arm Ph ac f ov l o i a g n il r a n u c o e J Bitner et al., J Pharmacovigilance 2014, 2:6 Journal of Pharmacovigilance DOI: 10.4172/2329-6887.1000151 ISSN: 2329-6887 Research Article Article OpenOpen Access Access The Role of Multidrug Interactions in the Safety of Pharmacotherapy for Concomitant Parkinson’s Disease and Arterial Hypertension in Poland Anna Bitner1*, Paweł Zalewski1, Julia L Newton2 and Jacek J Klawe1 1Department of Hygiene and Epidemiology, Faculty of Health Sciences Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Poland 2Institute for Ageing and Health, The Medical School, Newcastle University, United Kingdom Abstract Purpose: Multidrug interactions are amongst to the most frequent problems of pharmacotherapy. Such potentially harmful interactions are likely to occur in Parkinson’s disease (PD) patients treated with concomitant arterial hypertension. The aim of this study was to analyze the prevalence of interactions between selected antiparkinson and hypotensive agents. Methods: The analysis included data on the pharmacotherapy of PD and arterial hypertension, obtained from 80 men and women, diagnosed with Hoehn and Yahr stage II and III. However, the table presented data refer to person- drugs (n=186), as some of the respondents were prescribed more than one antiparkinson and/or hypotensive agent. Results: A total of 53 (28.5%) person-interactions were documented in the study group, among them 20 (10.8%) minor, 28 (25.8%) moderate and 5 (28.5%) major ones. The presence of interactions was documented in 37 (46.3%) patients. The number of different interactions present in a single patient amounted to three (n=3, 3.8%), two (n=10, 12.5%), one (n=24, 30.0%). Conclusions: Currently, we lack any detailed guidelines regarding pharmacotherapy of arterial hypertension and selection of hypotensive agents for patients with PD. Achieving desired hypotensive effect and reduction of adverse events resulting from drug-to-drug interactions constitute prerequisites of efficacious hypotensive treatment in patients with PD. Keywords: Parkinson’s disease; Arterial hypertension; Drug-drug the co-existence of arterial hypertension, orthostatic hypotension and interactions; Orthostatic hypotension the issue of drug - drug interactions constitute a serious therapeutic problem and necessitate individualization of treatment [3]. Introduction However, we lack evidence-based guidelines on pharmacotherapy Two or more drugs given at the same time may interact. The of arterial hypertension in patients with Parkinson’s disease, that would interaction may be potentiation or antagonism of one drug by take into consideration the issue of drug interactions. Untreated arterial another, or occasionally some other effect. Drug interactions may hypertension may lead to left ventricular hypertrophy in PD patients. be pharmacodynamic or pharmacokinetic. Pharmacodynamic interactions are interactions between drugs which have similar or The aim of this study was to analyze the prevalence of interactions antagonistic pharmacological effects or side-effects. Pharmacokinetic between selected antiparkinson and hypotensive agents in Poland. interactions occur when one drug alters the absorption, distribution, The analysis was based on a survey of medication use, conducted metabolism, or excretion of another, thus increasing or reducing among randomly chosen 80 patients with concomitant PD and arterial the amount of drug available to produce its pharmacological effects. hypertension. This article presents that drug-drug interactions are Multidrug interactions belong to the most frequent problems of one of the commonest causes of medication error and very important pharmacotherapy. Such potentially harmful interactions are likely to problem in Poland particularly in the elderly due to polytherapy. occur in Parkinson’s disease (PD) patients treated for concomitant Clinicians working with patients with Parkinson’s disease need to arterial hypertension [1,2]. know the significance of these interactions in order to properly counsel patients and prevent therapeutic problem. According to the World Health Organization (WHO) arterial hypertension constitutes one of the most prevalent human diseases. Alterations of the 24-hour arterial pressure profile have been observed in the population of Parkinson’s disease patients, but compared to the *Corresponding author: Anna Bitner, Department of Hygiene and Epidemiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. general population, a drop off in the arterial pressure is observed in Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland, Fax: +48 52 585-35-89;Tel: +48 52 the morning hours, along with its nocturnal elevation. Furthermore, 585-36-16; E-mail: [email protected] epidemiological data suggests that concomitant orthostatic hypotension Received October 08, 2014; Accepted November 04, 2014; Published November and arterial hypertension are present in 50% of individuals with PD 11, 2014 [1,2]. Citation: Bitner A, Zalewski P, Newton JL, Klawe JJ (2014) The Role of Multidrug Interactions in the Safety of Pharmacotherapy for Concomitant Parkinson’s Disease Pharmacotherapy for arterial hypertension in patients with and Arterial Hypertension in Poland. J Pharmacovigilance 2: 151. doi:10.4172/2329- Parkinson’s disease is more challenging than in hypertensive individuals 6887.1000151 without other comorbidities. Most hypotensive agents can exacerbate the Copyright: © 2014 Bitner A, et al. This is an open-access article distributed under signs of orthostatic hypotension or interact with antiparkinson drugs, the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and thus significantly deteriorating quality of life in PD patients. Therefore, source are credited. J Pharmacovigilance ISSN: 2329-6887 JP, an open access journal Volume 2 • Issue 6 • 1000151 Citation: Bitner A, Zalewski P, Newton JL, Klawe JJ (2014) The Role of Multidrug Interactions in the Safety of Pharmacotherapy for Concomitant Parkinson’s Disease and Arterial Hypertension in Poland. J Pharmacovigilance 2: 151. doi:10.4172/2329-6887.1000151 Page 2 of 6 Material and Methods of Parkinsonism and Extrapyramidal Disorders of the Sue Ryder Home in Bydgoszcz, as well as the members of the Society of Individuals with Material Disabilities “Akson” and regional branch of the Kuyavian-Pomeranian 80 men and women (mean age 77.725 ± 9.964 years, median 81 Association of Individuals with Parkinson’s Disease. Data from the years), diagnosed with Hoehn and Yahr stage II and III Parkinson’s medication lists was linked to the Polish interaction database. The disease with concomitant arterial hypertension and lacking other examination included an evaluation of all medications in terms comorbidities, were enrolled. The exclusion criteria pertained to the of occurring drug - drug interactions between antiparkinson and presence of other comorbidities (Endocrine diseases, Heart Muscle hypotensive agents (research questionnaire). Disease, depression, disordersof thecentralnervous system). We The respondents formed a homogenous group selected based on extracted data on use of chronic medications and relevant medical the United Kingdom Parkinson’s Disease Society Brain Bank criteria. conditions. The study was based on medication lists collected from All patients satisfied at least three of the following criteria of Parkinson’s patients selected from the Neurology Outpatient Clinic of the Dr. J. disease: unilateral onset, presence of rest tremor with a 4-6 Hz Biziel Memorial University Hospital no. 2 and at the Outpatient Clinic frequency, progressive character, persistent asymmetry of symptoms, excellent (70-100%) response to levodopa, severe levodopa-induced Agent 1 n % Agent 2 n % chorea, levodopa response for 5 years or more, clinical course of 10 Levodopa, benserazide 118 63.4 Amlodipine 23 12.4 years or more. Ropinirole hydrochloride 16 8.6 Ramipril 22 11.8 Concomitant arterial hypertension was the principal inclusion Selegiline hydrochloride 15 8.1 Metoprolol succinate 18 9.7 criterion of the study. The exclusion criteria pertained to the presence Biperiden lactate 10 5.4 Bisoprolol fumarate 15 8.1 of other comorbidities, especially those precluding the diagnosis of Piribedil 9 4.8 Enalapril maleate 12 6.5 Parkinson’s disease, namely negative response to large doses of levodopa Carbidopa, levodopa 7 3.8 Furosemide 12 6.5 in the absence of malabsorption, history of definite encephalitis, history Amantadine hydrochloride 5 2.7 Indapamide 9 4.8 of repeated head injury, neuroleptic treatment at onset of symptoms, Amantadine sulfate 4 2.2 Captopril 7 3.8 strictly unilateral features after 3 years, cerebellar signs, Babinski sign, Cabergoline 1 0.5 Spironolactone 5 2.7 presence of cerebral tumor, documented history of MPTP (1-methylo- Pridinol mesilate 1 0.5 Vinpocetine 5 2.7 4-phenyl-1,2,3,6-tetrahydropyridine) exposure, lack of coordinated Isosorbide mononitrate 5 2.7 binocular vertical eye movement, and more than one affected relative. Piracetam 5 2.7 Verapamil hydrochloride 4 2.2 The study was approved by the Human Research Committee of the Torasemide 4 2.2 Nicolas Copernicus University in Torun. Lisinopril 3 1.6 Potassium chloride 3 1.6 Methods Losartan potassium 3 1.6 We used the “Drug interactions” database affiliated with the Acebutolol 3 1.6 Ministry of Health, which allows for the identification