide. Clin Pharmacol Ther. 2010;88:214–22.CrossRefPubMedPubMedCentral
36.
go back to reference Micheli L, Sbrilli M, Nencini C. Severe hypoglycemia associated with levofloxacin in type 2 diabetic patients receiving polytherapy: two case reports. Int J Clin Pharmacol Ther. 2012;50:302–6.CrossRefPubMed Micheli L, Sbrilli M, Nencini C. Severe hypoglycemia associated with levofloxacin in type 2 diabetic patients receiving polytherapy: two case reports. Int J Clin Pharmacol Ther. 2012;50:302–6.CrossRefPubMed
37.
go back to reference Paris B, Yerino P, Ogilvie B, Parkinson A. Abstract 130: the proton pump inhibitors (PPIs) omeprazole and rabeprazole but not lansoprazole and pantoprazole are in vitro time-dependent inhibitors of CYP2C19. Drug Metab Rev. 2008;40:89–90. Paris B, Yerino P, Ogilvie B, Parkinson A. Abstract 130: the proton pump inhibitors (PPIs) omeprazole and rabeprazole but not lansoprazole and pantoprazole are in vitro time-dependent inhibitors of CYP2C19. Drug Metab Rev. 2008;40:89–90.
38.
go back to reference Gremmel T, Steiner S, Seidinger D, Koppensteiner R, Panzer S, Kopp CW. Calcium channel blockers decrease clopidogrel-mediated platelet inhibition. Heart. 2010;96:186–9.CrossRefPubMed Gremmel T, Steiner S, Seidinger D, Koppensteiner R, Panzer S, Kopp CW. Calcium channel blockers decrease clopidogrel-mediated platelet inhibition. Heart. 2010;96:186–9.CrossRefPubMed
39.
go back to reference Siller-Matula JM, Lang I, Christ G, Jilma B. Calcium-channel blockers reduce the antiplatelet effect of clopidogrel. J Am Coll Cardiol. 2008;52:1557–63.CrossRefPubMed Siller-Matula JM, Lang I, Christ G, Jilma B. Calcium-channel blockers reduce the antiplatelet effect of clopidogrel. J Am Coll Cardiol. 2008;52:1557–63.CrossRefPubMed
40.
go back to reference Good CW, Steinhubl SR, Brennan DM, Lincoff AM, Topol EJ, Berger PB. Is there a clinically significant interaction between calcium channel antagonists and clopidogrel?: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Circ Cardiovasc Interv. 2012;5:77–81.CrossRefPubMed Good CW, Steinhubl SR, Brennan DM, Lincoff AM, Topol EJ, Berger PB. Is there a clinically significant interaction between calcium channel antagonists and clopidogrel?: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Circ Cardiovasc Interv. 2012;5:77–81.CrossRefPubMed
41.
go back to reference Olesen JB, Gislason GH, Charlot MG, Fosbøl EL, Andersson C, Weeke P, et al. Calcium-channel blockers do not alter the clinical efficacy of clopidogrel after myocardial infarction: a nationwide cohort study. J Am Coll Cardiol. 2011;57:409–17.CrossRefPubMed Olesen JB, Gislason GH, Charlot MG, Fosbøl EL, Andersson C, Weeke P, et al. Calcium-channel blockers do not alter the clinical efficacy of clopidogrel after myocardial infarction: a nationwide cohort study. J Am Coll Cardiol. 2011;57:409–17.CrossRefPubMed
42.
go back to reference Paterno MD, Maviglia SM, Gorman PN, Seger DL, Yoshida E, Seger AC, et al. Tiering drug-drug interaction alerts by severity increases compliance rates. J Am Med Inform Assoc. 2009;16:40–6.CrossRefPubMedPubMedCentral Paterno MD, Maviglia SM, Gorman PN, Seger DL, Yoshida E, Seger AC, et al. Tiering drug-drug interaction alerts by severity increases compliance rates. J Am Med Inform Assoc. 2009;16:40–6.CrossRefPubMedPubMedCentral
Metadata
Title
Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil
Authors
Danilo D. Trevisan
Juliana B. Silva
Valéria C. Póvoa
Carla P. Araujo
Henrique C. Oliveira
Eliana P Araújo
Silvia R. Secoli
Maria Helena M. Lima
Publication date
01-09-2016
Publisher
Springer India
Published in
International Journal of Diabetes in Developing Countries / Issue 3/2016
Print ISSN: 0973-3930
Electronic ISSN: 1998-3832
DOI
https://doi.org/10.1007/s13410-015-0428-7

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