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CP-193 Drug-drug interactions among patients with chronic liver disease: A snapshot by clinical pharmacist

Background People with chronic liver diseases constitute a group of patients who often have polypharmacy, comorbidities, and pharmacokinetic and pharmacodynamic changes, that cause an increase in the risk of drug-drug interactions. Purpose To identify and describe drug-drug interactions based on their clinical significance and predictors of their occurrence among patients with chronic liver diseases. To compare the results from two available electronic sources for interaction evaluation. Material and methods A study was conducted on a hepatology ward from May to July 2015, at the gastroenterology and hepatology clinic. Data were gathered through a prospective chart review performed by a clinical pharmacist during a 4 h visit once per week. An estimate of whether gender, age, liver disease, comorbidities, use of certain drugs and total number of drugs per patient influenced the occurrence of drug-drug interactions was made, using correlation and binary regression analysis. Two separate drug interaction programs (Lexi-Interact and Epocrates) were applied to provide the analysis. Results From medicines use review of 100 patients with chronic liver diseases, we identified 486 drug-drug interactions (DDIs) using the Lexi-Interact and 293 using the Epocrates database. The most common type of interaction was class C and monitor/mоdify, deemed as clinically significant (367 DDIs; at least one was found in 83.5% of patients). Acetylsalicylic acid had the highest risk of causing potentially serious (class D, major severity; Lexi-Interact) interactions (25.3%). Most common interacting drug pairs were hydrochlorothiazide/bisoprolol, hydrochlorothiazide/ibuprofen and furosemide/spironolactone. Predictors of DDIs were total number of drugs per patient, number of comorbidities and gender. Statistically significant correlation with occurrence of DDIs was observed for the following covariates: total number of drugs per patient (p = 0.049), number of comorbidities (p = 0.023) and patient age (p = 0.039). Conclusion Most DDIs in the study identified the need for monitoring/modifying therapy. Patients on hydrochlorothiazide, furosemide and bisoprolol were more likely to have DDIs. Lexi-Interact was shown to be the more sensitive source. We advocate that on-ward participation of a clinical pharmacist in a hepatology team may prevent/minimise the frequency and severity of DDIs, provide prompt solutions and enhance patient care. References and/or Acknowledgements lexi.com/PDA-Software-for-Pharmacists/Lexi-Drugs-Interact https://online.epocrates.com No conflict of interest.