Polypharmacy and Drug Interactions in the COVID-19 Pandemic

Barcia, Ricardo Enrique; Keller, Guillermo Alberto; Bello, Natalia; Azzato, Francisco; Diez, Roberto Alejandro; Giunti, Guido

doi:10.14712/23362936.2023.30

Prague Medical Report > Archive > 2023, Vol. 124 > Issue 4 > Polypharmacy and Drug Interactions in…

Prague Med. Rep. 2023, 124, 392-412

https://doi.org/10.14712/23362936.2023.30

Polypharmacy and Drug Interactions in the COVID-19 Pandemic

Ricardo Enrique Barcia^1,2, Guillermo Alberto Keller³, Natalia Bello⁴, Francisco Azzato¹, Roberto Alejandro Diez³, Guido Giunti^5,6

¹6° Cátedra de Medicina Interna, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
²DrApp, Empresa de Desarrollos Informáticos para Medicina, Buenos Aires, Argentina
³Centro de Vigilancia y Seguridad de Medicamentos, Departamento de Toxicología y Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
⁴División Infectología, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
⁵School of Medicine, Trinity College Dublin, Dublin, Ireland
⁶University of Oulu, Oulu, Finland

Received July 2, 2023
Accepted November 15, 2023

The COVID-19 pandemic generated a great impact on health systems. We compared evolution, polypharmacy, and potential drug-drug interactions (P-DDIs) in COVID-19 and non-COVID-19 hospitalizations during first wave of pandemic. Prescriptions for hospitalized patients ≥ 18 years (COVID-19 and non-COVID-19 rooms) between April and September 2020 were included. The computerized medical decision support system SIMDA and the physician order entry system Hdc.DrApp.la were used. Patients in COVID-19 rooms were divided into detectable and non-detectable, according to real-time reverse transcription polymerase chain reaction (RT-PCR). Number of drugs, prescribed on day 1, after day 1, and total; polypharmacy, excessive polypharmacy, and P-DDIs were compared. 1,623 admissions were evaluated: 881 COVID-19, 538 detectable and 343 non-detectable, and 742 non-COVID-19. Mortality was 15% in COVID-19 and 13% in non-COVID-19 (RR [non-COVID-19 vs. COVID-19]: 0.84 [95% CI] [0.66–1.07]). In COVID-19, mortality was 19% in detectable and 9% in non-detectable (RR: 2.07 [1.42–3.00]). Average number of drugs was 4.54/patient (SD ± 3.06) in COVID-19 and 5.92/patient (±3.24) in non-COVID-19 (p<0.001) on day 1 and 5.57/patient (±3.93) in COVID-19 and 9.17/patient (±5.27) in non-COVID-19 (p<0.001) throughout the hospitalization. 45% received polypharmacy in COVID-19 and 62% in non-COVID-19 (RR: 1.38 [1.25–1.51]) and excessive polypharmacy 7% in COVID-19 and 14% in non-COVID-19 (RR: 2.09 [1.54–2.83]). The frequency of total P-DDIs was 0.31/patient (±0.67) in COVID-19 and 0.40/patient (±0.94) in non-COVID-19 (p=0.022). Hospitalizations in the COVID-19 setting are associated with less use of drugs, less polypharmacy and less P-DDIs. Detectable patients had higher mortality.