THE CLINICAL SIGNIFICANCE OF POTENTIAL DRUG-DRUG INTERACTIONS AND THEIR TARGETS FOR MINIMIZATION AMONG HYPERTENSIVE DIABETIC OUTPATIENTS AT A KENYAN REFERRAL HOSPITAL

Objective: To characterize the clinical significance of potential drug interactions and identify the targets for their minimization among adult diabetic hypertensive outpatients at Kenyatta National Hospital. Methods: This cross-sectional study collected and analyzed data from 104 diabetic hypertensive outpatients (aged ≥18 y) at the Department of Endocrinology Outpatient Clinic of Kenyatta National Hospital from 1st May 2019 to 31st August 2019. The main outcome measure was the clinical significance of potential drug interactions and the targets for minimization. Participants’ sociodemographic data, drugs prescribed and targets for prevention of potential drug-drug interactions were extracted from patient medical records into predesigned data collection forms. Potential drug interactions were identified using the Micromedex® drug interaction checker. Data was exported to STATA® software version 13 for analysis. Results: The study comprised predominantly females (70.2%) and the mean age was 61.6 (±10.8) years. Over 80% of patients were receiving renin inhibitors or metformin and the commonest potential drug interaction (25.0%) was antidiabetics-beta blockers. The most common potential clinical outcome of the drug-drug interaction was hyperkalemic lactic acidosis (14.4%), induced by combining enalapril with metformin, and hypoglycemia (9.6%) on concomitant use of antidiabetic and beta-blocker. Adverse clinical outcomes were mainly minimized through regular blood sugar checks (100%), blood pressure monitoring (98.1%), and minimal HbA1c (30.8%) checks as well as serum urea and electrolytes (17.3%) measurements. Conclusion: There are potential adverse outcomes of combination pharmacologic therapies among diabetic hypertensive patients in Kenyatta National Hospital. Apart from the clinical monitoring, clinicians should be aware that diabetic hypertensive patients are likely to have serious adverse effects of drug interactions and, therefore, institute or intensify other measures such as arterial blood gases and serum electrolyte tests