Published Paper Details:

BACKGROUND AND OBJECTIVES: High alert medications are Narrow therapeutic index drugs where a minute change in dose or blood concentration results in sub therapeutic, toxic effects or therapeutic failure. Thus, a strict monitoring is needed. Our study focused on the influence of P-glycoprotein transport system on high alert medications and its associated risks on subjects, preventing and managing of adverse drug events and its resulting morbidity rate. METHODS: After granting the protocol by the ethical committee, data was collected from the patient�s case sheet, drug-drug interactions and its adverse events in patients were observed, finally the documentation and its reporting were done. RESULTS: Based on the results of the study, it was found that each subject�s prescription is subjected to a minimum of 30% and maximum of 80% of drug interactions resulting in therapeutic inefficacy /toxicities of high alert medications under the influence of P- glycoprotein transport system (inhibitors/ inducers). Thus, to prevent drug adverse events and for effective management, 47% of DI needs monitoring, 12% of DI needs dose adjustment, 11% of DI needs drug replacement and for 8% of DI management involves avoiding of concomitant administration. The observed morbidity rate was found to be 91.6 per 1000 and possible morbidity rate was found to be 833.3 per 1000. The incidence rate of adverse effects due to drug interaction was found to be 22.9 per 100. Prevalence rate of adverse effects due to drug interaction was found to be 49.16 per 100. The order of high alert medications being altered (high to low) are ANTIARRYTHMICS >ADRENERGIC ANTAGONIST > INOTROPIC AGENTS > ANTIPLATELETS > ANTIBIOTICS AND ANTI FUNGALS > IMMUNOSUPPRESANTS > NEUROMUSCULAR BLOCKING AGENTS INTERPRETATION AND CONCLUSION: About 83% of the subject�s prescription needs modification. To improve the quality of life and to decrease morbidity rate, prescription auditing and also monitoring of drugs that alters the metabolism, distribution (Vd), Cmax, elimination and drug activation of high alert medications is required.