Nitrovasodilators are used to treat many conditions including coronary artery disease, chronic congestive heart failure, and arterial hypertension. They induce smooth muscle relaxation by increasing intracellular cyclic Guanosine Monophosphate (cGMP) concentrations and act ivating K+ channels through the release of Nitric Oxide (NO). Thus, they could interact with the drugs preventing the breakdown or increasing the synthesis of cGMP and induce the accumulation of cGMP resulting in excessive vasodilation and severe hypotension. Pharmacologically relevant drug interactions of Nitrovasodilators are discussed in this review. Coadministration of Nitrovasodilators and the drugs preventing the breakdown of cGMP like Phosphodiesterase 5 (PDE5) inhibitors or the drugs increasing the synthesis of cGMP like Riociguat could induce the accumulation of cGMP resulting in excessive vasodilation and severe hypotension. The prescribers and pharmacists are required to be aware of the drugs interacting with Nitrates to predict and prevent the adverse drug interactions.

Drug-drug interactions (DDIs) can lead to increased toxicity or reduction in therapeuticefficacy. This study was designed to assess the incidence of potential drug interactions (PDI) and rank their clinical value in post coronary care unit (Post-CCU) of a teaching hospital in Tehran, Iran.In this prospective study, three pharmacists with supervision of a clinical pharmacist actively gathered necessary information for detection of DDIs. Data were tabulated according to the combinations of drugs in treatment chart. Verification of potential drug interactions was carried out using the online Lexi-InteractTM 2011.A total of 203 patients (113 males and 90 females) were enrolled in the study. The mean age of patients was 61 ± 12.55 years (range=26-93). A total of 90 drugs were prescribed to 203 patients and most prescribed drugs were atorvastatin, clopidogrel and metoprolol. Mean of drugs was 11.22 per patient. A total of 3166 potential drug interactions have been identified by Lexi- InteractTM, 149 (4.71%) and 55 (1.73%) of which were categorized as D and X, respectively. The most serious interactions were clopidogrel+omeprazole and metoprolol+salbutamol.Drug interactions leading to serious adverse effects are to be cautiously watched for when multiple drugs are used simultaneously. In settings with multiple drug use attendance of apharmacist or clinical pharmacist, taking the responsibility for monitoring drug interactions and notifying the physician about potential problems could decrease the harm in patient and increase the patient safety.

Background: Number of patients undergoing kidney transplantation is ever increasing. Drug-drug interactions (DDIs) can complicate transplant patient’ s treatment course. Objective: To investigate patterns and factors associated with potential DDIs in kidney transplant recipients under maintenance immunosuppressive regimen at a referral transplantation center in Shiraz, Iran. Methods: 390 eligible kidney transplant outpatients referred to Motahhari clinic and one of the attending nephrologist’ s private office during an18-month period were assessed for DDIs. Using the Lexi-Interact online drug interactions software, the prescribed drugs were assessed for the number and type of potential DDIs. Only type D and X interactions were considered eligible for inclusion. Results: During the study period, 344 DDIs were detected of which, 290 were type D; 54 were type XDDIs. 81% of the detected DDIs were pharmacokinetics. Interaction between cyclosporine + mycophenolic acid (32. 3%) was the most frequent DDIs followed by cyclosporine + atorvastatin (11. 3%). Immunosuppressant (43. 44%) was the most frequently used medication responsible for DDIs. Number of co-administered medications (OR: 1. 34, 95% CI: 1. 12– 1. 51) and cyclosporine as main immunosuppressive main drug (OR: 10. 43, 95% CI: 6. 24– 17. 42) were identified as independent risk factors for DDIs. Conclusion: Major DDIs were common in kidney transplant recipients. Considering the importance of DDIs in kidney transplant patients, more attention is warranted in this regard by health care members, especially physicians and pharmacists.

Background: Patients with dyslipidemia are usually multimorbid and require polypharmacy. Therefore, it is important to identify potential drug-drug interactions (pDDIs) in time to prevent their consequences. We aimed to identify and analyze risk factors contributing to their occurrence to guide health professionals. Methods: A prospective cross-sectional study of 216 outpatients with dyslipidemia was conducted from May 2021 to April 2022 in Podgorica, the capital of Montenegro. pDDIs were identified using Medscape, Epocrates, and Drugs online interaction checkers. Multivariate regression analysis was performed to evaluate the potential predictors of interactions. Results: pDDIs were detected in 212 (98. 1%) participants, whereas pDDIs with high clinical significance were detected in 25. 46%, 40. 74%, and 58. 8% of subjects by Drugs, Epocrates, and Medscape, respectively. Polypharmacy emerged as a risk factor for the occurrence of pDDIs in all three checkers in each category of clinical significance. The use of non-steroidal anti-inflammatory drugs and antiplatelet drugs contributes to the incidence of severe pDDIs B=1. 014, 95%CI 0. 681-1. 346, P=0. 000 and B=0. 492, 95%CI 0. 286-0. 698, P=0. 000, by Epocrates and Medscape respectively. The number of prescribers per patient was a protective factor against moderate pDDI B=-0. 858, 95%CI-1. 572-(-0. 144), P=0. 019 and B=-0. 956, 95%CI-1. 671-(0. 241), P=0. 009, by Medscape and Epocrates, respectively, but a risk factor for the occurrence of minor pDDIs B=0. 373, 95%CI 0. 033-0. 712 P=0. 032 and B=0. 143, 95%CI 0. 042-0. 244, P=0. 006, by the same checkers. Conclusion: Knowledge of the risk factors contributing to the occurrence of pDDIs is important for the development and implementation of strategies for their prevention, and given the high prevalence of dyslipidemia, understanding these factors seems crucial nowadays.

Background: Drug-drug interactions can often lead to preventable adverse drug events and hospitalization. However, the clinical outcome of a potential drug-drug interaction that may range from minor alterations to major toxicity or loss of effect is often unknown. Drugs with narrow therapeutic index are more susceptible to the outcomes of interactions. Anticoagulants are one of the drug groups prone to drug-drug interactions and have important side effects. in this retrospective study, the frequency of drug-drug interactions involving warfarin, heparin and enoxaparin was investigated. Methods: Overall, 300 patients (including 55% males with an average age of 50. 75 years) participated in this study, and for each anticoagulant, 100 patient orders were randomly selected from the hospital system. Drug-drug interactions were evaluated using the Micromedex drug interaction checker. Results: A total of 1691 drug-drug interactions (306 major, 253 moderate, and 89 minor interactions) were recorded of which only 648 (average 2. 16) involved warfarin, heparin, or enoxaparin. Most interactions were recorded in patients admitted to the cardiovascular surgery (n=312) and cardiology (n=119) wards. There was a significant relationship between the number of drugs and the frequency of interaction. warfarin had the highest number of interactions (n=388). Conclusion: The frequency of drug interactions is high in patients on anticoagulant therapy. The efficacy and safety of these drugs can be affected by drug interactions. Accordingly, these interactions should always be considered, especially in patients with multiple drug use. Efficient monitoring strategies should be employed to optimize treatment while reducing adverse effects.