Journal of the Indian Academy of Geriatrics (Jan 2023)

Prescription analysis and evaluation of potential drug–drug interactions among patients attending the geriatric unit at a tertiary care hospital

  • Harsh Joshi,
  • Falguni D Majumdar,
  • Shreya N Patel,
  • Krishna Bhavin Modi,
  • Jaydeep Rathod,
  • Parth Kanani,
  • Karan B Shah,
  • Supriya Deepak Malhotra

DOI
https://doi.org/10.4103/jiag.jiag_46_23
Journal volume & issue
Vol. 19, no. 4
pp. 225 – 231

Abstract

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Background: The elderly stand a greater risk of drug-drug interactions (DDIs). This study was an earnest attempt at in-depth prescriptions analysis and evaluating the potential DDIs (pDDIs) among patients in the geriatric outpatient department (OPD). Aims and Objectives: The aim is to conduct prescriptions analysis of patients and to evaluate the pDDIs among patients in the geriatric OPD. Materials and Methods: A retrospective observational study began after Institutional Review Board approval. Demographic details, clinical profile, and drugs prescribed were recorded. The prescription analysis was done by prespecified criteria and pDDIs were identified using various tools. Results: Prescriptions of 202 patients with a mean age of 68.76 years were collected. Mean drugs prescribed were 6.07. Total number of fixed-dose combinations (FDCs) and over-the-counter drugs were 669 (40.50%) and 430 (26.03%), respectively. 129 (63.9%) prescriptions were incomplete in terms of dose, duration, frequency, or dosage form. Maximum interactions - 367 (34.42%) were found with aspirin followed by cardiovascular drugs. Total prescriptions with pDDIs were 137 (67.82%) Out of 34 (3.82%) serious interactions, pharmacodynamic pDDIs were seen with aspirin and enalapril/ramipril and pharmacokinetic were between omeprazole/rabeprazole and clopidogrel. Consequences of common pDDIs were identified as deterioration in renal function and hyperkalemia. The number of interactions was positively correlated with number of FDCs and number of drugs prescribed (r = 0.427, P = 0.0001 and r = 0.189, P = 0.0001, respectively). Conclusion: Prespecified prescription analysis criteria were one of the most useful tools to improve prescribing patterns. Drug interactions can be reduced by prescribing minimum drugs in elderly, alteration in time of dosing and fractionation of dose along with amalgamating the use of online DDI checker in hospital information system. Training of prescribers especially in geriatric patients is the need of the hour.

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