Evaluation and Management of Drug-Drug Interactions in Patients Hospitalized in Nephrology and Post-Transplant Wards in a Teaching Hospital

Abstract

Background: Kidney transplant patients usually take a combination of medications after transplantation; hence, medication safety becomes an important issue in order to maintain the new organ working properly. To evaluate the incidence and risk factors associated with potential drug-drug interactions (pDDIs) in hospitalized patients in Nephrology and Post-transplant wards to improve clinical management of pDDIs by a clinical pharmacist.

Methods: In this cross-sectional study, patients in Nephrology and Post-transplant wards were screened for pDDIs, using the interaction screening program Lexi-comp resource^®. After evaluating the detected pDDIs for clinical relevance, the intervention was performed through physicians or nurses for type D and X drug interactions. Intervention feedback, implemented recommendations, and any probable adverse drug reactions were documented.

Results: During the study, 399 patients (239 in nephrology and 160 in post-transplant wards) plus 6105 drug orders were evaluated, and a total of 3263 DDIs were identified; of them, 827 (23.5%) were determined to be D and X classifications, and a total of 89.97% of all hospitalized cases had at least 1 pDDIs. Factors that had the greatest influence on pDDI incidence included the number of drugs and the admitted wards. Patients in the post-transplant ward experienced 2.3 times more DDIs than those in the nephrology ward. In total, 78% of class X and D DDIs required intervention, of which 75% were accepted and implemented by the physicians and nurses.

Conclusion: Clinically relevant pDDIs are common in patients in Nephrology and Post-transplant wards, and pharmacists play a critical role in detecting and managing this medical problem in hospitalized patients.

J Pharm Care 2020; 8(1): 16-22.