Clinical drug-drug interactions in patients admitted to hospital with
COVID-19: high risk drug combinations, predictors, and management
Aim: Coronavirus disease 2019 (COVID-19) is an emerging infectious
disease that has no approved treatment. There are some medications which
may be prescribed for COVID-19 patients as investigational treatments.
Drug-drug interactions (DDIs) of medications used in treating COVID-19
is an important issue to be studied. Current study aimed to evaluate
potential DDIs (pDDIs) and their predictors in hospitalized COVID-19
patients. Methods: A retrospective chart review study was conducted in a
tertiary respiratory hospital dedicated for COVID-19 patients.
Interacting drug combinations, severity, reliability, mechanism, and
clinical management of pDDIs in confirmed COVID-19 cases were identified
using the Lexi-Interact database. Logistic regression was applied to
assess the correlation between occurrence of severe interactions and
probable risk factors. Results: Two hundred and twenty-seven patients’
medical charts were evaluated. About 68% of the patients had at least
one comorbidity. The most common comorbidity was hypertension (30.4%),
followed by obesity (27.8%) and diabetes (23.8%). At least one major
or contraindicated interaction was detected in 37.9% of the patients.
Above 50% of the interactions were between lopinavir/ritonavir
(protease inhibitor) and commonly prescribed medications (e.g.
atorvastatin, alprazolam, salmeterol, and tamsulosin) for management of
comorbidities or COVID-19 symptoms. Logistic regression analysis
demonstrated that two comorbidities (IHD and CRDs) and ICU admission are
significantly associated with occurrence of major or contraindicated
pDDIs. Conclusion: The frequency of pDDIs is relatively high in COVID-19
patients. Patients receiving a protease inhibitor and having comorbidity
or critical conditions should be monitored carefully in terms of DDIs.