Prevalence of drug to drug interactions in critical cardiac patients

Abstract Background Pharmacotherapy in the management of cardiovascular disease patients with multiple co-morbidities has been challenging due to polypharmacy (five or more drugs). They have been attributed with potential drug – drug interactions (DDI). Detecting the clinically significant drug interactions allows the opportunity for prevention through clinical drug decision support system (CDDSS) and clinical management. Purpose To identify significant potential DDI in critical cardiac patients Method We prospectively observed patients admitted at CCCU received multiple medications leading to potential DDI from Feb 2018 to July 2018 using two commercially available CDDSS along clinical management and pharmacovigilance algorithm. Results Patients admitted at CCCU co-administered with two or more drugs were analyzed. The mean age was 61.1 years. Total 649 patients were screened, resulting 87.7% (569/649) patients took more than five drugs. Of the 4249 potential DDI 543 were unique interacting drug pairs. On average, CCU patients were prescribed with 12.1 drugs, potentiating 14.1 potential DDI. Older patients (>60 years) received more medications than younger ones (mean 18.7 vs 15.1 drugs). 82.1% patients had one or more potential DDI with major and moderate severity detected by one or both CDDSS. Common potential clinical adverse was bleeding, QTc prolongation and CYP3A4 inhibition. Both CDDSS agreed on the severity ratings in 36.9%. There were significant association of potential DDI with specific risk factors (geriatric, female, Indian and heart failure patients) Conclusions Rate of potential DDI adversely influenced by polypharmacy, antiarrhythmic drugs, comorbidities and LOS. Significant potential DDI occur in the CCU, highlighting the need for CDDSS potentially prevent patient harm. Identified risk factors (geriatrics population, female sex, Indian ethnicity and heart failure patients) can be used in mitigating adverse DDI. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): NATIONAL HEART INSTITUTE