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Drug-Drug Interactions and Prescribing Pattern in Veterinary Practice in Iraq

Article in The Indian veterinary journal · October 2019

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 Supplementation of Phaleria macrocarpa ...
rial cell membranes and then shrink the cell
walls, so that it can disrupt cell permeability,
thus hampering its activities leading to their
death.
Summary
The Phaleria macrocarpa leaf extract has the
ability to reduce the total plate count at the
concentration of 20 to 50% and the number of
Escherichia coli at the concentration of 30 to
50%. The optimal concentration of Phaleria
macrocarpa leaf extract which can reduce the
number of Escherichia coli were at the concen-
tration of 40% and 50%.
References
Glisson, J.R., Hofacre, C.L., and Mathis, G.F., (2004) Com-
parative efficacy of enrofloxacin, oxytetracycline, and sul-
fadimethoxine for the control of morbidity and mortality caused
by Escherichia coli in broiler chickens. Avian Dis. 48(3): 658–
662.
Huff, G.R., Huff, W.E., Rath, N.C., and Tellez, G., (2006)
Limited treatment with β-1,3/1,6-glucan improves production
values of broiler chickens challenged with Escherichia coli.
Poult. Sci. 85:613–618.
Indian Vet. J., October 2019, 96 (10) : 14 - 17
Drug-Drug Interactions and Prescribing Pattern in Veterinary Practice in Iraq
Sarhan R. Sarhan1, Hayfaa A. Moheisen, Elaph K. Kamel and Zahraa J. Mohammad
Department of Physiology and Pharmacology, College of Veterinary Medicine, Wasit University, Wasit, Iraq
(Received : April, 2019 137/19
Abstract
The current study was conducted in different
veterinary private clinics and hospitals in Wasit
province, Iraq to investigate the potential drug-
drug interactions and prescribing patterns. A
retrospective study of prescription was carried
out from August 2018 to March 2019. 350
prescriptions from 65 veterinarians in differ-
ent cities (Alkut, Suwairah, Al-Na’maniya, Al
Zubaidiya and Al Azeeziaya) of Wasit province
1
Corresponding author : Email : srashid@uowasit.edu.iq
14 The Indian Veterinary Journal (October, 2019)
Nikham, and Basjir, T.E., (2012) Testing for antibacterial of
Phaleria macrocarpa fruit from gamma radiation and antibiot-
ics on pathogenic bacteria. Prosiding Pertemuan Ilmiah Peng-
etahuan dan Teknologi. 171: 1411-2213. [in bahasa]
Ngajow, M., Abidjulu, J., and Kamu, V.S., (2013) Antibacterial
effect of Pometia pinnata extracts on Staphylococcus aureus
in vitro. Jurnal MIPA Unsrat. 2(2): 128-132.
Prawesthirini, S., Siswanto, H.P., Estoepangestie, A.T.S.,
Effendi, M.H., Harijani, N., Budiarto, and Rahardjo, D. (2016)
Analysis of meat, milk, and egg quality. 8 th printed edition.
Surabaya, Indonesia.
Sari, B.L., Komala, O., and Astuty, E., (2011) Antibacterial
effectiveness of Phaleria Macrocarpa extracts againt microbes
caused diabetic gangrene. Jurnal Medika. 1(3): 22-30.
SPSS. 2008. SPSS 16.0 for Windows. SPSS Inc., Chicago,
IL, USA.
Toghyani, M., Gheisari, A., Chalamkari, G., and Moham-
madrezaei, M., (2010) Growth performance, serum biochem-
istry and blood hematology of broiler chicks fed different
levels of black seed (Nigella sativa) and peppermint (Mentha
piperita). Livest. Sci. 129:173-178.
Tristyanto, N., (2011) Antibacterial effect of Phaleria macro-
carpa fruit extract on Staphylococcus aureus. Analis Keseha-
tan Akademi Analis Kesehatan Malang. 1(1): 1-10.
Accepted : May, 2019)
were analyzed. The results indicated that 20
prescriptions (5.71 %) contained one drug, 315
prescriptions (90%) had two or three drugs and
15 prescriptions (4.28%) contained four or more
than four drugs. The number of prescriptions
which contained two and three antibiotics were
210 (60%) and 40 (11.4%), respectively.
Key word: Drug-drug interactions, drugs
adverse effects.
Drug prescription errors are the common
cause of adverse effect although can be largely
 Sarhan R. Sarhan et al.
preventable. Misuse of treatment can be dened
as any error in using of drugs which lead to
patient and increasing death rate. In medicine,
30% of hospital problems are associated with
drug administration errors (van den Bemt et
al., 2002). The administration of drugs is a very
important step because correcting the potential
risk at this step are limited (Ito and Yamazumi,
2003). Only limited and few studies had been
published on handling potential drug interac-
tions in the veterinary practice. Therefore, our
study aimed to determine potential exposure
to drug interactions in farm animals in differ-
ent veterinary clinics and hospitals in Wasit
province, Iraq.
Materials and Methods
A retrospective inspection of prescriptions was
carried out during a period from November 2018
to March 2019 and a 350 prescriptions from
different cities (Alkut, Suwairah, Al-Na’maniya,
Al Zubaidiya and Al Azeeziaya) of Wasit province
were analyzed for potential interactions, regard-
less of animals species. Indicators of drug use
pattern include an average number of drugs
prescribed per encounter, interactions between
prescribed drugs and type of drug interactions.
The prescription errors were compared with
standards indicated in the handbook for veteri-
nary medicines, compiled by Plumb (2008).
Results and Discussion
The results indicated that 20 prescriptions (5.71
%) contained one drug, 315 prescriptions (90%)
contained two or three drugs and 15 prescrip-
tions (4.28%) contained four or more drugs. The
number of prescriptions that contained two and
three antibiotics were 210 (60%) and 40 (11.4%),
respectively. The most commonly prescribed
antibiotics were ciprooxacin, chlortetracycline,
doxycycline and enrooxacin. Moreover, The
results showed that 56 prescriptions had at
least one drug interaction (16%). Most of these
interactions were related to antibiotics with
other drugs. The percentage of interactions
were as follow; doxycycline with multivitamins
were 35.71%, chlortetracycline with multivi-
tamins were 17.85%. While ciprooxacin with
erythromycin were 17.85% and enrooxacin
with antacid were 12.5%. additionally, the
The Indian Veterinary Journal (October, 2019)
study recorded other drugs interactions such
as ketoconazole with Ivermectin and the
percentage were 10.7% as well as NSAIDs with
dexamethasone were 5.35%. Tetracycline class
had the greatest interaction among antibiotics
(Table I). The results indicated that 64.28% of
the prescription errors were minor or had no
adverse effects, but 35.71% of the errors were
considered signicant.
Doxycycline and Chlortetracycline (an
antibacterial drug) were administered with
multivitamins in twenty and ten cases, respec-
tively. Elimination of tetracycline class such
as minocycline, tetracycline or doxycycline has
differences routes. For example, doxycycline
is excreted in the feces, and (20-30)% excreted
through urine. Drug interactions of Chlortetra-
cycline and Doxycycline affect absorption and
elimination methods of drug class. Doxycycline
and Chlortetracycline level in the plasma is
decreased about 30-90% with the administra-
tion of drugs containing trivalent and divalent
cations, for example, calcium, magnesium,
aluminium, zinc or iron (Hansten and Horn,
2005; Tatro, 2009; Baxter and Stockley, 2008).
Several mechanisms occur in interac-
tion of drugs including decreased dissolution
and chelating. Chelating dissolution occurs
when injection of doxycycline intravenously
with common products containing multivalent
cations (Hansten et al., loc cit); Tatro, loc cit;
Baxter and Stockley, loc cit). Ciprooxacin and
erythromycin (antibacterial drugs) were given in
combination to treat respiratory infection in ten
cases. Even barely some interactions were found
that some drugs potentiate one another in a risky
manner such as if macrolides like erythromycin
when given with uoroquinolones causes QT
prolongation (Shakeri and Stahlmann, 2006).
Enrooxacin was administered with Antacids
in seven cases. For example, if quinolone is
administrated with aluminium hydroxide,
it will reduce absorption of quinolone in the
gastrointestinal tract and reduce pharmacologi-
cal activity of the quinolone. Taking antacid (6
h before or 3 h after the antibiotic) to ensure
avoiding the interaction of antacid ingredients
with the antibiotic (Lomaestro and Bailie, 1991).
Ketoconazole was given with Ivermectin for
15
 Drug-Drug Interactions and Prescribing Pattern ...

Table I. Number of cases and percentage of interactions.

Drugs n=(56) % of interactions

Number of cases
20
Doxycycline with multivitamins 35.71
Hospital Clinic
3 17
Number of cases
10
Chlortetracycline with multivitamins 17.85
Hospital Clinic
2 8
Number of cases
10
Ciprofloxacin with erythromycin 17.85
Hospital Clinic
0 10
Number of cases
7
Enrofloxacin with antacid 12.5
Hospital Clinic
0 7
Number of cases
6
Ketoconazole with Ivermectin 10.7
Hospital Clinic
1 5
Number of cases
3
NSAIDs with dexamethasone 5.35
Hospital Clinic
1 2
n= no. of prescriptions had at least one drug interaction.

treating sarcoptic mange in six cases. Ketocon-
azole inhibits the groups of cytochrome P450
enzyme (Niwa et al., 2014; Novotn et al., 2014).
Therefore, Ketoconazole decreases the clearance
of ivermectin and consequently increase its toxic
level. Furthermore, ketoconazole can inhibit
p-glycoprotein, wherever p-glycoprotein is drug
efux transporter in the kidney, the intestine,
and the blood-brain barrier (Coelho et al., 2009).
Also, Ketoconazole could decrease the clearance
of many drugs and bioavailability (Hugnet et
al., 2007). Moreover, some studies found that
neurologic toxicity occurred when ketoconazole
was given with ivermectin in mange disease
(Mealey et al., 2001).
NSAIDs (Non-steroidal anti-inam-
matory drugs) were co-administered with
Dexamethasone in three cases. When NSAIDs
and corticosteroids are administrated together,
it will increase GI toxicity. Some of the studies
found that ulcer has occurred due to taking
corticosteroids with NSAIDs together with a
COX-1, but not a COX-2, inhibitor. That effect
may cause a decrease in arachidonic acid and
increasing the toxic effect of NSAIDs (Kataoka
et al., 2000).
In this study, a high rate of patients were
exposed to the adverse effects of drug interac-
tions. Although several combinations could be
useful in some cases, but the risk of adverse
effects becomes greater if medications included
drugs combination. In other hand, drug replace-
ment or mono-therapy will largely avoid drug
interactions (Katherine, 2002).

16 The Indian Veterinary Journal (October, 2019)

 Sarhan R. Sarhan et al.
Our survey recorded many similar cases
admitted to veterinary clinics or hospitals
in Wasit cities. substantially, the percent-
age of interactions in hospitals were very
low comparing to the interactions percentage
recorded in clinics which might be due to the
availability of many veterinary specialists with
good experiences. Therefore, the drugs used to
treat patients included in this study may be in
somewhat dependent on the drugs availability
and the prescribing practices of veterinarians at
hospitals and clinics.
Summary
Animals are potentially exposed to signicant
drug interactions have negative outcomes on the
drug’s efcacy, and may be harmful to the animal
and life-threatening. The study stated that the
prescription errors recorded in private clinics
were more than in hospitals, this is probably
due to the less experience and/or availability of
drugs in these clinics. Most of the adverse drug
reactions were due to the combination of two or
more antibiotics. Further study is required to
establish a unied system or software applica-
tion encompassing all veterinary medicines
and possible drugs interactions to avoid wrong
prescriptions.
References
Baxter, K. and Stockley, I.H. (2008) Stockley’s drug interac-
tions. 8th edition. London: Pharmaceut. Press; 285-250.
Coelho, J.C., Tucker, R., Mattoon, J., Roberts, G., Waiting,
D.K., Mealey, K.L. (2009) Biliary excretion of technetium-
99m-sestamibi in wild-type dogs and in dogs with intrin-
sic (ABCB1-1Delta mutation) and extrinsic (ketoconazole
treated) P glycoprotein deficiency. J. Vet. Pharmacol. Ther.
32:417–421.
The Indian Veterinary Journal (October, 2019)
View publication stats
Hansten, P.D. and Horn, J.R. (2005) Hansten and Horn’s
Managing clinically important drug interactions. St. Louis
(MO): Facts and Comparisons; p. 243.
Hugnet, C., Lespine, A. and Alvinerie, M. (2007) Multiple oral
dosing of ketoconazole increases dog exposure to ivermectin.
J Pharm Pharm Sci.10: 311–318.
Ito, H. and Yamazumi, S. (2003) Common types of medication
errors on long-term psychiatric care units. Inter. J. for Quality
in Health Care. 15:207-212.
Kataoka, H., Horie, Y., Koyama, R., Nakatsugi, S. and Furu-
kawa, M. (2000) Interaction between NSAIDs and steroid in
rat stomach: safety of nimesulide as a preferential COX-2
inhibitor in the stomach. Dig Dis Sci. 45:1366–1375.
Katherine, L. (2002) Incidence of drug interactions in vet-
erinary critical care patients. PhD Dissertation. Washington
State University, Pullmann, USA. p. 198.
Lomaestro, B.M. and Bailie, G.R. (1991) Quinolone-cation
interactions: a review. DICP, Ann Pharmacother. 25:1249-58.
Mealey, K.L., Bentjen, S.A., Gay, J.M. and Cantor, G.H. (2001)
Ivermectin sensitivity in collies is associated with a deletion
mutation of the mdr1 gene. Pharmacogenetics. 11:727–733.
Niwa, T., Imagawa, Y. and Yamazaki, H. (2014) Drug interac-
tions between nine antifungal agents and drugs metabolized
by human cytochrome P450. Curr Drug Metab. 15:651-679.
Novotn, A., Krasulov, K., Bartoňkov, I.,Korhoňov, M., Bachle-
da, P., Anzenbacher, P. and Dvořák, Z. (2014) Dual effects of
ketoconazole cis-enantiomers on CYP3A4 in human hepato-
cytes and HepG2 Cells. PLoS ONE. 9:e111286.
Plumb, D.C. (2008) Plumb’s Veterinary Drug Handbook. 6th
Ed. Wiley-Black well Publishing: pp. 188.
Shakeri-Nejad, K. and Stahlmann, R. (2006) Drug interac-
tions during therapy with three major groups of antimicrobial
agents. Expert Opin Pharmacother. 7:639–51.
Tatro, D.S. (2009) Drug interaction facts: the authority on drug
interactions. St. Louis (MO): Facts and Comparisons: p. 374.
van den Bemt, P.M.L.A., Fijn, R., van der Voort, P.H.J.,
Gossen, A.A., Egberts, T.C.G. and Brouwers, J.R.B.J. (2002)
Frequency and determinants of drug administration errors in
the intensive care unit. Crit. Car. Med. 30:846-850.
17