title: Clinical Weighting of Drug-Drug Interactions in Hospitalized Elderly.
abstract: Adverse drug reactions impact on patient health, effectiveness of pharmacological therapy and increased health care costs. This investigation intended to detect the most critical drug-drug interactions in hospitalized elderly patients, weighting clinical risk. We conducted a cross-sectional study between January and April 2014; all patients 70 years or older, hospitalized for >24 hr and prescribed at least one medication were included in the study. Drug-drug interactions were estimated by combining Stockley's, Hansten and Tatro drug interactions. Drug-drug interactions were weighted using a risk-analysis method based on failure modes, effects and criticality analysis. We calculated a criticality index for each drug involved in the drug-drug interactions based on the severity of the interaction mechanism, the frequency the drug was involved in drug-drug interactions and the risk of drug-drug interactions in patients with impaired renal function. The average number of drugs consumed in the hospital was 6 ± 2.69, involving 160 active ingredients. The most frequent were as follows: Furosemide, followed by Enalapril. Of drug-drug interactions, 2% were classified as contraindicated, 14% advised against and 83% advised caution during the hospital stay. Thirty-four drug-drug interactions were assessed, of which 23 were pharmacodynamic drug-drug interactions and 12 were pharmacokinetic drug-drug interactions (1 was both). The clinical risk calculated for each drug-drug interaction included heparins + non-steroidal anti-inflammatory drugs (NSAIDs) or Digoxin + Calcium Gluconate, cases which are pharmacodynamic drug-drug interactions with agonist effect and clinical risk of bleeding, one of the most common clinical risks in the hospital. An index of clinical risk for drug-drug interactions can be calculated based on severity by the interaction mechanism, the frequency that the drug is involved in drug-drug interactions and the risk of drug-drug interactions in an elderly patient with impaired renal function.
authors.affiliation: Epidemiologic and Health Service Research Unit, Aging Area, Mexican Institute of Social Security, National Medical Center Century XXI, Mexico City, Mexico.|Faculty of High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico.
authors.forename: Teresa
authors.initials: T
authors.lastname: Juárez-Cedillo
authors.affiliation: Epidemiologic and Health Service Research Unit, Aging Area, Mexican Institute of Social Security, National Medical Center Century XXI, Mexico City, Mexico.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Martinez-Hernández
authors.affiliation: Epidemiologic and Health Service Research Unit, Aging Area, Mexican Institute of Social Security, National Medical Center Century XXI, Mexico City, Mexico.
authors.forename: Angel
authors.initials: A
authors.lastname: Hernández-Constantino
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Specialist Hospital, Mexican Institute of Social Security, National Medical Center Century XXI, Mexico City, Mexico.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Cruz
authors.affiliation: Epidemiologic and Health Service Research Unit, Aging Area, Mexican Institute of Social Security, National Medical Center Century XXI, Mexico City, Mexico.
authors.forename: Annia M
authors.initials: AM
authors.lastname: Avalos-Mejia
authors.affiliation: Department of Critical Care Medicine, Specialist Hospital, La Raza Medical Center, Mexican Institute of Social Security, Mexico City, Mexico.|Department of Critical Care Medicine, National Cancer Institute of (INCan), Health Secretariat ( SSA), Mexico City, Mexico.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Sánchez-Hurtado
authors.affiliation: Faculty of High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico.
authors.forename: Valentin
authors.initials: V
authors.lastname: Islas Perez
authors.affiliation: School of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Hansten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D065731:Cytochrome P-450 CYP2C19 / Q000378:metabolism; D065689:Cytochrome P-450 CYP2C19 Inhibitors / Q000009:adverse effects; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000009:adverse effects; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000201:enzymology / Q000453:epidemiology / Q000209:etiology*; D006745:Hospital Bed Capacity, 300 to 499 / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008800:Mexico; D008962:Models, Theoretical
chemical_list: D065689:Cytochrome P-450 CYP2C19 Inhibitors; D065692:Cytochrome P-450 CYP3A Inhibitors; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human