Adverse Drug Reactions and Drug Interaction: GI Bleeding and Insomnia in a Hypertensive CVA Patient

A 61-year-old male with a history of cerebrovascular accident (CVA) and stage 3 hypertension presented with drowsiness and abdominal pain. The initial treatment included ondansetron, telmisartan, pantoprazole, aspirin, amlodipine, and Hosit. Adjustments were made after the patient's condition worsened, including the addition of atorvastatin, clopidogrel, and promethazine. However, the patient developed gastrointestinal bleeding, prompting the discontinuation of clopidogrel and the administration of low molecular-weight heparin (LMWH). The patient's condition improved after these adjustments, and he was discharged. The Naranjo Adverse drug reaction (ADR) probability scale and drug interaction probability scale (DIPS) were used to assess the likelihood of drug-induced adverse reactions and interactions. The Naranjo score of 7 indicated a probable ADR, while DIPS suggested a likely drug-drug interaction (DDI). This case highlights the complexities of managing multiple medications in a patient with CVA and hypertension.