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ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 32-37

Potential drug-drug interactions among elderly patients on anti-hypertensive medications in two tertiary healthcare facilities in Ekiti State, South-West Nigeria


1 Department of Pharmacology, Ekiti State University, Ado Ekiti, Nigeria
2 Department of Medicine, Ekiti State University, Ado Ekiti, Nigeria
3 Department of Medicine, University of Ilorin, Ilorin, Nigeria
4 Department of Family Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
5 Department of Family Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria

Date of Web Publication6-May-2016

Correspondence Address:
Joseph Olusesan Fadare
Department of Pharmacology, Ekiti State University, Ado Ekiti
Nigeria
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DOI: 10.4103/1118-8561.181896

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  Abstract 

Introduction: Drug-drug interactions remain a major cause of adverse drug reactions with great consequences such as increased morbidity and increased healthcare cost. In elderly patients with systemic hypertension, there is a tendency for them to be prescribed multiple medications and this may expose them to some drug-drug interactions (DDIs) especially in the context of physiological changes of ageing. The objective of this study was to evaluate potential drug-drug interaction among some Nigerian elderly hypertension. Methods: A cross-sectional study involving elderly hypertensive patients attending the general outpatient clinic of two tertiary healthcare facilities located in Ekiti State, South-West Nigeria. The information collected from the patients' medical records included their ages, gender, diagnosis and list of prescribed anti-hypertensive medications. Potential drug-drug interactions were checked for using the Multi-Drug Interaction Checker (Medscape Reference) and Epocrates Drug Interaction Checker (San Mateo CA, USA). Results: A total of 350 elderly patients attended the clinics during the study period of which 208 (59.4%) hypertensive patients were identified and their records used for analysis. The fixed-dose combination drug Moduretic® (Amiloride /Hydrochlorothiazide)-25.7% was the most commonly prescribed antihypertensive followed by Lisinopril (16.6%), Amlodipine (13.2%) and Nifedipine (12.6%). The anti-platelet Acetyl-salicylic acid (ASA) was prescribed for 100 (48.1%) patients and represented 19.8% of all prescribed medications. A total of 231 potential DDIs were found among the patients giving a mean of 1.3 interactions per patient. The most common identified drug pairs with potential interactions were ACE inhibitors - Amiloride, followed by ACE inhibitors - Hydrochlorothiazide, ACE inhibitors - ASA and ARB - Amiloride. Conclusion: Potential drug-drug interactions, though common in this study comprised mainly of minor and moderate types. Notwithstanding, physicians need to be reminded of the potential for interactions when prescribing for elderly patients

Keywords: Anti-hypertensive medications, drug-drug interactions, drug utilization, geriatric patients, polypharmacy


How to cite this article:
Fadare JO, Ajayi AE, Adeoti AO, Desalu OO, Obimakinde AM, Agboola SM. Potential drug-drug interactions among elderly patients on anti-hypertensive medications in two tertiary healthcare facilities in Ekiti State, South-West Nigeria. Sahel Med J 2016;19:32-7

How to cite this URL:
Fadare JO, Ajayi AE, Adeoti AO, Desalu OO, Obimakinde AM, Agboola SM. Potential drug-drug interactions among elderly patients on anti-hypertensive medications in two tertiary healthcare facilities in Ekiti State, South-West Nigeria. Sahel Med J [serial online] 2016 [cited 2019 Dec 9];19:32-7. Available from: http://www.smjonline.org/text.asp?2016/19/1/32/181896


  Introduction Top


Systemic hypertension has emerged as a leading cause of morbidity and mortality in many countries in Sub-Saharan Africa. [1],[2] Some community-based studies conducted in the region showed a higher prevalence of hypertension among the elderly group of the population when compared with the young age group. [3],[4],[5]

Elderly patients are very prone to develop adverse drug reactions (ADRs) due to the peculiarities of their aging process and propensity to have many comorbid conditions. An important factor that may affect the response of elderly patients is their physiological changes with respect to drug disposition . [6],[7],[8] Furthermore , changes due to up- or down-regulation of receptors and those due to disease-drug interactions are other peculiarities related to aging. [9],[10] Furthermore, enhanced sensitivity to drugs and a decrease in regulatory mechanisms have been reported in the elderly. This may result in adverse reactions such as orthostatic hypotension to anti-hypertensives and a greater risk of respiratory depression when opiates are used among this category of patients. [11],[12] Many studies have identified drug-drug interactions (DDIs) as major cause of ADRs, especially in elderly patients. [13],[14],[15],[16] Drug interactions are defined as a drug response that is modified by another drug, food, disease condition or the environment. [17] DDI has been classified mainly into two - pharmacokinetic and pharmacodynamic. [18] Pharmacokinetic drug interactions are those due to changes at the level of drug absorption, distribution, metabolism, and excretion. Interaction at these different levels may lead to either a decreased or increased concentration of the drug with corresponding clinical effects. Drug interactions of the pharmaco-dynamic type are usually due to changes in the expected effects of the drugs that is, antagonism or synergism and may lead to either treatment failure or toxic effects. Another way of classifying DDIs is according to their clinical significance, that is, whether or not they affect patient's outcome. DDIs are sometimes beneficial; however, they account for 41% of ADRs. [19],[20] The ADRs secondary to DDIs may consequently result in increased morbidity, prolonged hospitalizations, and increased healthcare costs. [21],[22] In elderly patients with systemic hypertension, there is a tendency for prescription of multiple medications, thus exposing them to the risk for adverse DDIs. [23] Predictors of DDIs identified from several studies include polypharmacy, old age, comorbid conditions, and gender difference. [14],[24],[25],[26],[27] Since the majority of DDIs are preventable, their timely identification would be necessary to avert the physical and economic burden on patients and their relatives. Although some studies on the pattern of drug utilization and potential DDIs have been conducted among hypertensive patients in Nigeria, no information about the potential interactions between the antihypertensive and co-prescribed anti-platelet drugs among elderly patients with systemic hypertension are found in the literature. [28],[29] The objectives of this study were to determine the prescribing pattern of anti-hypertensive and anti-platelet drugs among elderly hypertensive Nigerian patients while additional objectives were to find the prevalence of potential DDIs and identify the common DDIs . Our reasons for choosing these two groups of medication are that systemic hypertension is a chronic medical condition with most patients being prescribed antihypertensives and some form of anti-platelet/anticoagulant for primary prevention of complications. Other groups of medications prescribed for the patients such as anti-malarial drugs, antibiotics, and food supplements were not included in the analysis of potential DDIs primarily because the study was focused on antihypertensives and anti-platelets.


  Methods Top


Study setting

The study was conducted at the family medicine and general outpatients' clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti and the Federal Medical Centre, Ido-Ekiti, both located in Ekiti State, South-West Nigeria. These healthcare institutions cater for the medical needs of the population of Ekiti and other neighboring states. The general outpatients' clinic of these two tertiary healthcare facilities are usually the first point of contact for patients attending these hospitals, and they are run by 11 consultant family physicians, 30 resident doctors, and 10 medical officers.

Study design and data collection

This is a retrospective cross-sectional study involving elderly patients who are ≥65 years old. The medical records of this group of patients attended at the outpatients' clinic of the two hospitals between March and June 2013 were extracted from the medical records department. The medical records of only those on antihypertensive medications for at least 6 months were selected and included in the study. The medical records of patients on only one medication and those without prescription were excluded from the study. The bio-demographic details of the patients, the antihypertensive and anti-platelet drugs prescribed for patients were extracted from the case files and transcribed into a data collection form. The reason for choosing only these two classes of medication has been ascribed earlier. The data collection form was pretested using the records of ten patients from the medical outpatients department and necessary adjustments made before the commencement of the study. The data collection was carried out by two resident doctors and a consultant in the Family Medicine Department of the two hospitals.

Potential DDIs were checked by using the Multi-drug Interaction Checker (Medscape Reference ® ) and Epocrates Drug Interaction Checker (San Mateo, CA, USA). These instruments have been used and validated in earlier studies conducted in Nigeria and other African Countries. [30],[31] The antihypertensive and anti-platelet drugs prescribed for each patient were inputted into the two drug interaction checkers, and results recorded in the data collection forms as clinically significant, not clinically significant and the mechanism as pharmacokinetic or pharmacodynamic. [18],[26] Clinically significant potentially drug interactions are those when the drugs are contra-indicated, with serious interactions necessitating discontinuation of the medication/s and drug combinations requiring close monitoring of either laboratory or clinical parameters. Potential drug interactions that were minor and of no clinical importance were classified as not significant. [32]

Information from the data collection form was recorded on a spreadsheet and analyzed using IBM SPSS version 19 (IBM Corporation, Armonk, NY, USA). Results are expressed as means, frequencies, and percentages. Analysis of variance was used to compare the means of different groups among the study population. Values of P < 0.05 were considered as significant.

Ethical considerations

The study received ethical approval from the Hospital Research Ethics Committee prior to commencement of the study.


  Results Top


A total of 350 elderly patients attended the clinics during the study period of which 208 (59.4%) hypertensive patients were identified and their records were used for analysis. Female patients (106; 51%) constituted a slight majority among the hypertensive elderly patients. The mean age of the patients was 73.2 ± 7.7 years and their age distribution pattern was 65−74 years (125; 60.1%), 75−79 years (38; 18.3%), ≥80 years (45; 21.6%).

The mean number of prescribed drugs (antihypertensive and anti-platelets) was 2.4 ± 0.8. Thirty (15%) had one medication prescribed while 77 (37%), 82 (39%), and 19 (9%) had 2, 3 and 4 medications, respectively. Diuretics 134 (33%), calcium channel blockers 131 (32.3%), and angiotensin converting enzyme inhibitors (ACEIs) 111 (27.3%) were the most common classes of antihypertensive drugs prescribed. Others are beta-blockers 14 (3.4%), angiotensin-receptor blockers (ARBs) 8 (2%), and centrally acting antihypertensives 8 (2%). The fixed-dose combination drug Moduretic ® (amiloride/hydrochlorothiazide) -25.7% was the most commonly prescribed antihypertensive followed by lisinopril (16.6%), amlodipine (13.2%), and nifedipine (12.6%). The anti-platelet acetylsalicylic acid (ASA) was prescribed for 100 (48.1%) patients and represented 19.8% of all prescribed medications. No other anti-platelet or anticoagulant was prescribed for the patients.

One hundred and seventy-eight patients had two or more medications prescribed. Ninety-nine patients were identified with at least one potential DDIs giving a prevalence of 47.6% among the elderly hypertensive patients. A total of 231 potential DDIs were found among the patients giving a mean of 1.3 interactions per patient. The results of the cross tabulation of the number of interactions with some variables (age, sex, and number of prescribed drugs) showed statistically significant difference with number of prescribed drugs only (P < 0.001). The most common identified drug pairs with potential interactions were ACEIs-amiloride, followed by ACEIs-hydrochlorothiazide, ACEIs-ASA, and ARB-amiloride. The list of identified potential DDIs, its clinical manifestation and grading is as shown in [Table 1].
Table 1: List of identified potential drug-drug interactions


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  Discussion Top


This study reflects the high prevalence of hypertension among elderly patients and also highlights some important potential DDIs in this group. The prevalence rate of hypertension (59.4%) found among elderly patients in this study is slightly higher than 51.5% reported by Ejim et al. in a study among middle-aged and the elderly in Nigeria. [33] In contrast, a community-based study in South-East Nigeria conducted by Ulasi et al. found over 80% of participants aged >70 years to be hypertensive as compared to 40% among patients aged 30-39 years. [34]

The mean number of potential DDIs found in this study was 1.3 with over half of the patients with ≥2 medications having a combination with the potential for interaction. The prevalence of DDI among elderly patients with systemic hypertension in this study was 55.6% and it is comparatively <90.6% reported from a Croatian study on the incidence of potential DDIs among elderly patients with systemic hypertension. [35] Carter et al. found between 55-84% of Medicaid patients on antihypertensives having at least one potential DDI while a similar work among Palestinian hypertensive patients showed more than half with a potential DDI. [26],[36] Studies conducted in India and Nepal among cardiac inpatients revealed an incidence rate of 30.7% and 21.3%, respectively. [37],[38] The variation in the prevalence of DDI might be attributed to the study design, physicians prescribing pattern, differences in available medications, and difference in comorbidities among patients in the above-cited studies.

The most common potential DDIs found in this study were ACEI-ASA, ACEI-amiloride, and ACEI/hydrochlorothiazide. In a recent Nigerian study among hypertensive patients, ACEI-nonsteroidal anti-inflammatory drugs (53.3%) and ACEI-amiloride/hydrochlorothiazide (22.6%) were the most common potential DDIs. [39] In a cross-sectional study among elderly patients in some Finnish nursing homes, potassium-sparing diuretics were the most common identified agents causing DDIs. [40] Anti-platelets, anticoagulants, diuretics, and ACEIs have been identified as potential causes of DDIs in many other studies. [37],[38],[41] In this study, no anticoagulant was prescribed and this may be due to relatively stable state of the patients, the problem of monitoring and potential adverse reaction (warfarin), and cost issues (dipyridamole and clopidogrel). In a population-based study among elderly Brazilian patients, the combination of ACEI and a diuretic was the most common cause of potential DDI (56.7%). [42] Regarding the severity of the interactions, 59.1% and 40.9% of the identified DDIs among our patients were of moderate and mild class, respectively; a similar study from Pakistan had about 63.6% and 23% in the moderate and severe category, respectively. [43]

The most common clinical outcome of the identified potential DDIs in this study were the risk of hyperkalemia, hypotension, decreased drug efficacy, renal impairment, and heart conduction problems. In a study by Tulner et al., up to a quarter of patients with potential DDIs were found to have adverse effects and reduced efficacy of their treatment. [44]

The positive association between the number of prescribed drugs and potential interactions (P < 0.001) found in this study reflects findings from similar studies. [45],[46],[47],[48] However, in contrast to the recently cited studies, there was no positive association between the sex of the patients and their age.


  Conclusion Top


Potential DDIs, though common in this study, is comprised mainly of minor and moderate types. Physicians need to be reminded of the potential for serious interactions when prescribing for patients, especially the elderly. The introduction of interaction detection software in hospital pharmacies would assist in the reduction of interactions with serious clinical importance.

Study limitations

One of the limitations of this study is the theoretical nature of these interactions, as the interactions may not be experienced in our practice settings. However, the need for prescribers to be aware of potential DDIs and take proactive measures are major points in favor of this study. Another limitation is the category of patients and medications included in this study; it could lead to underestimation of potential DDIs. Limiting the study to only antihypertensive and anti-platelet drugs alone would enable practitioners to focus on potential DDIs with clinical significance among patients taking these medications. The relatively high prevalence of hypertension among the elderly bracket, the physiological changes due to the aging process, and the potential for ADRs is in support of this study. The two-centered nature of the study, relatively large sample size, and use of validated interaction screening tools are also additional strengths of the study.

Acknowledgments

The authors appreciate the staff of the Medical Records Unit of the two participating centers for assisting in the retrieval of patient's medical records.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hendriks ME, Wit FW, Roos MT, Brewster LM, Akande TM, de Beer IH, et al. Hypertension in Sub-Saharan Africa: Cross-sectional surveys in four rural and urban communities. PLoS One 2012;7:e32638.  Back to cited text no. 1
    
2.
Adeloye D, Basquill C. Estimating the prevalence and awareness rates of hypertension in Africa: A systematic analysis. PLoS One 2014;9:e104300.  Back to cited text no. 2
    
3.
Ogah OS, Madukwe OO, Chukwuonye II, Onyeonoro UU, Ukegbu AU, Akhimien MO, et al. Prevalence and determinants of hypertension in Abia State Nigeria: Results from the Abia State Non-Communicable Diseases and Cardiovascular Risk Factors Survey. Ethn Dis 2013;23:161-7.  Back to cited text no. 3
    
4.
Ahaneku GI, Osuji CU, Anisiuba BC, Ikeh VO, Oguejiofor OC, Ahaneku JE. Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria. Ann Afr Med 2011;10:120-6.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Murthy GV, Fox S, Sivasubramaniam S, Gilbert CE, Mahdi AM, Imam AU, et al. Prevalence and risk factors for hypertension and association with ethnicity in Nigeria: Results from a national survey. Cardiovasc J Afr 2013;24:344-50.  Back to cited text no. 5
    
6.
Hines LE, Murphy JE. Potentially harmful drug-drug interactions in the elderly: A review. Am J Geriatr Pharmacother 2011;9:364-77.  Back to cited text no. 6
    
7.
Lonsdale DO, Baker EH. Understanding and managing medication in elderly people. Best Pract Res Clin Obstet Gynaecol 2013;27:767-88.  Back to cited text no. 7
    
8.
Le Couteur DG, Hilmer SN, Glasgow N, Naganathan V, Cumming RG. Prescribing in older people. Aust Fam Physician 2004;33:777-81.  Back to cited text no. 8
    
9.
Shi S, Mörike K, Klotz U. The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol 2008;64:183-99.  Back to cited text no. 9
    
10.
Kim M, Dam A, Green J. Common GI drug interactions in the elderly. Curr Treat Options Gastroenterol 2014;12:292-309.  Back to cited text no. 10
    
11.
Bowie MW, Slattum PW. Pharmacodynamics in older adults: A review. Am J Geriatr Pharmacother 2007;5:263-303.  Back to cited text no. 11
    
12.
Trifirò G, Spina E. Age-related changes in pharmacodynamics: Focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab 2011;12:611-20.  Back to cited text no. 12
    
13.
Obreli Neto PR, Nobili A, de Lyra DP Jr, Pilger D, Guidoni CM, de Oliveira Baldoni A, et al. Incidence and predictors of adverse drug reactions caused by drug-drug interactions in elderly outpatients: A prospective cohort study. J Pharm Pharm Sci 2012;15:332-43.  Back to cited text no. 13
    
14.
Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. Expert Opin Drug Saf 2012;11:83-94.  Back to cited text no. 14
    
15.
Franceschi M, Scarcelli C, Niro V, Seripa D, Pazienza AM, Pepe G, et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: A prospective study of 1756 patients. Drug Saf 2008;31:545-56.  Back to cited text no. 15
    
16.
Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: A systematic review of prospective observational studies. Ann Pharmacother 2008;42:1017-25.  Back to cited text no. 16
    
17.
Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet 2007;370:185-91.  Back to cited text no. 17
    
18.
Lewis LD. Drug-drug interactions: Is there an optimal way to study them? Br J Clin Pharmacol 2010;70:781-3.  Back to cited text no. 18
    
19.
Aronson J. Beneficial drug interactions. Practitioner 1994;238:514-8.  Back to cited text no. 19
    
20.
Montastruc F, Sommet A, Bondon-Guitton E, Durrieu G, Bui E, Bagheri H, et al. The importance of drug-drug interactions as a cause of adverse drug reactions: A pharmacovigilance study of serotoninergic reuptake inhibitors in France. Eur J Clin Pharmacol 2012;68:767-75.  Back to cited text no. 20
    
21.
McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother 2002;36:1331-6.  Back to cited text no. 21
    
22.
Gyllensten H, Rehnberg C, Jönsson AK, Petzold M, Carlsten A, Andersson Sundell K. Cost of illness of patient-reported adverse drug events: A population-based cross-sectional survey. BMJ Open 2013;3:pii: e002574. DOI: 10.1136/bmjopen-2013-002574.  Back to cited text no. 22
    
23.
Williams BR, Kim J. Cardiovascular drug therapy in the elderly: Theoretical and practical considerations. Drugs Aging 2003;20:445-63.  Back to cited text no. 23
    
24.
Sharifi H, Hasanloei MA, Mahmoudi J. Polypharmacy-induced drug-drug interactions; threats to patient safety. Drug Res (Stuttg) 2014;64:633-7.  Back to cited text no. 24
    
25.
Moura CS, Acurcio FA, Belo NO. Drug-drug interactions associated with length of stay and cost of hospitalization. J Pharm Pharm Sci 2009;12:266-72.  Back to cited text no. 25
    
26.
Carter BL, Lund BC, Hayase N, Chrischilles E. The extent of potential antihypertensive drug interactions in a Medicaid population. Am J Hypertens 2002;15:953-7.  Back to cited text no. 26
    
27.
Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci 2006;9:427-33.  Back to cited text no. 27
    
28.
Yusuff KB, Balogun O. Physicians′ prescribing of anti-hypertensive combinations in a tertiary care setting in southwestern Nigeria. J Pharm Pharm Sci 2005;8:235-42.  Back to cited text no. 28
    
29.
Olanrewaju TO, Aderibigbe A, Busari OA, Sanya EO. Antihypertensive drug utilization and conformity to guidelines in a sub-Saharan African hypertensive population. Int J Clin Pharmacol Ther 2010;48:68-75.  Back to cited text no. 29
    
30.
Lubinga SJ, Uwiduhaye E. Potential drug-drug interactions on in-patient medication prescriptions at Mbarara Regional Referral Hospital (MRRH) in western Uganda: Prevalence, clinical importance and associated factors. Afr Health Sci 2011;11:499-507.  Back to cited text no. 30
    
31.
Oshikoya KA, Oreagba IA, Ogunleye OO, Lawal S, Senbanjo IO. Clinically significant interactions between antiretroviral and co-prescribed drugs for HIV-infected children: Profiling and comparison of two drug databases. Ther Clin Risk Manag 2013;9:215-21.  Back to cited text no. 31
    
32.
The Medscape Multi-Drug Interaction Checker. Available from: http://reference.medscape.com/drug-interactionchecker. [Last accessed on 2015 May 14].  Back to cited text no. 32
    
33.
Ejim EC, Okafor CI, Emehel A, Mbah AU, Onyia U, Egwuonwu T, et al. Prevalence of cardiovascular risk factors in the middle-aged and elderly population of a nigerian rural community. J Trop Med 2011;2011:308687.  Back to cited text no. 33
    
34.
Ulasi II, Ijoma CK, Onwubere BJ, Arodiwe E, Onodugo O, Okafor C. High prevalence and low awareness of hypertension in a market population in Enugu, Nigeria. Int J Hypertens 2011;2011:869675.  Back to cited text no. 34
    
35.
Bacic-Vrca V, Marusic S, Erdeljic V, Falamic S, Gojo-Tomic N, Rahelic D. The incidence of potential drug-drug interactions in elderly patients with arterial hypertension. Pharm World Sci 2010;32:815-21.  Back to cited text no. 35
    
36.
Sweileh WM, Sawalha AF, Jaradat NA. Extent of potential drug interactions among patients receiving anti-hypertensive medications. Saudi Med J 2005;26:548-52.  Back to cited text no. 36
    
37.
Patel VK, Acharya LD, Rajakannan T, Surulivelrajan M, Guddattu V, Padmakumar R. Potential drug interactions in patients admitted to cardiology wards of a south Indian teaching hospital. Australas Med J 2011;4:9-14.  Back to cited text no. 37
    
38.
Sharma S, Chhetri HP, Alam K. A study of potential drug-drug interactions among hospitalized cardiac patients in a teaching hospital in Western Nepal. Indian J Pharmacol 2014;46:152-6.  Back to cited text no. 38
[PUBMED]  Medknow Journal  
39.
Eshiet UI, Yusuff KB. Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: A probable shift of paradigm. Pharm Pract (Granada) 2014;12:419.  Back to cited text no. 39
    
40.
Hosia-Randell HM, Muurinen SM, Pitkälä KH. Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland: A cross-sectional study. Drugs Aging 2008;25:683-92.  Back to cited text no. 40
    
41.
Mateti U, Rajakannan T, Nekkanti H, Rajesh V, Mallaysamy S, Ramachandran P. Drug-drug interactions in hospitalized cardiac patients. J Young Pharm 2011;3:329-33.  Back to cited text no. 41
    
42.
Secoli SR, Figueras A, Lebrão ML, de Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly: A population-based, cross-sectional study. Drugs Aging 2010;27:759-70.  Back to cited text no. 42
    
43.
Ismail M, Iqbal Z, Khattak MB, Khan MI, Arsalan H, Javaid A, et al. Potential drug-drug interactions in internal medicine wards in hospital setting in Pakistan. Int J Clin Pharm 2013;35:455-62.  Back to cited text no. 43
    
44.
Tulner LR, Frankfort SV, Gijsen GJ, van Campen JP, Koks CH, Beijnen JH. Drug-drug interactions in a geriatric outpatient cohort: Prevalence and relevance. Drugs Aging 2008;25:343-55.  Back to cited text no. 44
    
45.
Kulkarni V, Bora SS, Sirisha S, Saji M, Sundaran S. A study on drug-drug interactions through prescription analysis in a South Indian teaching hospital. Ther Adv Drug Saf 2013;4:141-6.  Back to cited text no. 45
    
46.
Dhabali AA, Awang R, Zyoud SH. Clinically important drug-drug interactions in primary care. J Clin Pharm Ther 2012;37:426-30.  Back to cited text no. 46
    
47.
Obreli Neto PR, Nobili A, Marusic S, Pilger D, Guidoni CM, Baldoni Ade O, et al. Prevalence and predictors of potential drug-drug interactions in the elderly: A cross-sectional study in the brazilian primary public health system. J Pharm Pharm Sci 2012;15:344-54.  Back to cited text no. 47
    
48.
Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: A study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug Saf 2007;30:911-8.  Back to cited text no. 48
    



 
 
    Tables

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