A PROSPECTIVE STUDY OF DRUGâ€“DRUG INTERACTIONS AND ADVERSE DRUG REACTIONS AMONG STROKE PATIENTS IN A TERTIARY CARE HOSPITAL
Objective: Our study attempts to get an insight into the drugâ€“drug interactions (DDIs) and adverse drug reactions (ADRs) among stroke patients from
the Neurology Department in a private hospital.
Methods: In a prospective study spanning 6 months (May to October 2015), we have analyzed the prescription data of 221 patients with both
ischemic and hemorrhagic stroke. Gender, age, social habits, length of stay, drug utilization pattern, DDIs reported from the database and clinically
observed, and ADRs of individual drugs were observed among the patients. Of 221 cases, 208 (94.11%) were ischemic, 12 (5.43%) were hemorrhagic,
and 1 (0.45%) was transient ischemic attack.
Results: A number of 140 patients were males and 80 were females. The mean age of the patients was between 41 and 70 years. In ischemic patients,
357 major, 282 moderate, and 38 mild DDIs were reported using a specific database, while in hemorrhagic patients, 10 major, 7 moderate, and 1 mild
interaction were reported using a specific database. 18 DDIs were observed clinically and confirmed with evidence. 8 DDI-induced ADRs and 10 ADRs
caused by individual drugs were observed in our study population. 18 DDIs were observed clinically and confirmed with evidence. 8 DDI-induced
ADRs and 10 ADRs caused by individual drugs were observed in our study population.
Conclusion: Drugs if wrongly prescribed may cause negative outcomes and pose significant challenge to health-care providers and may contribute to
morbidity and mortality. Clinical pharmacist can play an important role in identifying and resolving drug-related problems through pharmaceutical
Keywords: Stroke, Drugâ€“drug interactions, Adverse drug reactions, Clinical pharmacist.
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association. Stroke 2013;44(7):2064-89.
Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, et al. Transient ischemic attack - proposal for a new definition. N Engl J Med 2002;347(21):1713-6.
Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26:14-20.
WHO: The top 10 causes of death online address; 2011. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/index.html. [Last accessed on 2015 Jul 01].
Strong K, Mathers C, Bonita R. Preventing stroke: Saving lives around the world. Lancet Neurol 2007;6(2):182-7.
Lawes CM, Vander Hoorn S, Rodgers A; International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet 2008;371:1513-8.
Townsend N, Wickramasinghe K, Bhatnagar P, Smolina K, Nichols M, Leal J, et al. Coronary Heart Disease Statistics. London: British Heart Foundation; 2012.
Katzan IL, Hammer MD, Hixson ED, Furlan AJ, Abou-Chebl A, Nadzam DM; Cleveland clinic health system stroke quality improvement team. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 2004;61(3):346-50.
Pandian JD, Srikanth V, Read SJ, Thrift AG. Poverty and stroke in India: A time to act. Stroke 2007;38(11):3063-9.
Celin AT, Seuma J, Ramesh A. Assessment of drug related problems in stroke patients admitted to a south Indian tertiary care teaching hospital. IJOPP 2012;5(4):28-33.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. Lancet Neurol 2009;8(4):355-69.
Furness PN, Goodfield MJ, MacLennan KA, Stevens A, Millard LG. Severe cutaneous reactions to captopril and enalapril; histological study and comparison with early mycosis fungoides. J Clin Pathol 1986;39(8):902-7.
Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke 2013;15(3):128-34.
Sridharan SE, Unnikrishnan JP, Sukumaran S, Sylaja PN, Nayak SD, Sarma PS, et al. Incidence, types, risk factors, and outcome of stroke in a developing country: The Trivandrum Stroke Registry. Stroke 2009;40(4):1212-8.
Subhash V, Damodar G, Ravikanth S, Vijayakumar G. Drug utilisation pattern of stroke patients in a tertiary care hospital. IJPCR 2012;2(1):3-7.
Subash V, Ravikanth S, Ayesha S, Dheeraj K. Drug-drug interaction occurring during hospital stay among stroke patients. Afr J Pharm Pharmacol 2012;37(6):2670-4.
Mehul D, Thuy D, Rebecca K, Naznin D. Significant acute kidney injury due to non - steroidal anti- inflammatory drugs: Inpatient setting. Pharmceuticals 2010;3(4):1279-85.
Eric R, Wei C, Dominick JA. Clopidogrel - drug interactions. J Am Coll Cardiol 2011;57(11):1151-63.
Vineetha BM, Justin K, Madhan R, Hathur BG. Phenytoin toxicity: A case report. J Young Pharm 2015;3(7):22-7.
Piazza G, Nguyen TN, Cios D, Labreche M, Hohlfelder B, Fanikos J, et al. Anticoagulation-associated adverse drug events. Am J Med 2011;124(12):1136-42.
Gartner AH. Aspirin-induced gastritis and gastrointestinal bleeding. J Am Dent Assoc 1976;93(1):111-7.
Supsongserm P, Boonmuang P, Nathisuwan S, Chaiyakunapruk KT. Risk factors related to rhabdomyolysis in Thai statin users: A case-control study. MUJPS 2013;40(4):1-7.
Aman G. Evaluation of amlodipine induced pedal edema (Eape) study. J Pharmacovigilance 2014;2:5.
Ravi PB, Ravishankar GM, Andrade C. Bilateral peripheral edema as a rare adverse effect of escitalopram. Indian J Psychiatry 2014;56(1):97.
Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ 2007 14;177(4):347-51.
Omar MA, Wilson JP. FDA adverse event reports on statin-associated rhabdomyolysis. Ann Pharmacother 2002;36(2):288-95.
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