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Potential drug–drug interactions at a referral hematology–oncology ward in Iran: a cross-sectional study

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Abstract

Purpose

To assess the pattern and probable risk factors for moderate and major drug–drug interactions in a referral hematology–oncology ward in Iran.

Methods

All patients admitted to hematology–oncology ward of Dr. Shariati Hospital during a 6-month period and received at least two anti-cancer or non-anti-cancer medications simultaneously were included. All being scheduled anti-cancer and non-anti-cancer medications both prescribed and administered during ward stay were considered for drug–drug interaction screening by Lexi-Interact On-Desktop software.

Results

One hundred and eighty-five drug–drug interactions with moderate or major severity were detected from 83 patients. Most of drug–drug interactions (69.73 %) were classified as pharmacokinetics. Fluconazole (25.95 %) was the most commonly offending medication in drug–drug interactions. Interaction of sulfamethoxazole-trimethoprim with fluconazole was the most common drug–drug interaction (27.27 %). Vincristine with imatinib was the only identified interaction between two anti-cancer agents. The number of administered medications during ward stay was considered as an independent risk factor for developing a drug–drug interaction.

Conclusions

Potential moderate or major drug–drug interactions occur frequently in patients with hematological malignancies or related diseases. Performing larger standard studies are required to assess the real clinical and economical effects of drug–drug interactions on patients with hematological and non-hematological malignancies.

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References

  1. Fuhr U (2008) Improvement in the handling of drug–drug interactions. Eur J Clin Pharmacol 64:167–171

    Article  PubMed  Google Scholar 

  2. Scripture CD, Figg WD (2006) Drug interactions in cancer therapy. Nat Rev Cancer 6:546–558

    Article  PubMed  CAS  Google Scholar 

  3. Lu C, Liao M, Cohen L, Xia CQ (2010) Emerging in vitro tools to evaluate cytochrome P450 and transporter-mediated drug–drug interactions. Curr Drug Discov Technol 7:199–222

    PubMed  CAS  Google Scholar 

  4. Köhler GI, Bode-Böger SM, Busse R, Hoopmann M, Welte T, Böger RH (2000) Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther 38:504–513

    PubMed  Google Scholar 

  5. Beijnen JH, Schellens JH (2004) Drug interactions in oncology. Lancet Oncol 5:489–496

    Article  PubMed  CAS  Google Scholar 

  6. Egger SS, Drewe J, Schlienger RG (2003) Potential drug–drug interactions in the medication of medical patients at hospital discharge. Eur J Clin Pharmacol 58:773–778

    PubMed  Google Scholar 

  7. Glintborg B, Andersen SE, Dalhoff K (2005) Drug-drug interactions among recently hospitalised patients–frequent but mostly clinically insignificant. Eur J Clin Pharmacol 61:675–681

    Article  PubMed  Google Scholar 

  8. Herr RD, Caravati EM, Tyler LS, Iorg E, Linscott MS (1992) Prospective evaluation of adverse drug interactions in the emergency department. Ann Emerg Med 21:1331–1336

    Article  PubMed  CAS  Google Scholar 

  9. Goldberg RM, Mabee J, Chan L, Wong S (1996) Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med 14:447–450

    Article  PubMed  CAS  Google Scholar 

  10. Guédon-Moreau L, Ducrocq D, Duc MF, Quieureux Y, L’Hôte C, Deligne J, Caron J (2004) Absolute contraindications in relation to potential drug interactions in outpatient prescriptions: analysis of the first five million prescriptions in 1999. Eur J Clin Pharmacol 59:899–904

    Article  PubMed  Google Scholar 

  11. Buajordet I, Ebbesen J, Erikssen J, Brørs O, Hilberg T (2001) Fatal adverse drug events: the paradox of drug treatment. J Intern Med 250:327–341

    Article  PubMed  CAS  Google Scholar 

  12. Riechelmann RP, Del Giglio A (2009) Drug interactions in oncology: how common are they? Ann Oncol 20:1907–1912

    Article  PubMed  CAS  Google Scholar 

  13. Lexi-interact. http://webstore.lexi.com/Lexi-Interact. Accessed June 1 2012

  14. Barrons R (2004) Evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm 61:380–385

    PubMed  Google Scholar 

  15. Vonbach P, Dubied A, Krähenbühl S, Beer JH (2008) Evaluation of frequently used drug interaction screening programs. Pharm World Sci 30:367–374

    Article  PubMed  Google Scholar 

  16. Reis AM, Cassiani SH (2010) Evaluation of three brands of drug interaction software for use in intensive care units. Pharm World Sci 32:822–828

    Article  PubMed  CAS  Google Scholar 

  17. World Health Organization. Collaborating Center for Drug Statistics Methodology. ATC/DDD Index 2012. http://www.whocc.no/atcddd/index. Accessed 1 June 2012

  18. Riechelmann RP, Tannock IF, Wang L, Saad ED, Taback NA, Krzyzanowska MK (2007) Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst 99:592–600

    Article  PubMed  Google Scholar 

  19. Kannan G, Anitha R, Rani VN, Thennarasu P, Alosh J, Vasantha J, Martin JR, Uma MR (2011) A study of drug–drug interactions in cancer patients of a south Indian tertiary care teaching hospital. J Postgrad Med 57:206–210

    Article  PubMed  CAS  Google Scholar 

  20. Guastaldi RB, Reis AM, Figueras A, Secoli SR (2011) Prevalence of potential drug–drug interactions in bone marrow transplant patients. Int J Clin Pharm 33:1002–1009

    Article  PubMed  CAS  Google Scholar 

  21. Riechelmann RP, Moreira F, Smaletz O, Saad ED (2005) Potential for drug interactions in hospitalized cancer patients. Cancer Chemother Pharmacol 56:286–290

    Article  PubMed  Google Scholar 

  22. Strandell J, Wahlin S (2011) Pharmacodynamic and pharmacokinetic drug interactions reported to VigiBase, the WHO global individual case safety report database. Eur J Clin Pharmacol 67:633–641

    Article  PubMed  CAS  Google Scholar 

  23. McCoy D, Depestel DD, Carver PL (2009) Primary antifungal prophylaxis in adult hematopoietic stem cell transplant recipients: current therapeutic concepts. Pharmacotherapy 29:1306–1325

    Article  PubMed  CAS  Google Scholar 

  24. Nivoix Y, Ubeaud-Sequier G, Engel P, Levêque D, Herbrecht R (2009) Drug-drug interactions of triazole antifungal agents in multimorbid patients and implications for patient care. Curr Drug Metab 10:395–409

    Article  PubMed  CAS  Google Scholar 

  25. Cronin S, Chandrasekar PH (2010) Safety of triazole antifungal drugs in patients with cancer. J Antimicrob Chemother 65:410–416

    Article  PubMed  CAS  Google Scholar 

  26. Leather HL (2004) Drug interactions in the hematopoietic stem cell transplant (HSCT) recipient: what every transplanter needs to know. Bone Marrow Transplant 33:137–152

    Article  PubMed  CAS  Google Scholar 

  27. Schmidt H, Naumann R, Jaschonek K, Einsele H, Dopfer R, Ehninger G (1989) Drug interaction between cyclosporin and phenytoin in allogeneic bone marrow transplantation. Bone Marrow Transplant 4:212–213

    PubMed  CAS  Google Scholar 

  28. Keown PA, Laupacis A, Carruthers G, Stawecki M, Koegler J, McKenzie FN, Wall W, Stiller CR (1984) Interaction between phenytoin and cyclosporine following organ transplantation. Transplantation 38:304–306

    PubMed  CAS  Google Scholar 

  29. Freeman DJ, Laupacis A, Keown PA, Stiller CR, Carruthers SG (1984) Evaluation of cyclosporin-phenytoin interaction with observations on cyclosporin metabolites. Br J Clin Pharmacol 18:887–893

    Article  PubMed  CAS  Google Scholar 

  30. Mori T, Aisa Y, Kato J, Nakamura Y, Ikeda Y, Okamoto S (2009) Drug interaction between voriconazole and calcineurin inhibitors in allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 44:371–374

    Article  PubMed  CAS  Google Scholar 

  31. van der Ven AJ, Schoondermark-van de Ven EM, Camps W, Melchers WJ, Koopmans PP, van der Meer JW, Galama JM (1996) Anti-toxoplasma effect of pyrimethamine, trimethoprim and sulphonamides alone and in combination: implications for therapy. J Antimicrob Chemother 38:75–80

    Article  PubMed  Google Scholar 

  32. Gill HJ, Maggs JL, Madden S, Pirmohamed M, Park BK (1996) The effect of fluconazole and ketoconazole on the metabolism of sulphamethoxazole. Br J Clin Pharmacol 42:347–353

    Article  PubMed  CAS  Google Scholar 

  33. Winter HR, Trapnell CB, Slattery JT, Jacobson M, Greenspan DL, Hooton TM, Unadkat JD (2004) The effect of clarithromycin, fluconazole, and rifabutin on sulfamethoxazole hydroxylamine formation in individuals with human immunodeficiency virus infection (AACTG 283). Clin Pharmacol Ther 76:313–322

    Article  PubMed  CAS  Google Scholar 

  34. Au WY, Kwong YL (2008) Arsenic trioxide: safety issues and their management. Acta Pharmacol Sin 29:296–304

    Article  PubMed  CAS  Google Scholar 

  35. Bagnes C, Panchuk PN, Recondo G (2010) Antineoplastic chemotherapy induced QTc prolongation. Curr Drug Saf 5:93–96

    Article  PubMed  CAS  Google Scholar 

  36. Lien YC, Lin SM, Nithipongvanitch R, Oberley TD, Noel T, Zhao Q, Daosukho C, St Clair DK (2006) Tumor necrosis factor receptor deficiency exacerbated Adriamycin-induced cardiomyocytes apoptosis: an insight into the Fas connection. Mol Cancer Ther 5:261–269

    Article  PubMed  CAS  Google Scholar 

  37. Hilmer SN, Cogger VC, Muller M, Le Couteur DG (2004) The hepatic pharmacokinetics of doxorubicin and liposomal doxorubicin. Drug Metab Dispos 32:794–799

    Article  PubMed  CAS  Google Scholar 

  38. Barbui T, Rambaldi A, Parenzan L, Zucchelli M, Perico N, Remuzzi G (1992) Neurological symptoms and coma associated with doxorubicin administration during chronic cyclosporin therapy. Lancet 339:1421

    Article  PubMed  CAS  Google Scholar 

  39. Rushing DA, Raber SR, Rodvold KA, Piscitelli SC, Plank GS, Tewksbury DA (1994) The effects of cyclosporine on the pharmacokinetics of doxorubicin in patients with small cell lung cancer. Cancer 74:834–841

    Article  PubMed  CAS  Google Scholar 

  40. Erlichman C, Moore M, Thiessen JJ, Kerr IG, Walker S, Goodman P, Bjarnason G, DeAngelis C, Bunting P (1993) Phase I pharmacokinetic study of cyclosporin A combined with doxorubicin. Cancer Res 53:4837–4842

    PubMed  CAS  Google Scholar 

  41. Sonneveld P, Suciu S, Weijermans P, Beksac M, Neuwirtova R, Solbu G, Lokhorst H, van der Lelie J, Dohner H, Gerhartz H, Segeren CM, Willemze R, Lowenberg B, European Organization for Research and Treatment of Cancer (EORTC), Leukaemia Cooperative Group (LCG), Dutch Haemato-Oncology Cooperative Study Group (HOVON) (2001) Cyclosporin A combined with vincristine, doxorubicin and dexamethasone (VAD) compared with VAD alone in patients with advanced refractory multiple myeloma: an EORTC-HOVON randomized phase III study (06914). Br J Haematol 115:895–902

    Article  PubMed  CAS  Google Scholar 

  42. Bartlett NL, Lum BL, Fisher GA, Brophy NA, Ehsan MN, Halsey J, Sikic BI (1994) Phase I trial of doxorubicin with cyclosporine as a modulator of multidrug resistance. J Clin Oncol 12:835–842

    PubMed  CAS  Google Scholar 

  43. Riechelmann RP, Zimmermann C, Chin SN, Wang L, O’Carroll A, Zarinehbaf S, Krzyzanowska MK (2008) Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manage 35:535–543

    Article  PubMed  Google Scholar 

  44. Secoli SR, Figueras A, Lebrão ML, de Lima FD, Santos JL (2010) Risk of potential drug–drug interactions among Brazilian elderly: a population-based, cross-sectional study. Drugs Aging 27:759–770

    Article  PubMed  Google Scholar 

  45. Miranda V, Fede A, Nobuo M, Ayres V, Giglio A, Miranda M, Riechelmann RP (2011) Adverse drug reactions and drug interactions as causes of hospital admission in oncology. J Pain Symptom Manage 42:342–353

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran

    Molouk Hadjibabaie & Iman Karimzadeh

  2. Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran

    Shirinsadat Badri

  3. Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Sarah Ataei & Amir Hossein Moslehi

  4. Hematology-Oncology and Stem Cell Transplantation Research Center, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Ardeshir Ghavamzadeh

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  1. Molouk Hadjibabaie
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  2. Shirinsadat Badri
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  5. Iman Karimzadeh
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Correspondence to Iman Karimzadeh.

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Hadjibabaie, M., Badri, S., Ataei, S. et al. Potential drug–drug interactions at a referral hematology–oncology ward in Iran: a cross-sectional study. Cancer Chemother Pharmacol 71, 1619–1627 (2013). https://doi.org/10.1007/s00280-013-2162-5

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  • DOI: https://doi.org/10.1007/s00280-013-2162-5

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