title: A study of potential drug-drug interactions among hospitalized cardiac patients in a teaching hospital in Western Nepal.
abstract: OBJECTIVE
  Drug-drug interaction (DDI) is of major concern in patients with complex therapeutic regimens. The involvement of cardiovascular medicines in drug interaction is even higher. However, reports of DDI between these groups of drugs are few. The study aims to identify the potential DDI among hospitalized cardiac patients. Furthermore, we assessed the possible risk factors associated with these interactions.
  
  
  METHODS
  The Type of study prospective observational study was conducted from May 2012 to August 2012 among hospitalized cardiac patients. Cardiac patients who were taking at least two drugs and who had a hospital stay of at least 24 h were enrolled. The medications of the patients were analyzed for possible interactions using the standard drug interaction database - Micromedex -2 (Thomson Reuters) × 2.0.
  
  
  RESULTS
  From a total of 150 enrolled patients, at least one interacting drug combination was identified among 32 patients. The incidence of potential DDI was 21.3%. A total of 48 potentially hazardous drug interactions were identified. Atorvastatin/azithromycin (10.4%), enalapril/metformin (10.4%), enalapril/potassium chloride (10.4%), atorvastatin/clarithromycin (8.3%) and furosemide/gentamicin (6.3%) were the most common interacting pairs. Drugs most commonly involved were atorvastatin, enalapril, digoxin, furosemide, clopidogrel and warfarin. Majority of interactions were of moderate severity (62.5%) and pharmacokinetic (58.3%) in nature. Increased number of medicines, prolonged hospital stays and comorbid conditions were the risk factors found associated with the potential DDI.
  
  
  CONCLUSIONS
  This study highlighted the need of intense monitoring of patients who have identified risk factors to help detect and prevent them from serious health hazards associated with drug interactions.
authors.affiliation: Department of Pharmacy, School of Sciences, Kathmandu University, Dulikhel, Kavre, Nepal.
authors.forename: Sushmita
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Pharmacy, School of Sciences, Kathmandu University, Dulikhel, Kavre, Nepal.
authors.forename: Himal Paudel
authors.initials: HP
authors.lastname: Chhetri
authors.affiliation: Manipal Teaching Hospital, Manipal College of Medical Sciences, Phulbari, Pokhara, Nepal.
authors.forename: Kadir
authors.initials: K
authors.lastname: Alam
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D005260:Female; D006331:Heart Diseases / Q000188:drug therapy*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D011446:Prospective Studies
chemical_list: D002317:Cardiovascular Agents
keywords: Cardiac patient; Micromedex; drug interaction; interaction severity
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