Risk factors for potential drug–drug interactions in patients with myasthenia gravis

ABSTRACT

Objectives:

Our aim was to determine risk factors for and frequency of potential drug-drug interactions (pDDIs) among hospitalized patients with myasthenia gravis (MG).

Methods:

This was a retrospective cross-sectional study of the-first time hospitalized MG patients or patients hospitalized because of the exacerbation of MG at the Neurology Clinic of the Clinical Center of Serbia, Belgrade. Medical records and discharge summaries of hospitalized MG patients over a 10-year period were reviewed. The pDDIs were identified by means of Micromedex, and multivariate regression methods were used to reveal potential predictors of number of pDDIs per patient.

Results:

The study included 687 patients with MG. In total, 2041 pDDIs were detected in 608 (88.5%) patients. Among the discovered pDDIs, 329 different pDDIs were observed. The most frequent pDDIs were pyridostigmine-prednisone (487patients/70.9%) and aspirin-prednisone (90 patients/13.1%) classified as moderate, and enalapril-potassium chloride (71patients/10.3%) classified as major pDDI. Five drugs (aspirin, insulin, prednisone, cyclosporine, metformin) were responsible for 22.6% of different pDDIs. Dyspnea, generalized form of MG, diabetes mellitus, hypertension, total number of drugs-used, use of antiplatelets were identified as the relevant risk factors for total number of pDDIs (R2 = 0.626,F = 73.797, p < 0.001), while age of patients and history of cancer were inversely correlated with such an outcome.

Conclusion:

The frequency of the pDDIs in hospitalized MG patients is high, and adversely influenced by dyspnea, generalized MG, diabetes mellitus, hypertension, total number of drugs-used and use of antiplatelets.

KEYWORDS:

• Myasthenia gravis
• potential drug-drug interactions
• risk factors
• prevalence
• micromedex

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was partially financed by grant No 175007, given by the Serbian Ministry of Education, Science and Technological Development.

Notes on contributors

Dejan Z. Aleksić

Dejan Z. Aleksić (MD, PhD) is a neurology specialist who works at Clinic of Neurology, Clinical Centre Kragujevac, Kragujevac, Serbia and as an Assistant Proffesor at the Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, Serbia.

Miloš N. Milosavljević

Miloš N. Milosavljević (MPharm, PhD) works as a Research Associate at the Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Srđan M. Stefanović

Srdjan M. Stefanović (MD, PhD) is a clinical pharmacology specialist and an Associate Professor of Clinical pharmacy at Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Andriana Bukonjić

Andriana Bukonjić (MPharm, PhD) works as an Assistant Professor at the Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Jovana Z. Milosavljević

Jovana Z. Milosavljević (MD, PhD student) works as a Junior Researcher at Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Slobodan M. Janković

Slobodan M. Janković (MD, PhD) is a general surgery and clinical pharmacology specialist who works as a Head of Clinical Pharmacology Department, Clinical Centre Kragujevac, Kragujevac, Serbia and as a Full Professor of Pharmacology and Toxicology and Clinical Pharmacy at the Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Ivo Božović

Ivo Božović, PhD student and neurology resident, works at Neurological Clinic at the Department for neuromuscular and spinal cord diseases, Clinical Centre Serbia, Belgrade, Serbia.

Stojan Perić

Stojan Perić (MD, PhD) is a neurology specialist who works at Neurological Clinic at the Department for neuromuscular and spinal cord diseases, Clinical Centre Serbia, Belgrade, Serbia and as a Clinical Assistant at the Faculty of Medicine, University of Belgrade, Serbia.

Dragana Lavrnić

Dragana Lavrnić (MD, PhD) works as a Full Professor of Neurology at the Faculty of Medicine, University of Belgrade, Serbia and as as a Head of the Department for neuromuscular and spinal cord diseases, Clinical Centre Serbia, Belgrade, Serbia.