THE CLINICAL SIGNIFICANCE OF POTENTIAL DRUG-DRUG INTERACTIONS AND THEIR TARGETS FOR MINIMIZATION AMONG HYPERTENSIVE DIABETIC OUTPATIENTS AT A KENYAN REFERRAL HOSPITAL

  • MAKITE SIMON LATI Clinical Pharmacist, Department of Pharmacy, Kangundo Level 4 Hospital, P. O Box 1002-90115, Kangundo
  • NYAMU GITONGA DAVID Senior Lecturer of Clinical Pharmacy, Department of Pharmaceutics and Pharmacy Practice, University of Nairobi, P. O. Box 19676-00202, Nairobi
  • ROSALINE NJOKI KINUTHIA Clinical Pharmacist, Department of Pharmacy, Kenyatta National Hospital. P. O. Box 20723-00202 KNH, Nairobi

Abstract

Objective: To characterize the clinical significance of potential drug interactions and identify the targets for their minimization among adult diabetic hypertensive outpatients at Kenyatta National Hospital.


Methods: This cross-sectional study collected and analyzed data from 104 diabetic hypertensive outpatients (aged ≥18 y) at the Department of Endocrinology Outpatient Clinic of Kenyatta National Hospital from 1st May 2019 to 31st August 2019. The main outcome measure was the clinical significance of potential drug interactions and the targets for minimization. Participants’ sociodemographic data, drugs prescribed and targets for prevention of potential drug-drug interactions were extracted from patient medical records into predesigned data collection forms. Potential drug interactions were identified using the Micromedex® drug interaction checker. Data was exported to STATA® software version 13 for analysis.


Results: The study comprised predominantly females (70.2%) and the mean age was 61.6 (±10.8) years. Over 80% of patients were receiving renin inhibitors or metformin and the commonest potential drug interaction (25.0%) was antidiabetics-beta blockers. The most common potential clinical outcome of the drug-drug interaction was hyperkalemic lactic acidosis (14.4%), induced by combining enalapril with metformin, and hypoglycemia (9.6%) on concomitant use of antidiabetic and beta-blocker. Adverse clinical outcomes were mainly minimized through regular blood sugar checks (100%), blood pressure monitoring (98.1%), and minimal HbA1c (30.8%) checks as well as serum urea and electrolytes (17.3%) measurements.


Conclusion: There are potential adverse outcomes of combination pharmacologic therapies among diabetic hypertensive patients in Kenyatta National Hospital. Apart from the clinical monitoring, clinicians should be aware that diabetic hypertensive patients are likely to have serious adverse effects of drug interactions and, therefore, institute or intensify other measures such as arterial blood gases and serum electrolyte tests.

Keywords: Clinical outcomes, Potential drug-drug interactions, Antidiabetics, Antihypertensives, Diabetes, Hypertension, Kenya

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References

1. Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol 2018;34:575–84.
2. Seedat Y, Rayner B. The abridged South African hypertension guideline 2011. South African Family Practice 2013;55:111-6.
3. Ogunsina MA, Anumah FO. Prevalence and correlates of hypertension and diabetes mellitus in an urban community in North-Western Nigeria. Pan Afr Med J 2018;8688:1–5.
4. Muchira J, Stuart Shor E, Kariuki J, Mukuna A, Ndigirigi I, Gakage L, et al. Distribution and characteristics of risk factors for cardiovascular–metabolic disease in a rural kenyan community. Int J Africa Nursing Sci 2015;3:76–81.
5. Mohan V, Seedat YK, Pradeepa R. The rising burden of diabetes and hypertension in Southeast Asian and African Regions: need for effective strategies for prevention and control in primary health care settings. Int J Hypertension 2013;1–14. DOI:10.1155/2013/409083
6. Shanmugam S. Chapter-28 management of hypertension in diabetes. Diabetes Mellitus; 2006. p. 124–8.
7. The health of the people: the African regional health report. Brazzaville: World Health Organization, Regional Office for Africa; 2006.
8. Manikandan R, Nandamuri SSS, Logaraj M. Assessment of medication adherence among patients with hypertension and diabetes mellitus in urban field practice. Asian J Pharm Clin Res 2018;11:130-2.
9. Maharani DD, Syafhan NF, Hersunaryati Y. Drug-related problems in hospitalized geriatric patients with diabetes mellitus. Int J Appl Pharm 2018;10:142-8.
10. Puspitasari AW, Azizahwati A, Hidayat AR. Analysis of potential drugs interaction on antihypertension drugs prescription in the community health center of sukmajaya district in period of june-november 2015. Asian J Pharm Clin Res 2017;10:61-5.
11. The safety of medicines in public health programmes: pharmacovigilance an essential tool. Geneva: World Health Organization; 2006.
12. Samardzic I. Incidence of potential drug-drug interactions with antidiabetic drugs. NCBI 2015;70:410-5.
13. Salvetti A. Thiazide diuretics in the treatment of hypertension: an update. J Am Soc Nephrol 2006;17(4 Suppl 2):S25–9.
14. Sawicki PT, Siebenhofer A. Betablocker treatment in diabetes mellitus. J Int Med 2001;250:11–7.
15. Ostman J. Beta-adrenergic blockade and diabetes mellitus a review.
Acta Med Scand Suppl 1983;672:69-77.
16. Ogamba E. Diabetes and hypertension in kisii teaching and referral. M Pharm Dissertation. University of Nairobi; 2016.
17. Guantai EM, Magot AA, Karimi PN, Maru SM, Nyamu DG. Identification and Characterization of potential drug interactions in hypertensive patients in a Kenyan Tertiary hospital Identification and characterization of potential drug interactions in Hypertensive patients in a Kenyan tertiary hospital. Afr J Pharmacol Ther 2018;7:7–12.
18. Cochran WG. Sampling techniques. 2nd Ed. New York: John Wiley and Sons, Inc; 1963.
19. Kim MJ, Lim NK, Choi SJ, Park HY. Hypertension is an independent risk factor for type 2 diabetes: the korean genome and epidemiology study. Hypertension Res Nat Publishing Group 2015;38:783–9.
20. Lawrence JM, Reid J, Taylor GJ, Stirling C, Reckless JP. Favorable effects of pioglitazone and metformin compared with gliclazide on lipoprotein sub-fractions in overweight patients with early type 2 diabetes. Diabetes Care 2003;27:41–6.
21. Ministry of Health. National Clinical Guidelines for Management of Diabetes Mellitus-Republic of Kenya 2010;1:1-156.
22. Bhatta M. A prospective, cross-sectional study on cost and adherence of antidiabetic prescriptions at a tertiary care teaching hospital in South India. Value Health 2014;17:A746.
23. Abraham HMA, White CM, White WB. The comparative efficacy and safety of the angiotensin receptor blockers in the management of hypertension and other cardiovascular diseases. Drug Safety 2014;38:33–54.
24. Weir M. Effects of renin-angiotensin system inhibition end-organ protection: can we do better? Clin Ther 2007;29:1803–24.
25. Raval A, Dhanaraj E, Bhansali A, Yadav R. Prescription patterns of antihypertensive agents in T2DM patients visiting tertiary care centre in North India. Value Health 2013;16:1-9.
26. Weinberg JM. Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy. Arch Int Med 2009;169:1587-98.
27. Iftikhar H, Saleem M, Kaji A. Metformin-associated severe lactic acidosis in the setting of acute kidney injury. Cureus 2019;11:1-4.
28. Hsu WH, Hsiao PJ, Lin PC, Chen SC, Lee MY, Shin SJ. Effect of metformin on kidney function in patients with type 2 diabetes mellitus and moderate chronic kidney disease. Oncotarget 2018;9:5416–23.
29. Haghighatpanah M, Thunga G, Jha A, Mallayasamy S. Study on prescribing Pattern of anti-diabetic drugs among type 2 diabetes patients with a complication in South Indian teaching hospital. Asian J Pharm Clin Res 2016;9:194–7.
30. Harris MI. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care 2001;24:979-82.
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LATI, M. S., N. G. DAVID, and R. N. KINUTHIA. “THE CLINICAL SIGNIFICANCE OF POTENTIAL DRUG-DRUG INTERACTIONS AND THEIR TARGETS FOR MINIMIZATION AMONG HYPERTENSIVE DIABETIC OUTPATIENTS AT A KENYAN REFERRAL HOSPITAL”. International Journal of Pharmacy and Pharmaceutical Sciences, Vol. 12, no. 10, Aug. 2020, pp. 6-11, doi:10.22159/ijpps.2020v12i10.38816.
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