Prevalence Severity and Determinants of Potential Drug–Drug Interactions among Hospital Prescriptions at Dongola Specialized Hospital Sudan 2025

In the complex world of modern medicine, patients often leave a hospital with a handful of different medicines to take at home. While each drug is chosen to treat a specific problem, they do not always stay isolated in the body. Sometimes, two or more medicines meet and react with one another, changing how they work. This phenomenon is known as a drug–drug interaction. It can happen when one medicine blocks another from doing its job, or when they combine to create a stronger effect than intended, potentially leading to harm. These reactions are a major concern for patient safety, especially in hospitals where people are often older, have multiple health conditions, and receive many different treatments at once. The goal of medical care is to heal, but when medicines interfere with each other, the path to recovery can become dangerous. Understanding how often these clashes happen, which medicines are involved, and which patients are most at risk is essential for keeping treatment safe and effective.

At Dongola Teaching Hospital in Sudan, a team of researchers set out to map the landscape of these interactions within their own walls. They looked back at 403 prescription records from patients who had been treated between March and September 2025. The team was not looking for a single mistake, but rather a pattern of how medicines were being prescribed together. They examined every record that contained two or more medicines, using a specialized digital tool to check if any of the drugs on the list would clash. This tool acts like a safety scanner, flagging combinations that are known to cause problems, ranging from minor annoyances to life-threatening dangers. The researchers wanted to know not just how many interactions occurred, but how serious they were, which specific drugs were most likely to cause trouble, and whether certain types of patients were more vulnerable than others.

The results revealed that potential interactions were far from rare. More than one-third of the prescriptions reviewed contained at least one pair of medicines that could interact. In total, the team identified 276 individual instances where drugs might clash. The severity of these clashes varied widely. Most of them fell into a category that requires doctors to watch the patient closely, rather than stopping the treatment entirely. About 59 percent of the interactions were significant enough to demand careful monitoring. A smaller group, roughly 28 percent, were considered minor or of unknown importance. However, the study also found a small but critical number of dangerous combinations. Sixteen interactions were classified as serious, meaning a different medicine should be used instead, and two were deemed completely contraindicated, meaning they should never be taken together because the risk of harm is too high. One of these dangerous pairs involved an antibiotic and a calcium product, a combination that can cause solid particles to form inside the body, posing a severe threat to vital organs.

When the researchers looked at which medicines were most often involved, a clear picture emerged. The most frequent interactions occurred among drugs used to treat heart and blood conditions. Specifically, combinations involving aspirin, a common blood thinner, appeared repeatedly. Aspirin was often paired with other blood-thinning medicines like enoxaparin or clopidogrel. While these combinations are sometimes necessary for patients with heart disease, they carry a high risk of causing bleeding, requiring doctors to be extremely vigilant. Other common troublemakers included drugs for blood pressure and mental health. The study highlighted that the risk was not random; it was driven by the complexity of the treatment plan.

The investigation also pinpointed exactly which patients were most likely to face these risks. The data showed that older age was a major factor. Patients aged 65 and older were significantly more likely to have interacting drugs than younger patients. This is likely because older adults often have more health conditions and take more medicines, increasing the chances of a clash. The number of medicines a patient took was an even stronger predictor. When a patient was prescribed five or more drugs at the same time, a situation known as polypharmacy, the likelihood of an interaction jumped dramatically. The study found that for every additional medicine added to a prescription, the odds of a clash increased substantially. Patients with chronic conditions affecting the heart, brain, or kidneys were also at higher risk, reflecting the complex nature of managing long-term illnesses.

Interestingly, the study ruled out some factors that might seem important at first glance. The researchers found that a patient's gender did not influence the likelihood of an interaction, nor did the specific department of the hospital where they were treated. Whether a patient was in the emergency room, the general wards, or the outpatient clinic made no statistical difference. This suggests that the risk comes from the medicines themselves and the patient's overall health profile, rather than where they are being treated or whether they are male or female. The mechanism behind most of these interactions was also identified. The majority occurred because the drugs acted on the same body systems, adding up their effects in a way that became too strong. This is different from interactions where one drug changes how the body absorbs or breaks down another. The researchers found that these additive effects were the primary source of the risk, spanning all levels of severity.

The findings from Dongola Teaching Hospital offer a clear message for improving patient safety. While most interactions can be managed with careful observation, the presence of even a few dangerous combinations underscores the need for systematic checks. The study suggests that hospitals should prioritize reviewing prescriptions for older patients and those taking many medicines. It also points to the value of electronic tools that can alert doctors to potential clashes before a prescription is finalized. By focusing on the specific groups and drug combinations that pose the highest risk, medical teams can better protect patients from preventable harm. The research confirms that while the challenge of managing multiple medicines is complex, understanding the patterns of interaction is the first step toward safer care.