Estudio observacional transversal por intervalos sobre interacciones medicamentosas en pacientes ingresados a cargo del Servicio de Neurología

Abstract

Objectives: To determine the prevalence and density of incidence of potential interactions, total and clinically relevant, in the treatment of patients admitted by the Neurology Service, as well as the main risk factors associated with their appearance. Identify and analyze the drugs, therapeutic groups, medicinal plants and homeopathic products involved in the interactions, especially clinically relevant ones, as well as the frequency and mechanisms of action involved and the alternatives or risk reduction strategies. The validity and importance given by neurologists to the main interactions with clinical relevance obtained in the study is also analyzed. Methodology: A descriptive, prospective, cross-sectional observational study was carried out at intervals, and during a period of 16 weeks, all the medical treatments of the patients in charge of the Neurology Service were collected with a frequency of 2 days not consecutive to the week. Demographic data (sex, age and allergies), the presence of certain comorbidities (hypertension, DM, onco-hematological diseases, dyslipidaemia, kidney and liver disease) as well as all the information related to its chronic treatment and the use of medicinal plants were collected. For the analysis of the treatments, all prescription lines were collated in the Lexicomp¿ database, registering all the drug interactions detected by pairs with the corresponding degree of severity (contraindicated, greater, moderate or less), evidence (excellent, good , adequate or deficient) and the clinical relevance (X, D, C, B or A) assigned by Lexicomp¿. Results: 348 treatments of 200 different patients were analyzed, 54,6% women, with a median (range) age of 71 (16-94) years and 4 (0-10) comorbidities. The prevalence of specific comorbidities was 60,9% for HTA, 35,3% for DM, 8,3% ofor onco-hematological disease and 35,9% for dyslipidemia. Besides, 19,8% had kidney disease and 6,3% liver failure. 87,1% had prescribed chronic treatment, with a median of 6 (1-19) drugs per patient; no patient was registered in treatment with medicinal plants or homeopathic products. Of the 2601 drugs analyzed, Lexicomp¿ database identified a total of 2769 drug interactions grouped in 631 pairs, most of them were type C (72,63%). 301 interactions (10,87%) were classified as clinically relevant, 253 as type D and 48 as type X; 51,16% of the drug interactions were pharmacodynamic and 48,17% pharmacokinetic. Finally, the risk factors associated with the presence of drug interactions after multivariate analysis were number of prescribed medications (for all variables), prescribed medications groups (number of clinically relevant drug interactions), age groups (presence of both drug interactions types and number of clinically relevant) and presence of oncohematological disease (number of total drug interactions).