title: Evaluation of Potential Drug-Drug Interactions with Antidepressants in Two Tertiary Care Hospitals.
abstract: BACKGROUND
  Limited resources of healthcare system and high use of antidepressants have raised some serious concerns regarding proper surveillance system of prescribed medicines. Not much literature is available from Pakistan regarding the potential drug-drug interactions (pDDIs) associated with antidepressants.
  
  
  OBJECTIVE
  The objective of this study was to assess the frequency of pDDIs associated with antidepressants, their severity, significance and their association with patient characteristics.
  
  
  METHODS
  A prospective, observational study was conducted in two major hospitals of Karachi for the period of three months. Patient profiles, medication charts, and physician notes were thoroughly reviewed to gather all the relevant information. Inclusion and exclusion criteria were set prior to data collection. The collected data was then analysed using Micromedex Drug-REAX System. Descriptive and binomial logistic regression analysis was used to express results.
  
  
  RESULTS
  Of 245 prescriptions reviewed, 141 prescriptions had at least one pDDI (57.5%). A total of 181 pDDIs were identified in prescription containing antidepressant. The ratio of pDDI per prescriptions was 0.78. 42.5% interactions were moderate in severity, 30% of interactions were rapid in onset, and 43% were considered as significant interactions. Polypharmacy (OR=3.41, p< 0.001) and presence of chronic problems (OR=2.14, p=0.002) were significantly associated with the occurrence of pDDIs. Citalopram and diclofenac (11.6%) was commonly prescribed interacting pair in this study.
  
  
  CONCLUSIONS
  The findings of this study recorded high frequency of antidepressants associated pDDIs. Our results confirm the significant association of polypharmacy with the occurrence of pDDIs with antidepressants. Future studies are warranted to establish these results by including hospitals in different parts of the country.
authors.affiliation: Pharmacist, Department of Pharmacy Services, King Faisal Specialist Hospital and Research Center , Jeddah, Saudi Arabia .
authors.forename: Muhammad Salman
authors.initials: MS
authors.lastname: Rafi
authors.affiliation: Professor, Department of Pharmaceutics, Faculty of Pharmacy, Hamdard University , Karachi, Pakistan .
authors.forename: Syed Baqir Shyum
authors.initials: SB
authors.lastname: Naqvi
authors.affiliation: Lecturer, Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University , Kuala Lumpur, Malaysia .
authors.forename: Muhammad Umair
authors.initials: MU
authors.lastname: Khan
authors.affiliation: Student, Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi , Karachi, Pakistan .
authors.forename: Muhammad
authors.initials: M
authors.lastname: Fayyaz
authors.affiliation: Student, Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi , Karachi, Pakistan .
authors.forename: Nida
authors.initials: N
authors.lastname: Ashraf
authors.affiliation: Student, Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi , Karachi, Pakistan .
authors.forename: Maqsood Ahmed
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Lecturer, Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University , Kuala Lumpur, Malaysia .
authors.forename: Akram
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Lecturer, Department of Pharmacy Practice, School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Champ Fleurs , Trinidad and Tobago .
authors.forename: Sameer
authors.initials: S
authors.lastname: Dhingra
keywords: Pakistan; Poly pharmacy; Surveillance system