Adverse Drug Reactions and Drug-Drug Interactions with Cardiovascular Medications Seen in Patients Attending a Teaching Hospital in Ghana
Many pharmacological agents are usually combined to manage inflammation, haemodynamic and neurohormonal alterations which occur in patients with cardiovascular diseases (CVDs). Combination therapy usually results in undesired drug-drug interactions (DDIs) and adverse drug reactions (ADRs). The aim of this study was to determine the various DDIs and ADRs that occurred in patients with CVDs receiving pharmacological treatment at the cardiac clinic, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Two hundred and forty-eight (248) patients were recruited for the study. Eligible participants were patients with heart failure, ischaemic heart disease or arrhythmias aged 13 years and above. ADR report involved documentation of adverse effects to previous cardiovascular therapy. ADRs were categorized based on the type of ADR, organ or system implicated, suspected medicine (s) that induced the effect and intervention provided to avert the problem. All medications prescribed during routine visit were also documented to assess for DDI. The prescription per patient were entered into an online medical information source (Medscape) to generate the interactions. The interactions were compared to Stockley’s drug interaction, 9th edition (2010) and British National Formulary, 66th edition (2013/2014). A total of 19 ADRs were reported in 17 patients, that is 6.9% of the sample. The proportion of these ADRs were 17.6%, 35.3% and 49.1% for age ranges 30-49, 50-69 and 70-89 years with the average age of 65.2 years. More men reported ADRs with the ratio of men to women being 0.59:0.41. Aspirin recorded the highest percentage drug interactions (21.3%, n=43), followed by furosemide (11.4%, n=23) and bisoprolol (12.4%, n=25). Out of the 202 interactions, 152 (75.2%) of the interactions were significant whereas 37 (18.3%) and 13 (6.4%) were mild and severe respectively. Again, 122 (60.4%) of the interactions were pharmacodynamic interactions whereas 72 (35.6%) of interactions were pharmacokinetic interactions. The mechanisms of the remaining 8 (4.0%) interactions were unknown. CONCLUSION: ADRs and DDIs occurred in patients with cardiovascular diseases receiving pharmacological treatment. Respiratory, gastrointestinal and central nervous systems were the commonest systems affected by ADRs. Manifestation of ADR was directly related to the number of co-morbidities and age of patients.
Ghana, Adverse Drug Reactions, Drug Interactions, Heart Failure, Ischaemic Heart Disease, Arrhythmias
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