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Introduction: Renal impairment is characterized by a progressive decline in glomerular filtration rate, a significant public health issue worldwide associated with high morbidity and mortality. In most cases, renal impairment is associated with comorbidities such as hypertension and diabetes, which require multiple drug therapy during a course of treatment, leading to polypharmacy. Objective: The objective of this study was to assess the prescribing pattern of drugs in renal-impaired patients at Dhiraj General Hospital. Materials and Methods: A total of 150 patients with renal impairment were finally recruited after strictly obeying the selection criteria in this cross-sectional, observational study conducted over 6 months in a tertiary care teaching hospital, directorate general of hydrocarbons. Relevant data were extracted by interviewing the patients and from prescriptions, case records, and investigational reports. Results: Of the total 150 patients, 94 (63%) were male and 56 (37%) female. The highest numbers of patients were in the age group >60 years (59 patients, 39.3%). Anemia was the most common comorbidity (143 patients, 95%) observed, followed by hypertension (129 patients, 86%) and diabetes mellitus (64 patients, 43%). A total of 1693 drugs were prescribed to 150 renal-impaired patients. Each patient received an average of 11.19 ± 3.51 (8%) drugs. Polypharmacy was seen in all patients. Drugs acting on the cardiovascular system constituted the bulk of the prescriptions (25.87%), followed by gastrointestinal (GI) drugs (18.72%), vitamins and minerals (14.94%), and antibiotics (8.33%). Conclusion: There is polypharmacy in patients with renal impairment due to associated comorbidities. The prevalence of polypharmacy was high in patients with chronic kidney disease (CKD). Antihypertensive drugs, drugs used for the GI system, antibiotics, and antidiabetic drugs were frequently used in CKD patients.

Background: Chronic kidney disease (CKD), also known as chronic renal insufficiency, progressive kidney deterioration, or nephropathy, is an illness, in which the kidneys fail to function properly. When prescription and over-the-counter medications are combined, the risk of adverse drug reactions and interactions increases, which are the main causes of hospitalizations and mortality. The aims and strategies for reducing the incidence, morbidity, mortality, and health costs of CKD in India are outlined in this new chapter. Aim: A cross-sectional observational study to estimate the pattern of discharge prescription pattern in patients of CKD associated with hypertension and diabetes mellitus. Methodology: 100 patients with CKD and comorbidities of hypertension, diabetes, or both were included in observational cross-sectional research done at the Nephrology Department of Dhiraj Hospital. The laboratory findings, as well as their comorbidity, discharge prescription medicines, and comorbidity, were all documented and examined. Results: Calcium channel blockers (CCBs) were the most often recommended antihypertensive medication for hypertensive patients with CKD. Diuretics were the least often given class of antihypertensive medicine. In antidiabetic medication, class sulfonylurea and dipeptidyl peptidase-4 inhibitors had similar prescription rates which are the highest prescribing medication for diabetes mellitus with CKD. Biguanides were the least prescribed class of drugs. Conclusion: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers are widely used to treat hypertensive patients with CKD; but due to chances of arrhythmia, CCBs are prescribed. This research might aid in the identification of educational and quality-improvement opportunities to minimize medication-related errors and increase benefits in this population.

Background: In recent times, emphasis on pharmacovigilance (PV) is elevated due to increased cases of adverse drug reactions (ADRs) coming into notice. Psychotropic medications that are the mainstay of treating psychiatric patients are linked to various adverse drug reactions. The given study lays accentuation on determining the pattern of ADRs due to the use of antipsychotics and antidepressants. Objectives: In this study, we aim to determine the incidence of ADRs and their effect on the quality of life (QOL) of the patients after the ADR (s). Methodology: This is a prospective observational study of a total of 300 subjects receiving antipsychotics and/or antidepressants. They were screened for possible ADRs. Possible risk factors for the development of ADRs were also assessed. The difference in the pattern of ADRs in patients prescribed with Antidepressants (ADs) and/or Antipsychotics (APs) was observed. The average number of APs and/or ADs per prescription was calculated. The causality and severity assessment of the observed ADRs was done by the World Health Organization-Uppsala Monitoring Center (WHO-UMC) scale, Naranjo's algorithm, and Hartwig–Siegel scale, respectively. Lastly, the impact of ADRs on the QOL of the patients receiving APs and/or ADs was evaluated. Results: The prevalence of ADRs in patients receiving APs and/or ADs is 24.33%. Olanzapine is the most commonly prescribed AP while sertraline is the most commonly prescribed AD. Olanzapine and sertraline are responsible for the highest number of ADRs as AP and AD, respectively. Females are found to be at higher risk for developing ADRs. Multiple comorbidities and polypharmacy are also considered to be possible risk factors. The average number of APs and/or antidepressants per prescription is 1.94 drugs. APs are found to be responsible for a higher number of ADRs in comparison with ADs. The maximum number of ADRs falls into the possible criteria of causality assessment by the WHO-UMC scale and Naranjo's algorithm. All the observed ADRs fall into the mild and moderate category of severity by the Hartwig–Siegel scale. The ADRs have a significant impact on the physical health and psychological domain of QOL assessment. Conclusion: The need for PV is highlighted by the results obtained in this study. Intense monitoring and increased awareness can help improve the rate of ADR (s) occurrence in patients receiving psychotropic medications. As a result, the impact of ADRs on the QOL of the patients can also be reduced.

Background: Several studies suggest that adverse drug reactions (ADRs) are commonly seen among hospitalized elderly and found common causes of hospital admission leading to substantial morbidity and mortality among elderly. However, no meta-analysis was conducted till date to estimate the overall incidence of ADRs among elderly. Objectives: To estimate the overall incidence of ADRs in elderly patients, incidence of ADRs in elderly in different health-care settings, incidence of serious ADRs in elderly patients, and the continent-wise incidence of ADRs in elderly patients. Design: Meta-analysis and systematic review. Methodology: Studies were identified through searching different databases such as MEDLINE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Key, and Scopus (published from 1980 to October, 2015) and by hand searching the reputed journals on geriatrics and gerontology and references of the included articles. Original peer-reviewed research articles published in English, defined ADRs according to the WHO's or similar definition and assessed the incidence of ADRs in elderly or having sufficient raw data to determine the incidence were included. Disease- or treatment-specific studies were excluded. Before meta-analysis, the studies were evaluated for heterogeneity using Chi-square and I2 statistics. The overall incidence of ADRs among the elderly with 95% confidence interval (CI) was determined using a random-effects model (DerSimonian and Laird method). Subgroup analyses were performed based on study settings and continent where the studies conducted. All the analyses were carried out using Review Manager (RevMan, version: 5.3) software. Results: Of the 5747 articles retrieved, only 56 and 54 articles were included for systematic review and meta-analysis, respectively. The overall incidence (95% CI) of ADRs among elderly population was 12.94%. The health-care setting-wise overall incidences of ADRs in the elderly were 17.53%, 19.54%, and 6.92% in inpatients, outpatients, and patients hospitalized due to ADRs, respectively. The continent-wise overall incidences of ADRs in elderly were 12.15%, 22.94%, 12.34%, and 18.76% in Asia, Australia, Europe, and USA, respectively. Electrolyte disorders and skin rashes were the common manifestations of the drugs. Cardiovascular drugs and NSAIDs were the most common causative drugs for the ADRs among elderly. Polypharmacy was the major risk factor for ADRs in elderly population, irrespective of the type of health-care settings and continents. Conclusions: The incidence of ADRs in the elderly was higher and is a significant health-care burden in the elderly. Appropriate prescribing, proper compliance, and monitoring for ADRs are needed to decrease the incidence of ADRs in elderly patients.