A pharmacoepidemiologic study of drug interactions in a Brazilian teaching hospital.
OBJECTIVE
Although drug-drug interactions constitute only a small proportion of adverse drug reactions, they are often predictable and therefore avoidable or manageable. There are few studies on drug-drug interactions from Brazil. This study aimed to assess the frequency of drug-drug interactions in prescriptions and their potential clinical significance in patients of a Brazilian teaching hospital.


METHODS
From January to April 2004, a sample of 1785 drug prescriptions was drawn from a total of 11,250. Drug-drug interactions were identified by using Micromedex DrugReax System. Patients'records with major drug-drug interactions were reviewed by a pharmacist and a medical doctor looking for signs, symptoms, and lab tests that could indicate adverse drug reactions due to such interactions.


RESULTS
From the 1785 prescriptions examined, 1089 (61%) were from the male adult ward. Patients' average age was 52.7 years (SD = 18.9; range, 12-98). The median number of drugs in each prescription was 7 (range, 2-26). At least 1 drug-drug interactions was present in 887 (49.7%) prescriptions. Regarding the severity of the clinical result, the interactions were classified as minor (20; 2.3%), moderate (184; 20.7%), major (30; 3.4%), and undetermined because of an incidence of more than 1 interaction in a single patient (653; 73.6%). From the 30 patients with major interactions, 17 (56.7%) presented adverse drug reactions induced by exposure to a major drug-drug interaction.


CONCLUSIONS
Patients did suffer adverse drug reactions from major drug-drug interactions. Many physicians may be unaware of drug-drug interactions. Education, computerized prescribing systems and drug information, collaborative drug selection, and pharmaceutical care are strongly encouraged for physicians and pharmacists.
Cruciol-Souza
Joice Mara
JM
Hospital Universitário, Universidade Estadual de Londrina, Londrina, PR, Brasil. jcruciol@yahoo.com.br
Thomson
João Carlos
JC
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002648:Child; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D017891:Pharmacoepidemiology; D012984:Software