Evaluation of Drug Interactions in Hospitalized Patients with Respiratory Disorders in Greece

HIGHLIGHTS: What are the main findings? Patients admitted for hospitalization in Greece due to respiratory disorders are patients with multimorbidity, polypharmacy, and a high prevalence of drug–drug interactions (DDIs) in their medication regimens. Clinically significant DDIs that may require modulation in medical regimen or patient monitoring for side effects accounted for 58% upon admission and discharge and less during hospitalization (43%). What are the implications of the main findings? The recorded DDIs mostly refer to cases requiring monitoring and caution to avoid the oc-currence of QT-prolongation, INR modulation, and CYP-mediated metabolism inhibition. The clinical significance of DDIs within the cohort can be considered manageable under proper patient monitoring, but clinicians should be aware and always examine if any oc-curring arrhythmias, INR modulations, and prolonged or increased drug actions are linked with DDIs. ABSTRACT: Background: Patients with respiratory disorders often have additional diseases and are usually treated with more than one medication to manage their respiratory conditions as well as additional comorbidities. Thus, they are frequently exposed to polypharmacy (≥5 drugs), which raises the risk for drug–drug interactions (DDIs) and adverse drug reactions (ADRs). In this work, we present the results regarding the prevalence of DDIs in hospitalized patients with respiratory disorders in Greece. Methods: A 6-month descriptive single-center retrospective observational study enrolled 102 patients with acute or chronic respiratory disorders. Clinical characteristics and medication regimens were recorded upon admission, hospitalization, and discharge. The prevalence of DDIs and their clinical significance was recorded and analyzed. Results: Unspecified acute lower respiratory tract infection (25%), exacerbations of chronic obstructive pulmonary disease (12%) and pneumonia (8%) were the most frequent reasons for admission. Cardiovascular disorders (46%), co-existing respiratory disorders (32%), and diabetes (25%) were the most prevalent comorbidities. Polypharmacy was noted in 61% of patients upon admission, 98% during hospitalization, and 63% upon discharge. Associated DDIs were estimated to be 55% upon admission, 96% throughout hospitalization, and 63% on discharge. Pharmacodynamic (PD) DDIs were the most prevalent cases (81%) and referred mostly to potential risk for QT-prolongation (31.4% of PD-DDIs) or modulation of coagulation process as expressed through the international normalized ratio (INR) (29.0% of DDIs). Pharmacokinetic (PK) DDIs (19% of DDIs) were due to inhibition of Cytochrome P450 mediated metabolism that could lead to elevated systemic drug concentrations. Clinically significant DDIs characterized as “serious-use alternative” related to 7% of cases while 59% of DDIs referred to combinations that could be characterized as “use with caution—monitor”. Clinically significant DDIs mostly referred to medication regimens upon admission and discharge and were associated with outpatient prescriptions. Conclusions: Hospitalized patients with respiratory disorders often experience multimorbidity and polypharmacy that raise the risk of DDIs. Clinicians should be conscious especially if any occurring arrhythmias, INR modulations, and prolonged or increased drug action is associated with DDIs.