Drug-drug interactions in patients with COVID-19
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Drug-drug interactions in patients with COVID-19 According to study results reported in Drugs & Aging, concomitant treatment of COVID-19-hospitalised patients with lopinavir/ritonavir and/or hydroxychloroquine resulted in increased numbers of potentially severe drug-drug interactions (DDIs), suggesting that their use "in patients with COVID-19 with polypharmacy needs to be carefully considered". The retrospective study analysed 502 patients treated at the Luigi Sacco Hospital in Milan between 21 February 2020 and 20 April 2020. There were 338 males and 164 females, 15–99 (median 61) years of age. The appropriateness of drug prescriptions was assessed using the INTERcheck computerised prescription support system. There were 399 patients (79%) who received ≥2 drugs, at admission (56%) and during hospitalisation (73%). At admission, the most frequently used drugs were antihypertensive agents, oral antidiabetic drugs, proton pump inhibitors, and diuretics. During hospitalisation, the use of corticosteroids, immunosuppressants, antibiotics and heparins significantly increased. Of the drugs only administered during hospitalisation, patients received hydroxychloroquine (n=320), lopinavir/ritonavir (n=256) and/or remdesivir (n=70). At least one potential DDI was identified in 271/399 patients (68%), which increased from 46% of patients at admission to 85% of patients during hospitalisation. Potentially severe DDIs were identified in 55% of patients, which increased from 22% at admission to 80% during hospitalisation. Most DDIs at admission were associated with furosemide, amiodarone, quetiapine or β-agonist bronchodilators; all involved QT interval prolongation. During hospitalisation, 88% of events also involved QT prolongation, mainly related to lopinavir/ritonavir with azithromycin, piperacillin or hydroxychloroquine, or to hydroxychloroquine with azithromycin or piperacillin. Lopinavir/ritonavir also increased the risk of statin-induced myopathy, benzodiazepineinduced central nervous system depression, altered anti-thrombotic responses, and corticosteroid-induced Cushinglike syndrome. The incidence of potentially inappropriate medications (PIMs) and the anticholinergic burden (ACB) were assessed in 200 patients aged >65 years. At admission, at least one PIM was identified in 95% of patients, which reduced to 88% during hospitalisation, although the difference was not significant. There were 19% of patients with ACB scores of ≥3, while 2.5% of patients had scores of ≥5. "The main finding of this study is that hospitalised patients with COVID-19 are at high risk of DDIs", note the authors, "mainly because of the drugs administered" to treat the infection. Cattaneo D, et al. Drug-Drug Interactions and Prescription Appropriateness in Patients with COVID-19: A Retrospective Analysis from a Reference Hospital in Northern Italy. 803516445 Drugs and Aging : 5 Nov 2020. Available from: URL: http://doi.org/10.1007/s40266-020-00812-8
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