EVALUATION AND MANAGEMENT OF DRUG–DRUG INTERACTIONS IN STROKE PATIENTS

Background: Stroke patients frequently require multiple medications for the management of acute neurological events and associated comorbidities, leading to polypharmacy and an increased risk of potential drug–drug interactions (pDDIs). These interactions may compromise therapeutic outcomes and patient safety, particularly in critically ill and elderly populations. Objective: To evaluate the prevalence, severity, and clinical significance of potential drug–drug interactions among stroke patients and to assess the impact of clinical pharmacist interventions in their management. Materials and Methods: A prospective interventional study was conducted over six months in the Department of General Medicine at HKE’s Basaveshwar Teaching and General Hospital, Kalaburagi. A total of 102 hospitalized stroke patients receiving at least two medications were included. Patient demographic details, comorbidities, and medication profiles were reviewed. Potential drug–drug interactions were identified and classified using Micromedex® based on severity and documentation. Identified pDDIs were communicated to prescribers, and pharmacist interventions were recorded along with acceptance rates. Results: Among the 102 stroke patients evaluated, 65.7% of prescriptions contained at least one pDDI, with a total of 236 interactions identified. Hyper-polypharmacy (>10 drugs) was observed in 75.5% of patients. The majority of pDDIs were classified as major (61.2%), followed by moderate (37.3%) and contraindicated (1.5%) interactions. Most interactions were supported by fair documentation. Of the identified pDDIs, 48 were communicated to prescribers, and 77.1% of pharmacist recommendations were accepted. Dose adjustment and regular monitoring were the most common interventions. Ondansetron and clopidogrel were the most frequently involved drugs. Conclusion: The study demonstrates a high prevalence of clinically significant pDDIs among stroke patients, largely driven by advanced age, comorbidities, and polypharmacy. Clinical pharmacist involvement played a crucial role in identifying, preventing, and managing pDDIs, thereby enhancing medication safety. Early pharmacist participation in prescription review and multidisciplinary care is essential to minimize drug-related risks in stroke management.