Essay : Drug Interaction and Toxicity

POTENTIAL ANTIHYPERTENSIVE DRUG INTERACTIONS AND THEIR TOXICITY

Raden Aulia Laifa Kusuma
aulialaifa25@gmail.com
D-III Pharmacy Study Program
Health Polytechnic Ministry of Health, Tasikmalaya

Hypertension is one of the diseases with the most patients in Indonesia. This is evidenced
by the RISKESDAS data in 2021 which states that the prevalence of hypertension in Indonesia is
34.1%, which means an increase compared to the prevalence of hypertension in 2013 of 25.8%
(Maulidah, 2022). Antihypertensive drugs such as amlodipine, captopril, and nifedipine often
experience drug interactions. Drug interaction is one of the factors that can affect the body's
response to treatment such as causing drug side effects or toxicity due to increasing drug levels in
plasma or reducing plasma levels which cause the results of therapy to be not optimal. One study
report states that the proportion of antihypertensive drug interactions is more (66.2%) than the
absence of drug interactions (Indriani & Oktaviani, 2020). The increase in the incidence of drug
interactions is due to the increasing number of drugs used so that it is necessary to pay attention to
problems in drug use (Dewi et al., 2014). This essay aims to determine the potential interactions
that occur, as well as the mechanisms and toxicity that occur in antihypertensive drugs based on
literature studies.

Drug interactions are interactions that can occur when the effect of a drug is altered by
another drug, food, or beverage resulting in decreased therapeutic effect, increased toxicity, or
unexpected pharmacologic effects (Agustin & Fitrianingsih, 2020). Drug interactions are of three
types pharmaceutical interactions, pharmacokinetic interactions, and pharmacodynamic
interactions (Faizah et al., 2021). Pharmaceutical interactions are interactions that occur between
drugs because immiscible or incompatible drugs are direct and can be seen from physical or
chemical (precipitation, discoloration, and invisible) which then causes the drug to become
inactive, this interaction occurs before the drug is introduced into the body. Pharmacokinetic
interactions, namely absorption, distribution, metabolism and excretion (ADME) can increase or
decrease drug plasma levels, thereby reducing or increasing pharmacological effects.
Pharmacodynamic interactions occur between drugs that have similar or opposite pharmacological
Essay : Drug Interaction and Toxicity

effects or side effects. This may occur because the drugs compete on the same receptor or because
the drugs act on the same physiologic system.

According to research conducted by Lusi, the most common interactions in

antihypertensive drugs are pharmacodynamic interactions and pharmacokinetic interactions,
which states that there are 63.9% cases of pharmacodynamic interactions, and 14.8%
pharmacokinetic interactions (Indriani & Oktaviani, 2020). Factors affecting pharmacokinetics are
absorption, distribution, metabolism, elimination, individual factors, as well as the dose and
schedule of drug administration. Factors that influence pharmacodynamics are target receptor or
site of action, concurrent pharmacologic activity, physico-chemical properties of the drug,
mechanism of action, metabolism or biotransformation pathways, individual variability, and drug
dosage. So from the results of this study, there is a need for collaboration, especially pharmacy in
an effort to provide safe and effective treatment to avoid the risk of drug interactions and early
treatment if actual drug interactions occur that endanger patients.

The results of several studies indicate that the pharmaceutical interactions that occur in
antihypertensive drugs are the drug nifedipine with ranitidine which shows an interaction where
the mechanism of interaction is ranitidine increases nifedipine levels; the drug amplodipine with
simvastatin also shows an interaction where the mechanism amplodipine can increase simvastatin
levels; and the drug amlodipine with telmisartan drug interactions that can cause headaches
(Indriani & Oktaviani, 2020).

The results of pharmacodynamic interactions conducted by several researchers show that

the drug amlodipine with diclofenac sodium drug has an interaction, namely the combination of
these drugs can increase blood pressure; amlodipine drug with mefenamic acid causes interaction,
namely the combination of these drugs can increase blood pressure; amlodipine drug with
ibuprofen causes interaction, which can increase blood pressure; amlodipine drug with captopril
drug has an interaction that can increase the hypotensive effect; and nifedipine drug with
diclofenac sodium drug can interact which can increase blood pressure (Indriani & Oktaviani,
2020). From the results of these studies it can be concluded that this pharmacodynamic interaction
occurs when other drugs affect the receptor system or workplace of a drug, so that it can cause the
work of a drug to be ineffective.
Essay : Drug Interaction and Toxicity

It can be concluded that drug interactions are the effects of one drug that is altered by the
presence of another drug, food, drink or by chemicals. There are three general types of drug
interactions, namely pharmaceutical interactions, pharmacokinetic interactions, and
pharmacodynamic interactions. The extensive use of antihypertensive drugs combined with the
presence of polypharmacy in many hypertensive patients results in a significant risk of drug
interactions. The mechanisms of drug interactions that occur in antihypertensive drugs are
pharmacokinetic and pharmacodynamic. Whereas the majority of pharmacokinetic interactions
indicate that a drug interferes with the metabolism of another drug which results in a decrease in
drug effect and increases the adverse side effects of the drug, pharmacodynamic interactions occur
when another drug affects the receptor system so that it can cause the action of a drug to be
ineffective. The high potential incidence of drug interactions during treatment can affect the
achievement of therapeutic effects and increase the risk of side effects. The way to prevent or
reduce the occurrence of drug interactions and toxicity that occurs in patients is the role of a
pharmacist who must convey drug information to patients such as conveying drug information
more thoroughly and completely, especially in providing information related to side effects and
drug interactions that can occur when a patient uses two or more drugs simultaneously at the same
time, besides that there is also a need to improve the computerized drug screening system before
being given to patients and the most important thing to do is to monitor interacting drugs and
provide early treatment in case of drug interactions that endanger patients.
Essay : Drug Interaction and Toxicity

REFERENCES

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