By John Horn, PharmD, professor of pharmacy, University of Washington School of Pharmacy, Seattle.
Drug-related problems (DRPs) are an “unspoken pandemic.” Serious DRPs are directly responsible for 6-10% of hospitalizations. About 25% of the population will suffer from at least one serious DRP during their lifetime, ending up with severe morbidity, hospitalization, or even mortality.
Although DRPs are often associated with the elderly population and the concomitant use of several medications, DRPs can occur while taking a single medication at any age.
Typically, medications are prescribed for specific indications with the benefit substantially outweighing the risk associated with the treatment. This risk-benefit ratio can be altered by several factors including the following:
(1) Patient-drug interactions – Some people can suffer serious and even fatal reactions to their medications due to individual vulnerability to develop serious adverse effects or lack of drug efficacy. The patient-specific factors that govern such outcomes include diet, genetic profile, smoking status, lab results, and concurrent disease states, among others.
(2) Drug-drug interactions – When patients are exposed to more than one drug, an interaction between the drugs may occur and can often be very serious. A common example is where one medication substantially increases or decreases the concentration of another medication in the body. Combinations of drugs can also lead to an increased toxic effect (e.g., hypotension, hypoglycemia, hyperkalemia), a synergistic harmful effect of medications on various body organs/functions (e.g., blood pressure, cardiac rhythm, bone marrow suppression, cognitive functions) and/or reduce the therapeutic effect of one or both drugs.
The emergence of serious DRPs in patients is often linked to the lack of appropriate alerting of clinicians to the potential risks. With the large number of drug therapies available, healthcare providers need assistance to assess potential DRPs and relevant management options.