Clinically significant drug-drug interactions in the treatment of cardiovascular diseases on hospital admission

Aneta Drndarević; Ivana Draganov; Branislava Miljković; Dane Cvijanović; Aleksandar Davidović; Tatjana Savković; Sandra Vezmar Kovačević

Aneta Drndarević University of Belgrade – Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy
Ivana Draganov University of Belgrade – Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy
Branislava Miljković University of Belgrade – Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy
Dane Cvijanović CHC Zvezdara, Intern Clinic, Clinical Ward for Cardiovascular Diseases
Aleksandar Davidović CHC Zvezdara, Intern Clinic, Clinical Ward for Cardiovascular Diseases
Tatjana Savković CHC Zvezdara, Service for Pharmaceutical Heath Care
Sandra Vezmar Kovačević University of Belgrade – Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy

Abstract

Clinically significant drug-drug interactions (DDIs) are expected in patients with cardiovascular diseases due to the number of drugs in therapy. The aim of the research was to analyze DDIs during treatment which preceeded the admission to the cardiology department. In the cardiology department of the Clinical Hospital Center Zvezdara, the treatment of patients with ≥2 drugs before admission was analyzed. DDIs were identified using the Lexicomp database (Lexi-Interact). Data were analyzed descriptively and with linear regression analysis. During research, out of 132 participants 88.6% had ≥1, while 41.7% had ≥5 DDIs. The total number of DDIs was 648 (median 3, range 0-19). Men constituted 64.4% of the population, with a median age of 70 years (32-90). Patients had 4 diagnoses (1-13) and 6 medications on admission (2-15). In 3.8% of patients, contraindicated DDIs of anticholinergics were observed, 23.5% had DDIs that required caution or a change in therapy, while interactions requiring follow-up were observed in 86.4% of patients. Angiotensin-converting enzyme inhibitors (30.4%), acetylsalicylic acid (26.6%) and loop diuretics (16.5%) were most frequently involved in DDIs, while the most common adverse events could be renal failure (21.5%), hypotension 19.7%) and bleeding (13.7%). The number of drugs in therapy was a predictor of DDIs (p <0.001). Patients with cardiovascular disease are often exposed to polypharmacy and consequently DDIs. Cardiovascular drugs were most frequently involved in DDIs, but contraindicated DDIs were present in anticholinergic drugs. In patients with cardiovascular diseases, monitoring of renal function, hypotension and bleeding is required.