Baseline medication profile and risk of CYP3A4 mediated drug-drug interactions among COVID-19 hospitalized patients in Spain

COVID-19 remains a significant cause of hospitalizations and deaths. Some COVID-19 treatments interact with a key liver enzyme complex, CYP450. Detecting potential drug interactions with these antivirals is crucial as they are usually indicated for patients with chronic treatments. Describe the baseline co-medication profile in hospitalized COVID-19 patients in Spain and analyze potential CYP3A4 mediated drug-drug interactions (DDI) and contraindications. Observational, retrospective, multi-center study, based on hospital electronic medical records. Patients were adults hospitalized for respiratory COVID-19 between January 1, 2022, and March 31, 2022. Descriptive analyses were performed for all outcomes. The mean age was 73.9 years old; 57% were male, 58% non-smokers, and 99.45% of patients had multiple comorbidities associated with an increased risk of COVID-19. 76% of patients were vaccinated against SARS-CoV-2, but only 30% with a full schedule including a booster dose. 90.32% of patients had co-medications upon admission, and 84.1% took three or more medications. 98.7% had medications with potential CYP3A4 mediated DDI, 40% had contraindicated drugs, and 37% had major DDI risk. 71.33% of all drugs administered had potential interactions. 25.33% of the patients had renal impairment, 88.81% moderate or severe, and 2.83% exhibited hepatic impairment. The study reveals high prevalence of co-medications and potential DDI among high-risk COVID-19 patients, with a high prevalence of polypharmacy, particularly the elderly, and a substantial number of contraindicated drugs. It emphasizes the need for careful medication management, close monitoring, and vigilance in prescribing treatments to mitigate DDI risks.