Date of Award

Winter 1-4-2020

Document Type


Degree Name



Department of Pharmacy Practice

First Advisor

Dr. Karthik S Udupa


Background: Cancer patients are more prone to drug interactions as multiple medications are administered concomitantly along with cytotoxic agents in addition with drugs targeted to treat underlying comorbidities, and these are poorly evaluated. In the challenging field of cancer where the number of patients diagnosed increases in a geometric manner, the difficulties faced by healthcare professionals to treat the patients poses a great deal of arduous task in designing an optimum therapeutic regimen. This study addresses the current dilemma and suggests to bring about a resolution to the existing problem. Objectives: The primary objective of this study is to characterize, in a group of lung cancer patients, the frequency of clinically pertinent interactions involving anticancer drugs along with prescribed drugs and other anti-tumour agents. Secondary objective involves identifying the types of drugs mainly involved, their severity and adverse consequences, and discussing its management. Methodology: The study was conducted in Kasturba Hospital, Manipal, a tertiary care setting. 197 patients receiving chemotherapy fulfilled the inclusion criteria. Drug interactions were recorded from two sources, Micromedex Healthcare services and Epocrates (free version), and categorised as pharmacokinetic and pharmacodynamic interactions. Severity and significance of the drug interactions were assessed as per the two sources. A descriptive analysis of the data collected was carried out using Microsoft Excel Spreadsheet.Results: Among 196 patients receiving chemotherapy, 555 drug interactions were found in 185 patients using both, Micromedex and Epocrates. Based on mechanism of action, 76% of the interactions were found be to pharmacodynamic, 20% of the interactions fell under the pharmacokinetic category, and 4% of the interactions were found to be occurring via both mechanisms, pharmacokinetic as well as pharmacodynamic. 112 drug interactions were found in Micromedex alone while 589 interactions were found using only Epocrates.Conclusion:Numerous drug- drug interactions were found in patients admitted to Kasturba Hospital, Manipal. This suggests a strong need for collaboration between the oncologists and clinical pharmacists, who with their clinical knowledge can help minimise the number of drug- drug interactions by conducting medication therapy reviews regularly, and help resolve the current issue in the future.