Drug interactions in hospitalized patients: Critical importance of renal disease and drug monitoring based on data from hospital departments of internal medicine in Serbia

Drug-drug interactions (DDIs) have been associated with adverse drug reactions (ADRs) which can cause hospitalization. The aim of this study was to associate potential DDIs (pDDIs) with potential ADRs upon admission to hospital among patients on five internal medicine wards. A cross-sectional study was performed on the cardiology, nephrology, endocrinology, gastroenterology, and geriatrics ward. The patients' sociodemographic characteristics, medical history, clinical and laboratory parameters were recorded. In total, 474 patients participated in the study. The mean age was 69.7 ± 12.8 years. We identified 1,949 pDDIs in 389 patients (82.1%), with an average of 5.0 ± 4.7 (range 1 - 34). angiotensin-converting enzyme inhibitors, loop diuretics, aspirin, and β-blockers were most frequently involved in DDIs, and the most common possible adverse outcomes were renal failure, decreased blood pressure, bleeding, and hypoglycemia. Asthma/chronic obstructive pulmonary disease, heart failure, nephrology ward, number of medications, acute myocardial infarction and diabetes were predictive for clinically relevant pDDIs. Elevated urea and serum creatinine levels were associated with pDDIs resulting in possible renal failure. Anticoagulants were associated with Prothrombin time-international normalized ratio levels >3 (6.23; 3.80 - 10.21; p < 0.001), whereas the presence of pDDIs leading to clopidogrel inefficacy was associated with elevated troponin levels (OR 4.03; 1.96 - 8.27; p < 0.001). We associated comorbidities with different classes of clinically significant pDDIs and possible outcomes such as renal failure, bleeding, and clopidogrel inefficacy with appropriate laboratory parameters outside the reference range. The pDDI-associated inefficacy of clopidogrel may have caused patient hospitalization due to reinfarction.