The Clinical Respiratory Journal (Jan 2021)
Drug safety in hospitalized patients with tuberculosis: Drug interactions and adverse drug effects
Abstract
Abstract Background Hospitalized patients with tuberculosis (TB) are prescribed with drugs having high risk of potential drug‐drug interactions (pDDIs) and adverse drug effects (ADEs). Objectives To explore the adverse effects of anti‐tuberculosis (anti‐TB) drugs and the prevalence and predictors of pDDIs in hospitalized patients with TB. Methods Clinical profiles of 436 TB patients were reviewed for adverse effects induced by anti‐TB drugs and screened for pDDIs using Micromedex‐DrugReax. Prevalence and severity levels of pDDIs were reported. Odds ratios for predictors were calculated using logistic regression analysis. Results Of total 436 patients, adverse effects of anti‐TB drugs were found in 36%. ADEs were highly prevalent in patients with high doses of anti‐TB drugs. Hepatotoxicity, neuropathy, insomnia, arthralgia, psychosis, hematological alterations, skin rashes, red color stool, diplopia, and photophobia were the identified ADEs. All drugs types‐ and anti‐TB drugs‐pDDIs were reported in 78.2% and 55.7%, respectively. Major‐pDDIs of anti‐TB drugs were identified in 55.5%. Total 1090 anti‐TB drugs pDDIs were found, among them, 55.6% were of major‐ and 40.5% were of moderate‐severity. Significant association was observed for the pDDIs with ≥7 prescribed medicines (P < 0.001). Potential adverse outcomes of the most frequent interactions were hepatotoxicity, decreased drug’s effectiveness, QT‐interval prolongation, nephrotoxicity, and gastrointestinal ulceration. Conclusions Patients with TB present with a considerable number of clinically important pDDIs and ADEs (particularly hepatotoxicity). TB patients should be monitored for adverse effects of anti‐TB drugs. Attention should be given to major‐pDDIs. Patients more at risk to interactions should be identified and monitored for related adverse outcomes.
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