{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T01:14:51Z","timestamp":1782436491195,"version":"3.54.5"},"reference-count":34,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009647","name":"University Grants Commission- Nepal","doi-asserted-by":"publisher","award":["FRG-80\/81-HS-07"],"award-info":[{"award-number":["FRG-80\/81-HS-07"]}],"id":[{"id":"10.13039\/501100009647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,1]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Drug\u2013drug interactions (DDIs) are a significant concern for patients on complex therapeutic regimens, especially involving cardiovascular medications, which are frequently implicated in these interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study used a standardised interaction database to determine the frequency, severity and risk factors associated with potential DDIs (pDDIs) among cardiovascular disease (CVD) in-patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The prospective cross-sectional study was conducted at a tertiary care hospital in Nepal from April 2024 to October 2024. A total of 106 eligible CVD in-patients were evaluated for pDDIs using the Lexicomp DDI checker database, and the interactions were categorised based on severity and risk rating. Binary logistic regression identified factors associated with pDDIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study identified 621 pDDIs using the Lexicomp database, with median values of 8 pDDIs per patient. Patients with at least one pDDI comprised 64.2% of the sample. Most pDDIs were of moderate severity (77.3%) with risk ratings of C (65.7%). The most common cardiovascular medications involved in the detected DDI pairs were diuretics (31.2%), antiplatelets and anticoagulants (23.8%) and calcium channel blockers (12.2%). Multivariate binary logistic regression revealed that patients who stayed longer (adjusted OR (AOR) 9.08, 95%\u2009CI 1.027 to 80.216, p=0.047), those receiving more medications (AOR 18.85, 95%\u2009CI 2.975 to 119.370, p=0.002) and those who were admitted to the intensive cardiac care unit (AOR 16.31, 95%\u2009CI 2.728 to 97.461, p=0.002) were significantly more likely to experience pDDIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study found a higher prevalence of pDDIs. It is advisable to incorporate medication reviews into routine cardiac care and use a drug interaction checker to identify pDDIs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099721","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T10:50:37Z","timestamp":1755859837000},"page":"e099721","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Potential drug\u2013drug interactions among hospitalised cardiac patients in Nepal: a prospective observational study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9293-7551","authenticated-orcid":false,"given":"Binod Kumar","family":"Sah","sequence":"first","affiliation":[{"name":"Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki, Nepal"},{"name":"Department of Pharmacy, Narayani Hospital, Birgunj, 44300 Parsa, Province Madhesh, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun Kumar","family":"Karna","sequence":"additional","affiliation":[{"name":"Department of Medicine, Narayani Hospital, Birgunj, 44300 Parsa, Province Madhesh, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangam","family":"Subedi","sequence":"additional","affiliation":[{"name":"Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit Kumar","family":"Sah","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Narayani Hospital, Birgunj, 44300 Parsa, Province Madhesh, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Research and Academics, Kathmandu Cancer Center, Tathali, Nala Road, Province Bagmati, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nim Bahadur","family":"Dangi","sequence":"additional","affiliation":[{"name":"Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"2025123106470869000_15.8.e099721.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-017-2357-5"},{"key":"2025123106470869000_15.8.e099721.2","unstructured":"Zeind CS , Carvalho MG , Cheng JW , et al . Applied therapeutics: the clinical use of drugs. Lippincott Williams & Wilkins, 2023."},{"key":"2025123106470869000_15.8.e099721.3","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/agm2.12051","article-title":"Polypharmacy in elderly cancer patients: Challenges and the way clinical pharmacists can contribute in resource-limited settings","volume":"2","author":"Shrestha","year":"2019","journal-title":"Aging Med (Milton)"},{"key":"2025123106470869000_15.8.e099721.4","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.ejim.2010.05.014","article-title":"Adverse drug reactions detected by stimulated spontaneous reporting in an internal medicine department in Romania","volume":"21","author":"Farcas","year":"2010","journal-title":"Eur J Intern Med"},{"key":"2025123106470869000_15.8.e099721.5","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3592"},{"key":"2025123106470869000_15.8.e099721.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.11.001"},{"key":"2025123106470869000_15.8.e099721.7","article-title":"Burden of Cardiovascular Diseases in Nepal from 1990 to 2019: The Global Burden of Disease Study, 2019","volume":"2023","author":"Pandey","year":"2023","journal-title":"Glob Health Epidemiol Genom"},{"key":"2025123106470869000_15.8.e099721.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.117.311849"},{"key":"2025123106470869000_15.8.e099721.9","doi-asserted-by":"crossref","first-page":"946415","DOI":"10.3389\/fphar.2022.946415","article-title":"Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study","volume":"13","author":"Zhao","year":"2022","journal-title":"Front Pharmacol"},{"key":"2025123106470869000_15.8.e099721.10","first-page":"737","article-title":"Detection and analysis of potential drug-drug interactions among patients admitted to the cardiac care unit in a tertiary care hospital","volume":"27","author":"Khaled","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025123106470869000_15.8.e099721.11","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4103\/0253-7613.129303","article-title":"A study of potential drug-drug interactions among hospitalized cardiac patients in a teaching hospital in Western Nepal","volume":"46","author":"Sharma","year":"2014","journal-title":"Indian J Pharmacol"},{"key":"2025123106470869000_15.8.e099721.12","first-page":"5093","article-title":"Potential and actual drug-drug interactions among patients with cardiovascular disease: a comprehensive analysis of data from a tertiary care hospital in South India","volume":"12","author":"Khatiwada","year":"2021","journal-title":"Int J Pharm Sci Res"},{"key":"2025123106470869000_15.8.e099721.13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s40801-023-00373-3","article-title":"Potentially Harmful Drug-Drug Interactions and Their Associated Factors Among Hospitalized Cardiac Patients: A Cross-Sectional Study","volume":"10","author":"Kalash","year":"2023","journal-title":"Drugs Real World Outcomes"},{"key":"2025123106470869000_15.8.e099721.14","article-title":"Exploring potential drug-drug interactions in discharge prescriptions: ChatGPT\u2019s effectiveness in assessing those interactions","volume":"17","author":"Thapa","year":"2025","journal-title":"Explor Res Clin Soc Pharm"},{"key":"2025123106470869000_15.8.e099721.15","unstructured":"Narayani hospital. 2025. Available: https:\/\/narayanihospital.gov.np\/ [Accessed 01 Jun 2025]."},{"key":"2025123106470869000_15.8.e099721.16","doi-asserted-by":"crossref","first-page":"25","DOI":"10.24874\/PES03.01.003","article-title":"Determination of sample size and sampling methods in applied research","volume":"3","author":"Nanjundeswaraswamy","year":"2021","journal-title":"PES"},{"key":"2025123106470869000_15.8.e099721.17","unstructured":"Facts and comparisons user academy - drug interactions. Lexicomp, Wolters Kluwer; 2024. Available: https:\/\/www.wolterskluwer.com\/en\/solutions\/lexicomp\/resources\/facts-comparisons-user-academy\/drug-interactions [Accessed 05 Jan 2025]."},{"key":"2025123106470869000_15.8.e099721.18","doi-asserted-by":"crossref","first-page":"257","DOI":"10.4103\/2279-042X.192461","article-title":"A comparison of five common drug-drug interaction software programs regarding accuracy and comprehensiveness","volume":"5","author":"Kheshti","year":"2016","journal-title":"J Res Pharm Pract"},{"key":"2025123106470869000_15.8.e099721.19","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1007\/s11096-021-01346-8","article-title":"Determination of potential drug-drug interactions in prescription orders dispensed in a community pharmacy setting using Micromedex\u00ae and Lexicomp\u00ae: a retrospective observational study","volume":"44","author":"Abbas","year":"2022","journal-title":"Int J Clin Pharm"},{"key":"2025123106470869000_15.8.e099721.20","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4066\/AMJ.2011.450","article-title":"Potential drug interactions in patients admitted to cardiology wards of a south Indian teaching hospital","volume":"4","author":"Patel","year":"2011","journal-title":"Australas Med J"},{"key":"2025123106470869000_15.8.e099721.21","unstructured":"Muhammad N , Afridi R . Prevalence, types and predictors of potential drug-drug interactions in an internal medicine ward of The Mardan Medical Complex, Mardan, Kpk, Pakistan. International Journal of Basic Medical Sciences and Pharmacy (IJBMSP) 2017;6."},{"key":"2025123106470869000_15.8.e099721.22","doi-asserted-by":"crossref","first-page":"543","DOI":"10.4274\/tjps.galenos.2021.96603","article-title":"Potential Drug Interactions in Adults Living in Manaus: A Real-World Comparison of Two Databases, 2019","volume":"19","author":"Biase","year":"2022","journal-title":"Turk J Pharm Sci"},{"key":"2025123106470869000_15.8.e099721.23","doi-asserted-by":"crossref","DOI":"10.1177\/2050312119857353","article-title":"Potential drug-drug interactions and associated factors among hospitalized cardiac patients at Jimma University Medical Center, Southwest Ethiopia","volume":"7","author":"Diksis","year":"2019","journal-title":"SAGE Open Med"},{"key":"2025123106470869000_15.8.e099721.24","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-024-01412-w"},{"key":"2025123106470869000_15.8.e099721.25","doi-asserted-by":"crossref","DOI":"10.1186\/s40545-021-00348-1","article-title":"Potential drug-drug interactions in patients with cardiovascular diseases: findings from a prospective observational study","volume":"14","author":"Akbar","year":"2021","journal-title":"J Pharm Policy Pract"},{"key":"2025123106470869000_15.8.e099721.26","first-page":"282","article-title":"Potential drug-drug interactions among hospitalized patients in a developing country","volume":"8","author":"Mousavi","year":"2017","journal-title":"Caspian J Intern Med"},{"key":"2025123106470869000_15.8.e099721.27","doi-asserted-by":"publisher","DOI":"10.2165\/11538650-000000000-00000"},{"key":"2025123106470869000_15.8.e099721.28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1080\/00015385.2021.1878423","article-title":"Diuretic therapy in congestive heart failure","volume":"77","author":"Kennelly","year":"2022","journal-title":"Acta Cardiol"},{"key":"2025123106470869000_15.8.e099721.29","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10741-020-10003-7","article-title":"Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials","volume":"26","author":"Eid","year":"2021","journal-title":"Heart Fail Rev"},{"key":"2025123106470869000_15.8.e099721.30","doi-asserted-by":"crossref","unstructured":"Mozayani A , Raymon L . Handbook of drug interactions: a clinical and forensic guide. Springer Science & Business Media, 2011.","DOI":"10.1007\/978-1-61779-222-9"},{"key":"2025123106470869000_15.8.e099721.31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ejim.2012.09.011","article-title":"How many potential drug-drug interactions cause adverse drug reactions in hospitalized patients?","volume":"24","author":"Buc\u015fa","year":"2013","journal-title":"Eur J Intern Med"},{"key":"2025123106470869000_15.8.e099721.32","doi-asserted-by":"crossref","DOI":"10.1186\/s40360-022-00582-6","article-title":"Prevalence of potential drug\u2009-\u2009drug interactions in the cardiothoracic intensive care unit patients in a Chinese tertiary care teaching hospital","volume":"23","author":"Wang","year":"2022","journal-title":"BMC Pharmacol Toxicol"},{"key":"2025123106470869000_15.8.e099721.33","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-010-0987-y"},{"key":"2025123106470869000_15.8.e099721.34","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/j.2042-7174.2012.00221.x","article-title":"Drug-drug interactions in the medical intensive care unit: an assessment of frequency, severity and the medications involved","volume":"20","author":"Smithburger","year":"2012","journal-title":"Int J Pharm Pract"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-099721","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:48:55Z","timestamp":1767192535000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-099721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,22]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bmjopen-2025-099721"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-099721","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}