About this Research Topic

Background

Drug interactions can be defined as a modification in the effectiveness or in the toxicity of a drug caused by a concomitant administration of another drug, herbal or other medicinal products or food. Drug interactions are a real and relevant problem in clinical practice due to the increasing prevalence of multimorbidity and polypharmacy, particularly in elderly patients. They represent a significant proportion of adverse drug reactions and could account for 1% of hospitalizations in the general population and 2–5% of hospital admissions in the elderly. Drug interactions are generally classified according to the underlying mechanism in pharmaceutical (interactions before drugs are administered), pharmacokinetics (modification of the absorption, distribution, metabolism or excretion of the drug) and pharmacodynamics (modification of the effect of the drug without alteration in drug kinetic). A large part of drug interactions, such as those mediated by the cytochrome P450 pathway of drug metabolism, are considered preventable since they can be predicted from the known pharmacological properties of the drugs involved. However, not all potential drug interactions necessarily have clinically significant consequences and not necessarily occur in all patients. Fewer studies are available on actual interactions where relevant clinical problems arise.

Thousands of articles on drug interactions have been published during recent years, but few give sufficient information about the clinical importance or public health impact of drug interactions. Therefore, it is difficult to assess if and how they alter clinical practice in the real world.

Other risk factors for drug interactions include age, genetic polymorphism, patients’ self-medication with OTC drugs, herbals or dietary supplements, often not reported to physicians. Genetic polymorphisms are an important risk factor for drug interactions since they can influence drug-metabolizing enzymes, drug transporters and drug targets.

The prevalence of potential drug interactions is very high, arriving up to 90%. The list of drug pairs that can potentially interact due to a genetic mechanism is very long but the clinical relevance of these interactions can be influenced by different factors reducing the risk for the patient.

In this Research Topic, we want to include Original or Brief Research Report, and Reviews focused on the real-world impact of drug interactions, analyses on the risk factors, including the genetic ones, epidemiological studies comparing the incidence of potential to actual drug interactions in different context, use of different resources, like computerized clinical support systems, available to both clinicians and patients to improve recognition and prevention of interactions and their impact on the public health, studies on healthcare databases to evaluate the epidemiology and the consequences of drug interactions in the real world, efficacy of educational interventions or other strategies to reduce drug interactions in clinical practice.

Studies could focus not only on drug-drug interactions but also on drug-herbs and drug-food interactions.

Keywords: Drug-drug interactions, drug-food interactions, drug-herbals interactions, drug information, adverse drug reactions

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