Antifungal-drug interactions in oncology: A cross-sectional study highlighting the role of pharmacists.

Abstract

Study objective: Complex pharmacotherapy in cancer patients increases the likelihood of drug-drug interactions (DDIs). Pharmacists play a critical role in the identification and management of DDIs. The aim of present study was to evaluate the role of pharmacist in identifying antifungal drug interactions in cancer patients and providing relevant recommendations.

Methodology: A retrospective, cross-sectional study was conducted to identify antifungal drug interactions over the period of 5 years (2019-2023) among cancer patients. Electronic medical record of 384 hospitalized patients receiving systemic antifungal therapy were reviewed. Severity of interactions and risk classification were made using UptoDate^® Lexidrug^TM software. Pharmacists' recommendations regarding DDIs were also documented. Descriptive statistics and logistic regression were applied to interpret results.

Results: Antifungals were more frequently prescribed to adult patients (53.9%). Female cancer patients were significantly more likely to encounter DDIs than males (p < 0.003). Type of cancer and fungal infections were significantly associated with incidence of DDIs (p < 0.01; p = 0.000). Pharmacist identified DDIs in 53.9% antifungal prescriptions with 22.2% classified as major interactions. A substantial proportion of these interactions involved voriconazole (40.1%). Majority of pharmacist's recommendations included dose optimization of voriconazole (10.4%), close monitoring of RFTs (8.9%) and withholding amphotericin (5.2%) during chemotherapy. All of the recommendations made by pharmacists were accepted by physicians (100%).

Conclusion: The findings indicate that pharmacists identified DDIs in 53.9% of prescriptions and all of their recommendations were accepted by physicians. This highlights the critical role of pharmacists in detecting potential interactions, ensuring medication safety, and minimizing adverse effects associated with complex pharmacotherapy.