Real clinical impact of drug-drug interactions of immunosuppressants in transplant patients

No Thumbnail Available

Date

2021-12-01

Authors

Isabel Gago-Sanchez, Ana
Font, Pilar
Cardenas, Manuel
Dolores Aumente, Maria
Ramon Del Prado, Jose
Angel Calleja, Miguel

Advisors

Journal Title

Journal ISSN

Volume Title

Publisher

John wiley & sons ltd
Metrics
Google Scholar
Export

Research Projects

Organizational Units

Journal Issue

Abstract

The main objective was to determine the prevalence of real drug-drug interactions (DDIs) of immunosuppressants in transplant patients. We conducted a prospective, observational 1-year study at a tertiary hospital, including all transplanted patients. We evaluated data from monitoring blood concentrations of immunosuppressive drugs and adverse drug events (ADEs) caused by DDIs. The DDIs were classified as C, D, or X according to their Lexi-Interact rating (C = monitor therapy, D = consider therapy modification, X = avoid combination). The clinical importance of real DDIs was expressed in terms of patient outcomes. The causality of DDIs was determined using Drug Interaction Probability Scale. The data were analyzed using Statistical Package for Social Sciences v. 25.0. A total of 309 transplant patients were included. Their mean age was 52.0 +/- 14.7 years (18-79) and 69.9% were male. The prevalence of real DDIs was 21.7%. Immunosuppressive drugs administered with antifungal azoles and tacrolimus (TAC) with nifedipine have a great clinical impact. Real DDIs caused ADEs in 22 patients. The most common clinical outcome was nephrotoxicity (1.6%; n = 5), followed by hypertension (1.3%; n = 4). Suggestions for avoiding category D and X DDIs included: changing the immunosuppressant dosage, using paracetamol instead of non-steroidal anti-inflammatory drugs, and interrupting atorvastatin. The number of drugs prescribed and having been prescribed TAC was associated with an increased risk of real DDIs. There are many potential DDIs described in the literature but only a small percentage proved to be real DDIs, based on the patients ' outcomes.

Description

MeSH Terms

DeCS Terms

CIE Terms

Keywords

adverse drug events, clinically relevant, drug-drug interactions, immunosuppressants, prevalence, transplant, Stem-cell transplantation, Hospitalized-patients, Azole antifungals, Management, Polypharmacy, Prevalence, Tacrolimus, Magnitude, Agents, Care

Citation