Date of Award

Winter 1-4-2019

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Karthik S Udupa

Abstract

Background: To study the prescribing pattern of chemotherapeutic drugs in Breast Cancer patients and to survey the prevalence of exigent drug-drug interactions (DDIs) between chemotherapeutic drugs and non-chemotherapeutic drugs and evaluate the risk factors associated with these drug-drug interactions in India. Methods: All discharged patients’ data in the Department of Oncology were collected from September 2019 to March 2020 with the help of Hospital Information System and inpatient file of the breast cancer patients collected from the Medical Records Department. Drugs were screened for interactions by Micromedex solutions database and Epocrates database. Descriptive statistics were generated and was used to identify the drug-drug interactions and the associated factors. Results: The median age of the selected study population was 46.5±17.6 (24-85). Those falling between the ages 25-54 were 284(67.29%), those between 55-64 were 89 (21.09%), those above 64 were 47 (11.13%) and those below 25 were 2 (0.47%). BMIs were observed as Underweight (n=26; 6.87%), Normal (n=181; 42.89%), Overweight (n=142; 33.64%), Obese (n=54; 12.79%) and Unknown (n=16; 3.81%). Some of the most frequently prescribed anticancer drugs were Doxorubicin, prescribed in 339 patients (80.33%), Cyclophosphamide (79.85%) and Paclitaxel in 207 patients (49.05%). Antitumor Anti-neoplastics in 645 patients (21.28%), Alkylating Agents in 329 patients (10.85%), Antimetabolite Anti-neoplastics in 14 patients (0.46%), Hormonal agents in 5 (0.16%), Taxanes in 3 (0.09%) and Kinase Inhibitors were prescribed in 1 (0.03%). Dexamethasone in 402 patients (95.2%), Pantoprazole in 395 patients (93.6%) and Palonosetron prescribed in 379 patients (89.8%). Some of the most frequently observed interactions as per the two databases (MICROMEDEX SOLUTIONS and EPOCRATES) utilized were also analysed; Doxorubicin and Dexamethasone in 336 patients (18.02%), Cyclophosphamide and Dexamethasone in 333 patients (17.86%) and Cyclophosphamide and Doxorubicin in 326 patients (17.48%). Out of a total of 3030 interactions, 997 (33%) interactions were identified by IBM Micromedex. Of these, 637 (73%) interactions were Pharmacokinetic in nature and 340 (34%) were Pharmacodynamic. Of 3030 total interactions, 2033 (67%) interactions were identified by Epocrates. Of which, 1496 (73.58%) interactions were of Pharmacodynamic nature while 537 (26.41%) were Pharmacokinetic. Most interactions were seen with Doxorubicin, prescribed in 339 (80.33%) cases and associated with 1054 (34.78%) cases of interactions. Followed by Cyclophosphamide, in 337 (79.85%) cases and associated with 785 (25.90%) interaction and Paclitaxel, prescribed in 207 (49.05%) cases and associated with 215 (7.09%) interactions. Similarly, this was also conducted in Hormonal anticancer agents. Letrozole, most prescribed agent, (n=25;5.92%) had 0 cases of interaction.Conclusion: All the data produced through analysis in this study point to a single fact, i.e. better and more intensive Breast Cancer patient care is necessary in preserving the health as well as improving the QoL of the BC patient. The same can be achieved through a multifaceted scheme of activities such as involving clinical pharmacists in daily rounds to help in better detecting the interactions by assisting in active participation of therapy decision and/or by utilizing databases which help in checking interactions before they take place. A better way will be to have more than one Database to increase the sensitivity of the process.

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