Drugs-Induced QT Interval Prolongation among End-Stage Renal Disease
Patients in Jordan
Abstract
Background In spite of high risk of mortality due to drug-induced QT
interval prolongation (QTcP) usage among end stage renal disease
patients (ESRD), no previous studies were conducted to assess medication
safety of this drugs category among this vulnerable patients group.
Objectives This study aimed to investigate the appropriateness and
potential drug-drug interactions of QTcP-inducing drugs among ESRD
patients in Jordan. Method This study was a cross-sectional
retrospective study conducted in the outpatient clinics of 200 Jordanian
healthcare facilities over three years (2017, 2018, and 2019) using
Hakeem© database for data collection. CredibleMeds© was used to identify
and categorise QTcP-inducing drugs. Drug-drug interactions and
appropriateness of prescribing were assessed by Micromedex Drug Reax©
software and a multidisciplinary committee, respectively. Results Of the
407 patients included, 954 drugs with risk of QTcP were dispensed; 618
(64.8%) had interactions with other drugs; 10.4% were major, 29.3%
were moderate, and 60.3% were minor drug-drug interactions. Absence of
major polypharmacy and co-morbidity decreased the odds of major
drug-drug interactions by 61% (OR 0.61; 95% CI 0.23-0.97; p=0.02), and
72% (OR 0.72; 95% CI 0.44-1.23; p=0.04), respectively. After clinical
evaluation, 17.6% of the dispensed drugs were considered inappropriate
application, 12.9% were classified as inappropriate choice, and 26.4%
were judged as inappropriate decision. Urology clinics were more likely
to prescribe QTcP-inducing drugs based on inappropriate decision.
Conclusion Major drug-drug interactions and dispensing medications with
risk of QTcP based on inappropriate prescribing decisions for patients
with ESRD were reported to be high in outpatient clinics in Jordan.