1
|
Potential Drug-Related Problems in Pediatric Patients-Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden. PHARMACY 2023; 11:pharmacy11010035. [PMID: 36827673 PMCID: PMC9967379 DOI: 10.3390/pharmacy11010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/16/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.
Collapse
|
2
|
Pruente J, Daunter AK, Bowman A, Erickson SR, Whibley D, Whitney DG. Trajectories of medication use and polypharmacy among children with cerebral palsy. J Manag Care Spec Pharm 2023; 29:58-68. [PMID: 36580123 PMCID: PMC10387963 DOI: 10.18553/jmcp.2023.29.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND: Children with cerebral palsy (CP) may have chronic exposure to polypharmacy to address several medical needs, but there is little research on the topic to inform surveillance methods and clinical practice. OBJECTIVE: To identify the trajectories of medication number and pediatric polypharmacy (≥2 concurrent medications) exposure over 3.5 years among children with CP. METHODS: This cohort study used commercial claims from January 1, 2015, to December 31, 2018 (4-year period). Children with CP, aged 5-18 years by January 1, 2016, and with continuous health plan enrollment for all 4 years, were included and categorized as with or without co-occurring neurological/ RESULTS: Of the 1,252 children with CP, 600 were in the CP only cohort (mean [SD]; age, 11.4 [4.1] years; 46.0% female) and 652 were in the CP + NDDs cohort (age, 11.9 [4.1] years; 41.3% female; 32.7% had ≥2 of the NDDs). For the primary GBTM, 3 trajectory groups were identified for CP only: on average, no prescribed medications (69.7% of the cohort), 1 medication/month (24.8%), and 4 medications/month (5.5%). Five trajectory groups were identified for CP + NDDs: 0 (22.4%), 1 (25.6%), 2 (25.2%), 4 (18.4%), and 6 (8.4%) prescribed medications/month. For the secondary GBTM, 3 trajectory groups were identified for CP only: 80.5% were characterized as negligible probability of polypharmacy exposure, 10.8% as low probability, and 8.7% as high probability. Five trajectory groups were identified for CP + NDDs: 37.9% as negligible probability of polypharmacy exposure, 32.8% as constantly high probability, and 29.2% as changing probability (eg, increasing/decreasing). CONCLUSIONS: Children with CP are chronically exposed to differing levels of polypharmacy. Findings can help establish polypharmacy surveillance practices. Studies need to determine if polypharmaceutical strategies are balanced to optimize health and development for children with CP. DISCLOSURES: Dr Whitney is supported by the University of Michigan Office of Health Equity and Inclusion Diversity Fund. The funding source had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Collapse
Affiliation(s)
- Jessica Pruente
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Alecia K Daunter
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Angeline Bowman
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Steven R Erickson
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| |
Collapse
|
3
|
Evaluation of Concomitant Use of Anticancer Drugs and Herbal Products: From Interactions to Synergic Activity. Cancers (Basel) 2022; 14:cancers14215203. [PMID: 36358622 PMCID: PMC9657145 DOI: 10.3390/cancers14215203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 01/07/2023] Open
Abstract
CAM is used by about 40% of cancer patients in Western Countries, with peaks of 80% for breast cancer patients. Cancer patients use CAM to boost immune function, to control cancer symptoms and treatment-related side effects, and to improve health-related quality of life (HR-QoL) and survival. Unfortunately, self-prescription of natural remedies in cancer patients can lead to unexpected toxicities and can reduce the effectiveness of cancer therapy. Although CAM usually refers to all the "natural or organic" products/methods that are generally considered less toxic, there are concerns about drug interactions, especially in patients participating in clinical trials with experimental agents. Despite the claims of the promising and potential benefits made by prescribers, many CAMs lack clear scientific evidence of their safety and efficacy. Given the widespread use of CAM-both clearly declared and overt-in this review, we focused on the most important known data on the risk of interactions between biologics and oncology drugs with the goal of opening up CAM in accordance with the meaning of integrative medicine.
Collapse
|
4
|
Tukukino C, Parodi López N, Svensson SA, Wallerstedt SM. Drug interaction alerts in older primary care patients, and related medically justified actions. Eur J Clin Pharmacol 2022; 78:1115-1126. [PMID: 35355082 PMCID: PMC9184366 DOI: 10.1007/s00228-022-03292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe presented interaction alerts in older patients, and the extent to which these require further medical action for the specific patient or are already being addressed. METHODS Interaction alerts presented at a physician consultation, for 274 consecutive primary care patients treated with two or more drugs (median age: 75 years; 59% female), were extracted. These alerts are based on Janusmed, a decision support integrated in the medical records that provides recommendations for managing the interactions. One general practitioner (GP) and one GP/clinical pharmacologist determined in retrospect, first independently and then in consensus, whether the alerts justified further medical action, considering each patient's health condition. RESULTS In all, 405 drug interaction alerts in 151 (55%) patients were triggered. Medical action in response was deemed medically justified for 35 (9%) alerts in 26 (17%) patients. These actions most often involved a switch to a less interacting drug from the same drug class (n = 10), a separate intake (n = 9), or the ordering of a laboratory test (n = 8). Out of 531 actions suggested by the alert system, only 38 (7%) were applicable to the specific patient, as, for instance, laboratory parameters were already being satisfactorily monitored or a separate intake implemented. CONCLUSIONS More than every other older patient receives drug treatment that triggers drug interaction alerts. Nine in ten alerts were already being addressed or were not relevant in the clinical setting, whereas, for the remaining tenth, some medical action, that for unknown reasons had not been taken, was reasonable. These findings show that interaction alerts are questionable as indicators of problematic prescribing.
Collapse
Affiliation(s)
- Carina Tukukino
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden
| | - Staffan A Svensson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.,Närhälsan Hjällbo Health Centre, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden. .,HTA-Centrum, Sahlgrenska University Hospital, Gothenburg, Sweden.
| |
Collapse
|
5
|
Maideen NMP, Balasubramanian R, Muthusamy S, Nallasamy V. An Overview of Clinically Imperative and Pharmacodynamically Significant Drug Interactions of Renin-Angiotensin-Aldosterone System (RAAS) Blockers. Curr Cardiol Rev 2022; 18:e110522204611. [PMID: 35546745 PMCID: PMC9893153 DOI: 10.2174/1573403x18666220511152330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hypertension is a leading cause of cardiovascular disease and chronic kidney disease, resulting in premature death and disability. The Renin-Angiotensin-Aldosterone System (RAAS) blockers, including Angiotensin-Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs), are used as first-line antihypertensive therapy to treat hypertensive patients with comorbidities, including diabetes, ischemic heart disease, heart failure, and chronic kidney disease. The use of RAS blockers is associated with the risks, such as hyperkalemia, angioedema, etc. The drugs potentiating them interact pharmacodynamically, resulting in adverse consequences. This review article focuses on the clinically important drug interactions of RAAS blockers. MATERIALS AND METHODS The electronic databases, such as Medline/PubMed Central/PubMed, Google Scholar, ScienceDirect, Cochrane Library, Directory of Open Access Journals (DOAJ), Embase, and reference lists were searched to identify relevant articles. RESULTS The risk of hyperkalemia may be enhanced potentially in patients receiving a RAS blocker and potassium-sparing diuretics, potassium supplements, trimethoprim, adrenergic betablockers, antifungal agents, calcineurin inhibitors, pentamidine, heparins or an NSAID, concomitantly. The patients taking ACE inhibitors and mTOR inhibitors, DPP4 inhibitors, alteplase, or sacubitril/valsartan concurrently may be at increased risk of developing angioedema. CONCLUSION Clinicians, pharmacists, and other healthcare practitioners should be accountable for medication safety. To avoid adverse implications, prescribers and pharmacists must be aware of the drugs that interact with RAAS blockers.
Collapse
Affiliation(s)
| | | | - Sudha Muthusamy
- Department of Pharmacology, J.K.K. Nattraja College of Pharmacy, Komarapalayam- 638 183, India
| | | |
Collapse
|
6
|
Perić A, Udilović A, Dobrić S, Vezmar Kovačević S. The impact of treatment choices on potential drug-drug interactions in hypertensive patients. Br J Clin Pharmacol 2021; 88:2340-2348. [PMID: 34862631 DOI: 10.1111/bcp.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim of this study was to analyse potential drug-drug interactions (pDDIs) and their potential adverse drug reactions (ADRs) among hypertensive patients. Moreover, we investigated the possibility of reducing pDDIs with different treatment choices. METHODS This was a cross-sectional study including all outpatients with hypertension and two or more medications, treated in a university hospital in Serbia. Lexicomp Interact (Lexi-Comp, Inc., Hudson, OH) was used for identification of pDDIs and potential ADRs. Treatment choices were explored according to patient characteristics, treatment guidelines and the interacting potential of drugs. Data were analysed using descriptive analysis and multiple logistic regression. RESULTS A total of 350 patients were included in this study, with average age (77 [36-98] years and 6.1 [2.5]) medications. The majority of patients (86.0%) had at least one clinically significant pDDI, and the average was 3.78 (3.90) (range 1-25). Suggestions for treatment change aimed mainly at eliminating drug duplications, reducing the use of thiazide diuretics, sulfonylureas, alpha-lipoic acid and pentoxifylline and increasing the use of calcium-channel blockers, when appropriate. pDDIs would have decreased to 2.10 (2.52), P <.001, yet male gender, ≥6 medications, cardiovascular diseases, diabetes, benign prostatic hyperplasia, would be predictive of two or more pDDIs. The main potential adverse outcomes of pDDIs were hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis. CONCLUSION Careful choice of drugs can reduce but not eliminate pDDIs and their potential ADRs in hypertensive patients. Close monitoring for hypotension, renal failure, hypoglycaemia, bradycardia and lactic acidosis is necessary.
Collapse
Affiliation(s)
- Aneta Perić
- Sector for Pharmacy, Military Medical Academy, Belgrade, Serbia.,Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Ana Udilović
- Deutsche Rentenversicherung Bayern Süd Rehafachzentrum Bad Füssing-Passau Standort Passau, Pasau, Germany
| | - Silva Dobrić
- Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
7
|
Abbas A, Al-Shaibi S, Sankaralingam S, Awaisu A, Kattezhathu VS, Wongwiwatthananukit S, Owusu YB. Determination of potential drug-drug interactions in prescription orders dispensed in a community pharmacy setting using Micromedex ® and Lexicomp ®: a retrospective observational study. Int J Clin Pharm 2021; 44:348-356. [PMID: 34811600 DOI: 10.1007/s11096-021-01346-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Background Community pharmacists have a role in identifying drug-drug interactions (DDIs) when processing prescription orders and dispensing medications to patients. The harmful effects of DDIs can be prevented or minimized by using an electronic DDI checker to screen for potential DDIs (pDDIs). However, different DDI checkers have variable rates of detecting pDDIs. Aim To estimate the prevalence of pDDIs in prescriptions dispensed in a community pharmacy setting using two electronic DDI databases and to evaluate the association between the pDDIs and contributory factors. Method Eligible prescription orders dispensed by a community pharmacy chain in Qatar from January to July 2020 were included in this retrospective observational study. For each prescription, Micromedex® and Lexicomp® were simultaneously used to identify pDDIs, and the interactions categorized based on severity and risk rating. Results Seven hundred-twenty prescriptions met the inclusion criteria, of which Micromedex® and Lexicomp® respectively identified 125 prescriptions (17.4%) and 230 prescriptions (31.9%) as having at least one pDDI. Moderate strength of agreement was found between Lexicomp® and Micromedex® in identifying pDDIs (Cohen's Kappa = 0.546). Micromedex® classified 61.6% of DDIs as major severity, while Lexicomp® classified 30.8% as major severity. The number of concurrent medications per prescription was significantly and positively associated with pDDI. Conclusion This study demonstrates a high prevalence of pDDIs among prescriptions dispensed in a community pharmacy setting. It is advisable that community pharmacists in Qatar, who typically do not have access to computerized patient profiles, use these DDI checkers to ensure all pDDIs are communicated to respective prescribers for appropriate action.
Collapse
Affiliation(s)
- Afraa Abbas
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Samaher Al-Shaibi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Sowndramalingam Sankaralingam
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | | | - Supakit Wongwiwatthananukit
- Department of Pharmacy Practice, The Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, Hilo, HI, USA
| | - Yaw B Owusu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| |
Collapse
|
8
|
Anand TV, Wallace BK, Chase HS. Prevalence of potentially harmful multidrug interactions on medication lists of elderly ambulatory patients. BMC Geriatr 2021; 21:648. [PMID: 34798832 PMCID: PMC8603594 DOI: 10.1186/s12877-021-02594-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background It has been hypothesized that polypharmacy may increase the frequency of multidrug interactions (MDIs) where one drug interacts with two or more other drugs, amplifying the risk of associated adverse drug events (ADEs). The main objective of this study was to determine the prevalence of MDIs in medication lists of elderly ambulatory patients and to identify the medications most commonly involved in MDIs that amplify the risk of ADEs. Methods Medication lists stored in the electronic health record (EHR) of 6,545 outpatients ≥60 years old were extracted from the enterprise data warehouse. Network analysis identified patients with three or more interacting medications from their medication lists. Potentially harmful interactions were identified from the enterprise drug-drug interaction alerting system. MDIs were considered to amplify the risk if interactions could increase the probability of ADEs. Results MDIs were identified in 1.3 % of the medication lists, the majority of which involved three interacting drugs (75.6 %) while the remainder involved four (15.6 %) or five or more (8.9 %) interacting drugs. The average number of medications on the lists was 3.1 ± 2.3 in patients with no drug interactions and 8.6 ± 3.4 in patients with MDIs. The prevalence of MDIs on medication lists was greater than 10 % in patients prescribed bupropion, tramadol, trazodone, cyclobenzaprine, fluoxetine, ondansetron, or quetiapine and greater than 20 % in patients prescribed amiodarone or methotrexate. All MDIs were potentially risk-amplifying due to pharmacodynamic interactions, where three or more medications were associated with the same ADE, or pharmacokinetic, where two or more drugs reduced the metabolism of a third drug. The most common drugs involved in MDIs were psychotropic, comprising 35.1 % of all drugs involved. The most common serious potential ADEs associated with the interactions were serotonin syndrome, seizures, prolonged QT interval and bleeding. Conclusions An identifiable number of medications, the majority of which are psychotropic, may be involved in MDIs in elderly ambulatory patients which may amplify the risk of serious ADEs. To mitigate the risk, providers will need to pay special attention to the overlapping drug-drug interactions which result in MDIs. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02594-z.
Collapse
Affiliation(s)
- Tara V Anand
- Department of Biomedical informatics, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Brendan K Wallace
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Herbert S Chase
- Department of Biomedical informatics, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| |
Collapse
|
9
|
Zerah L, Henrard S, Wilting I, O'Mahony D, Rodondi N, Dalleur O, Dalton K, Knol W, Haschke M, Spinewine A. Prevalence of drug-drug interactions in older people before and after hospital admission: analysis from the OPERAM trial. BMC Geriatr 2021; 21:571. [PMID: 34663238 PMCID: PMC8524798 DOI: 10.1186/s12877-021-02532-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Drug-drug interactions (DDIs) are highly prevalent in older patients but little is known about prevalence of DDIs over time. Our main objective was to assess changes in the prevalence and characteristics of drug-drug interactions (DDIs) during a one-year period after hospital admission in older people, and associated risk factors. Methods We conducted a sub-study of the European OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people), which assessed the effects of a structured medication review (experimental arm) compared to usual care (control arm) on reducing drug-related hospital readmissions. All OPERAM patients (≥70 years, with multimorbidity and polypharmacy, hospitalized in four centers in Bern, Brussels, Cork and Utrecht between December 2016 and October 2018, followed over 1 year) who were alive at hospital discharge and had full medication data during the index hospitalization (at baseline i.e., enrolment at admission, and at discharge) were included. DDIs were assessed using an international consensus list of potentially clinically significant DDIs in older people. The point-prevalence of DDIs was evaluated at baseline, discharge, and at 2, 6 and 12 months after hospitalization. Logistic regression models were performed to assess independent variables associated with changes in DDIs 2 months after baseline. Results Of the 1950 patients (median age 79 years) included, 1045 (54%) had at least one potentially clinically significant DDI at baseline; point-prevalence rates were 58, 57, 56 and 57% at discharge, and 2, 6 and 12 months, respectively. The prevalence increased significantly from baseline to discharge (P < .001 [significant only in the control group]), then remained stable over time (P for trend .31). The five most common DDIs –all pharmacodynamic in nature– accounted for 80% of all DDIs and involved drugs that affect potassium concentrations, centrally-acting drugs and antithrombotics. At 2 months, DDIs had increased in 459 (27%) patients and decreased in 331 (19%). The main factor predictive of a change in the prevalence of DDIs was hyperpolypharmacy (≥10 medications). Conclusions DDIs were very common; their prevalence increased during hospitalization and tended to remain stable thereafter. Medication review may help control this increase and minimize the risk of adverse drug events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02532-z.
Collapse
Affiliation(s)
- Lorène Zerah
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- School of Medicine, Geriatric Medicine, University College Cork, Cork, Ireland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Pharmacy, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Pharmacy Department, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| |
Collapse
|
10
|
Lalagkas PN, Poulentzas G, Tsiolis L, Berberoglou E, Hadjipavlou-Litina D, Douros A, Kontogiorgis C, Constantinides T. Investigating Potential Drug-Drug Interactions from Greek e-Prescription Data. Curr Drug Saf 2021; 17:114-120. [PMID: 34397333 DOI: 10.2174/1574886316666210816115811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence of potential drug-drug interactions (pDDIs) is indicative of the prevalence of actual drug-drug interactions and prescription quality. However, they are significantly understudied in Greece. OBJECTIVE To determine the prevalence of pDDIs among outpatients and identify factors associated with their occurrence. METHODS Anonymous e-prescription data between 2012 and 2017 were obtained from community pharmacies in Thessaloniki, Greece. Patients taking more than one medication for at least three months were included. pDDIs were identified and categorized depending on their clinical significance using Drug Interactions Checker. Crude and adjusted odds ratios (ORs) with accompanying 95% confidence intervals (CIs) of risk factors of pDDIs occurrence were identified using multivariable logistic regression. RESULTS During the study period, 6,000 anonymous e-prescriptions (1,000 per year) satisfying the inclusion criteria, were collected. The overall prevalence of major pDDIs was 17.4% (63.0% for moderate pDDIs). The most common major pDDIs were between amlodipine and simvastatin (22.8% of major interactions) followed by clopidogrel and omeprazole (6.4% of major interactions). Polypharmacy (≥5 concomitantly received medications) was associated with an increased risk of major pDDIs (adjusted OR, 5.72; 95% CI, 4.87-6.72); no associations were observed regarding age, sex and number of prescribing physicians. CONCLUSION The prevalence of pDDIs in this study was higher than previously reported in other European countries, with polypharmacy being a potential risk factor. Those results argue for a need for improvement in the area of prescribing in Greece.
Collapse
Affiliation(s)
- Panagiotis-Nikolaos Lalagkas
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Poulentzas
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Lampros Tsiolis
- Division of Pharmaceutical Chemistry, Department of Pharmacy, Aristotle University of Thessaloniki, Greece
| | - Eleftherios Berberoglou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitra Hadjipavlou-Litina
- Division of Pharmaceutical Chemistry, Department of Pharmacy, Aristotle University of Thessaloniki, Greece
| | - Antonios Douros
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodoros Constantinides
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| |
Collapse
|
11
|
Szilvay A, Somogyi O, Dobszay A, Meskó A, Zelkó R, Hankó B. Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them-A multicenter descriptive study according to medication reviews in Hungarian community pharmacies. PLoS One 2021; 16:e0253645. [PMID: 34157039 PMCID: PMC8219127 DOI: 10.1371/journal.pone.0253645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The study examined the Drug-Related Problems (DRPs) of patients with polypharmacy in 78 Hungarian community pharmacies, especially the interaction risks in terms of their clinical severity. Also, the objective was to analyze pharmacists’ interventions to solve the identified interaction risks. Methodology The research was carried out in the framework of the training of specialist pharmacists at Semmelweis University, with the participation of 78 graduated pharmacists with the collaboration of 98 GPs. A total of 755 patients participated in pharmaceutical counseling which meant a medication review process. DRPs were uniformly categorized and the interventions were recorded by pharmacists, while a detailed analysis of interaction risks was performed by authors. Results A total of 984 DRPs were registered. The most common category of DRPs was the "non-quantitative safety problems" (62.6%). Interaction risk was the most common cause of DRPs (54.0%). The highest proportion of interaction risks were between two prescription drugs (66.7%). In 30.7% of interaction risks’ cases, there was not known negative outcome. In contrast, it was recommended to modify the therapy in 14.9% of interaction risks. Acetylsalicylic acid (22.8%), acenocoumarol (17.7%), and diclofenac (13.9%) were the most common active substances which caused serious interaction risks. A total of 599 pharmacist interventions were used to solve the 531 interaction risks. Pharmacists notified the GPs about the problem in 28.4% of cases and they intervened without the GP in 63.1% of cases, most often with patient education (27.4%). Conclusion Medication review by community pharmacists is required for the safe medicine using of patients with polypharmacy, as a significant number of DRPs have been recorded. The incidence of interaction risks stood out. It is essential to develop a pharmaceutical guideline to properly classify the clinical relevance of interaction risks (e.g. according to high-risk active substances) and to increase the collaboration with GPs.
Collapse
Affiliation(s)
- András Szilvay
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Orsolya Somogyi
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Annamária Dobszay
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Attiláné Meskó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Romána Zelkó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Balázs Hankó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| |
Collapse
|
12
|
Létinier L, Ferreira A, Marceron A, Babin M, Micallef J, Miremont-Salamé G, Pariente A. Spontaneous Reports of Serious Adverse Drug Reactions Resulting From Drug-Drug Interactions: An Analysis From the French Pharmacovigilance Database. Front Pharmacol 2021; 11:624562. [PMID: 33841134 PMCID: PMC8024557 DOI: 10.3389/fphar.2020.624562] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Few data are available on the clinical impact of drug-drug interactions (DDIs). Most of the studies are limited to the analysis of exposure to potential DDI or the targeted impact of the combination of a few drugs or therapeutic classes. The analysis of adverse drug reaction (ADR) reports could be a mean to study generally the adverse effects identified due to a DDI. Our objective was to describe the characteristics of ADRs resulting from DDIs reported to the French Pharmacovigilance system and to identify the drugs most often implicated in these ADRs. Considering all ADR reports from January 01, 2012, to December 31, 2016, we identified all cases of ADR resulting from a DDI (DDI-ADRs). We then described these in terms of patients' characteristics, ADR seriousness, drugs involved (two or more per case), and ADR type. Of the 4,027 reports relating to DDI-ADRs, 3,303 were related to serious ADRs. Patients with serious DDI-ADRs had a median age of 76 years (interquartile range: 63-84); 53% were male. Of all serious DDI-ADRs, 11% were life-threatening and 8% fatal. In 36% of cases, the DDI causing the ADR involved at least three drugs. Overall, 8,424 different drugs were mentioned in the 3,303 serious DDI-ADRs considered. Altogether, drugs from the "antithrombotic agents" subgroup were incriminated in 34% of serious DDI-ADRs. Antidepressants were the second most represented therapeutic/pharmacological subgroup (5% of serious DDI-ADRs). Among the 3,843 ADR types reported in the 3,303 serious DDI-ADRs considered, the most frequently represented were hemorrhage (40% clinical hemorrhage; 6% biological hemorrhage), renal failure (8%), pharmacokinetic alteration (5%), and cardiac arrhythmias (4%). Hemorrhagic accidents are still an important part of serious ADRs resulting from DDIs reported in France. The other clinical consequences of DDIs seem less well identified by pharmacovigilance. Moreover, more than one-third of serious DDI-ADRs involved at least three drugs.
Collapse
Affiliation(s)
- Louis Létinier
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
- CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Amandine Ferreira
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
| | - Alexandre Marceron
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
| | - Marina Babin
- Service de Pharmacologie Toxicologie et CRPV, CHU, Angers, France
| | - Joëlle Micallef
- CRPV Marseille Provence Corse, Service Hospitalo-Universitaire de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France
- Aix Marseille Université, Institut des Neurosciences des Systèmes, INSERM 1106, Marseille, France
| | - Ghada Miremont-Salamé
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
- CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Antoine Pariente
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Bordeaux, France
- CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | | |
Collapse
|
13
|
Holm J, Mannheimer B, Malmström RE, Eliasson E, Lindh JD. Bleeding and thromboembolism due to drug-drug interactions with non-vitamin K antagonist oral anticoagulants-a Swedish, register-based cohort study in atrial fibrillation outpatients. Eur J Clin Pharmacol 2020; 77:409-419. [PMID: 33029651 PMCID: PMC7867544 DOI: 10.1007/s00228-020-03015-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/01/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To study the association between interacting drugs and bleeding or thromboembolism in atrial fibrillation outpatients treated with non-vitamin K antagonist oral anticoagulants (NOACs). METHODS Population-based cohort study of outpatients treated with NOACs in Sweden from 2008 to 2017. Patients with atrial fibrillation and newly initiated NOAC treatment were identified in the Prescribed Drug Register. Comorbidities and outcome data were retrieved from the Patient Register and the Cause of Death Register. Cox-regression analyses were performed to evaluate the primary endpoints any severe bleed and ischemic stroke/transient ischemic attack/stroke unspecified during the first six months of treatment. Secondary endpoints were gastrointestinal bleeding, intracranial bleeding, ischemic stroke, and venous thromboembolism. RESULTS Increased risk of any severe bleed was found when NOAC treatment, and drugs with pharmacodynamic effect on bleeding were combined, compared to NOAC only. An increased risk with these combinations was evident for apixaban (hazard ratio (HR) 1.47; 95% CI 1.33-1.63), rivaroxaban (HR 1.7; 95% CI 1.49-1.92), and dabigatran (HR 1.26; 95% CI 1.05-1.52). For apixaban, there was an increased risk of any severe bleed when combined with CYP3A4 and/or P-glycoprotein (P-gp) inhibitors (HR 1.23; 95% CI 1.01-1.5). The use of inducers of CYP3A4 and/or P-gp was low in this cohort, and effects on ischemic stroke/TIA/stroke unspecified could not be established. CONCLUSION Increased risk of bleeding was seen for pharmacodynamic and pharmacokinetic interactions with NOACs. Prescribers need to be vigilant of the effect of interacting drugs on the risk profile of patients treated with NOACs.
Collapse
Affiliation(s)
- Johan Holm
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. .,Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.
| | - Buster Mannheimer
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Rickard E Malmström
- Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Erik Eliasson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonatan D Lindh
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
14
|
Tecen-Yucel K, Bayraktar-Ekincioglu A, Yildirim T, Yilmaz SR, Demirkan K, Erdem Y. Assessment of Clinically Relevant Drug Interactions by Online Programs in Renal Transplant Recipients. J Manag Care Spec Pharm 2020; 26:1291-1296. [PMID: 32996393 PMCID: PMC10390948 DOI: 10.18553/jmcp.2020.26.10.1291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Potential drug-drug interactions (pDDIs) with immunosuppressive drugs are frequently observed in renal transplant recipients. Drug interaction programs are acknowledged as a fundamental tool to alert physicians to pDDIs, but there is a high concern about variation among different programs in terms of quality and reliability of information. OBJECTIVES To (a) characterize the difference in severity levels of pDDIs with tacrolimus and cyclosporine provided by 3 drug interaction programs and (b) identify clinically relevant DDIs with these immunosuppressive drugs in renal transplant recipients. METHODS This study was conducted in a nephrology outpatient clinic at the University Research & Training Hospital between November 2017 and February 2018. A clinical pharmacist attended clinic visits with physicians and evaluated drug interactions. Micromedex, Medscape, and Lexicomp drug interaction programs were used to identify pDDIs and their severities. Furthermore, Drug Interaction Probability Scale (DIPS) criteria were applied to identify clinically relevant drug interactions seen in clinic patients. Finally, a clinical pharmacist intervened to manage clinically relevant drug interactions identified by DIPS. RESULTS 80 patients (54 under tacrolimus; 26 under cyclosporine treatment) were included in this study. The 3 drug interaction programs generated 648 pDDIs, 63 of which were different drug interaction pairs. Ninety-eight pDDIs were common to all 3 drug interaction programs. Sixty-three different drug interaction pairs were evaluated according to severity level, and 3 drug interaction pairs were at the same level (moderate) among the programs. The Fleiss' kappa overall interrater agreement was poor. The kappa revealed a moderate agreement for interaction pairs with a "severe" rating and a slight agreement for interaction pairs with a "major" rating. According to the DIPS evaluation, 11 pDDIs were classified as "possible," and the percentage of clinically relevant drug-drug interactions was 4.0% (10/248), 4.2% (11/265), and 8.2% (11/135) for Medscape, Lexicomp, and Micromedex, respectively. Although daily doses of immunosuppressive drugs were not changed, the blood concentrations of these drugs increased after administration of an interacting drug. As a result, in order to maintain normal therapeutic range of concentrations, dose reduction or drug change was applied where appropriate. CONCLUSIONS Interaction checker programs are commonly used by health institutions, since they provide quick and summarized information on mechanism and management of drug interactions, when no clinical pharmacist is present to interpret. However, the likelihood of detecting clinically relevant DDIs by interaction checker programs is relatively low, and there are inconsistencies among different programs. Individualized patient monitoring should be maintained by a multidisciplinary health care team that includes a clinical pharmacist, and decision making should be based on professional assessment of the renal transplant patient. DISCLOSURES No outside funding supported this study. The authors have no conflicts of interest to disclose.
Collapse
Affiliation(s)
- Kamer Tecen-Yucel
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | | | - Tolga Yildirim
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seref Rahmi Yilmaz
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Yunus Erdem
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
15
|
Monteith S, Glenn T, Gitlin M, Bauer M. Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs. PHARMACOPSYCHIATRY 2020; 53:220-227. [DOI: 10.1055/a-1156-4193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AbstractBackground Patients with bipolar disorder frequently experience polypharmacy, putting them at risk for clinically significant drug-drug interactions (DDI). Online drug interaction database programs are used to alert physicians, but there are no internationally recognized standards to define DDI. This study compared the category of potential DDI returned by 6 commercial drug interaction database programs for drug interaction pairs involving drugs commonly prescribed for bipolar disorder.Methods The category of potential DDI provided by 6 drug interaction database programs (3 subscription, 3 open access) was obtained for 125 drug interaction pairs. The pairs involved 103 drugs (38 psychiatric, 65 nonpsychiatric); 88 pairs included a psychiatric and nonpsychiatric drug; 37 pairs included 2 psychiatric drugs. Every pair contained at least 1 mood stabilizer or antidepressant. The category provided by 6 drug interaction database programs was compared using percent agreement and Fleiss kappa statistic of interrater reliability.Results For the 125 drug pairs, the overall percent agreement among the 6 drug interaction database programs was 60%; the Fleiss kappa agreement was slight. For drug interaction pairs with any category rating of severe (contraindicated), the kappa agreement was moderate. For drug interaction pairs with any category rating of major, the kappa agreement was slight.Conclusion There is poor agreement among drug interaction database programs for the category of potential DDI involving psychiatric drugs. Drug interaction database programs provide valuable information, but the lack of consistency should be recognized as a limitation. When assistance is needed, physicians should check more than 1 drug interaction database program.
Collapse
Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Michael Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
16
|
de Oliveira LM, Diel JDAC, Nunes A, da Silva Dal Pizzol T. Prevalence of drug interactions in hospitalised elderly patients: a systematic review. Eur J Hosp Pharm 2020; 28:4-9. [PMID: 33355278 DOI: 10.1136/ejhpharm-2019-002111] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The prevalence of drug-drug interactions (DDIs) in hospital settings is variable, and elderly patients are considered a high risk population for DDIs. There are no systematic reviews describing the prevalence of DDIs in hospitalised elderly patients. OBJECTIVES To assess and summarise the available data on the prevalence of DDIs in hospitalised elderly patients and to describe which drugs, drug classes and drug combinations are most commonly involved in DDIs. DATA SOURCE A systematic electronic literature search was conducted on Medline/PubMed, Embase, Lilacs, SciElo, Web of Science, Cinahl, Scopus, Cochrane, OpenGrey, Capes Thesis Bank, OasisBR, OpenAire and abstracts from scientific events, without limitation on language or period of publication. Study selection was completed on 21 September 2018. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Original observational studies that reported the prevalence of actual or potential DDIs during hospitalisation in patients aged 60 years or older were included. The main outcome measure was prevalence of DDIs and number of DDIs per patient. Subgroup analysis was performed in studies that reported the prevalence of DDIs in geriatric units. STUDY APPRAISAL AND SYNTHESIS METHODS Study quality was assessed using the Agency for Healthcare Research and Quality methodological checklist for cross sectional and prevalence studies. RESULTS 34 studies were included, involving 9577 patients. The prevalence of DDIs ranged from 8.34% to 100%. In studies conducted in geriatric units, the prevalence ranged from 80.5% to 90.5%. The number of DDIs per patient ranged from 1.2 to 30.6. Single drugs most commonly involved in DDIs were furosemide, captopril, warfarin and dipyrone. Drug classes mostly involved were potassium sparing diuretics and angiotensin converting enzyme inhibitors. LIMITATIONS The main limitation is the heterogeneity between the included studies that precluded a meta-analysis. Several different methods were used to identify DDIs, majorly, and potential DDIs. Few studies have reported measures to control the quality of the collected data. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The prevalence of DDIs ranged widely, and the variation may reflect differences in the conditions of the elderly patients and level of attention (or complexity of care), as well as methodological differences, especially the methods and/or software used to identify DDIs. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42018096720.
Collapse
Affiliation(s)
- Luciana Mello de Oliveira
- Programa de Pós-Graduação em Epidemiologia, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Alessandra Nunes
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tatiane da Silva Dal Pizzol
- Programa de Pós-Graduação em Epidemiologia, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
17
|
Tukukino C, Wallerstedt SM. Drug information centre queries and responses about drug interactions over 10 years-A descriptive analysis. Basic Clin Pharmacol Toxicol 2020; 126:65-74. [PMID: 31310705 PMCID: PMC6972620 DOI: 10.1111/bcpt.13294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/08/2019] [Indexed: 01/19/2023]
Abstract
Many people are treated with ≥1 drug, implying that risks of drug interactions need to be considered. The aim of this study was to describe drug interaction queries from healthcare professionals to a drug information centre in Sweden over 10 years focusing on drugs frequently asked about and the advice provided. Advice was recorded in mutually exclusive groups: Avoid, Adjust dose, Separate intake, Vigilance or No problem. For queries with Avoid, Adjust dose or Separate intake advice, alerts were extracted from an interaction database (Janusmed). Of 4335 queries to the centre in 2008-2017, 589 (14%) concerned interactions. Most were posed by physicians (91%) and concerned a specific patient (83%) before treatment initiation (76%). Sertraline, warfarin and methotrexate were the most frequently asked about, whereas queries about cyclophosphamide and rifampicine occurred most often in relation to the number of exposed patients. Advice provided in 557 (95%) replies comprised Avoid: n = 85 (15%), Adjust dose: n = 57 (10%), Separate intake: n = 17 (3%), Vigilance: n = 235 (42%) or No problem: n = 163 (29%). In all, 113 (71%) of 159 queries with Avoid/Adjust dose/Separate intake advice elicited an action alert on Janusmed, whereas 31 (20%) did not result in any alert at all. Summarized, seven in ten replies from the drug information centre recommended an explicit drug treatment action, regarding either specific prescribing aspects, for instance dose adjustments, or active follow-up including monitoring potential adverse reactions and/or laboratory results. Readily accessible decision support regarding drug interactions often provides relevant action alerts, but cannot be solely relied on.
Collapse
Affiliation(s)
- Carina Tukukino
- Department of Clinical PharmacologySahlgrenska University HospitalGothenburgSweden
- Department of Pharmacology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Susanna M. Wallerstedt
- Department of Pharmacology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- HTA‐centrumSahlgrenska University HospitalGothenburgSweden
| |
Collapse
|
18
|
Holm J, Eiermann B, Kimland E, Mannheimer B. Prevalence of potential drug-drug interactions in Swedish pediatric outpatients. PLoS One 2019; 14:e0220685. [PMID: 31381591 PMCID: PMC6681954 DOI: 10.1371/journal.pone.0220685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/22/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To describe the occurrence of potential drug-drug interactions (DDIs) in prescribed drugs, dispensed to pediatric outpatients in Sweden. METHODS A cross sectional study was conducted based on data from a national register of prescribed drugs, dispensed at pharmacies, to children 0-17 years old. The study period was January 1 to April 30, 2010. Drug dispensing data was linked to the DDI database SFINX. Prevalence and frequencies of potential interactions were investigated, and drugs commonly involved in interactions were identified. The study focused on clinically relevant potential interactions, class D (should be avoided), and class C (can be handled, e.g. by dose adjustment). RESULTS In the Swedish pediatric population, 0 to 17 years of age, 12% (n = 231 078) of children had at least two dispensed drugs. In this group of patients, 0.14% had potential D-interactions and 1,3% had potential C-interactions. The number of D- and C-interactions that may lead to reduced effects were 181 (52%), and 1224 (32%) respectively. The ten most frequent drugs were involved in 78% and 65% of all potential D-, and C-interactions respectively. Furthermore, 80%, and 58% of the D-, and C-interactions respectively occurred in patients aged 12 to 17. CONCLUSIONS We identified a limited number of drugs that were represented in the majority of potential interactions. Interactions that can lead to a reduced treatment effect constituted approximately half of D-interactions, and a third of C-interactions. The frequency of potential interactions was higher in older children. The results may contribute to increased prescriber awareness of important potential drug interactions among pediatric outpatients.
Collapse
Affiliation(s)
- Johan Holm
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- * E-mail:
| | - Birgit Eiermann
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Inera AB, Swedish Association of Local Authorities and Regions, Stockholm, Sweden
| | - Elin Kimland
- Swedish Medical Products Agency, Uppsala, Sweden
| | - Buster Mannheimer
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Andersson ML, Mannheimer B, Lindh JD. The effect of simvastatin on warfarin anticoagulation: a Swedish register-based nationwide cohort study. Eur J Clin Pharmacol 2019; 75:1387-1392. [PMID: 31201436 DOI: 10.1007/s00228-019-02703-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Some data indicate that simvastatin may increase the anticoagulative effect in patients treated with warfarin, but the evidence is scarce. The aim of the present study was to investigate how the anticoagulative effect of warfarin is affected by the initiation of simvastatin in a very large patient sample. METHODS In a retrospective cohort study, we included 5637 individuals on warfarin treatment initiating simvastatin. INR values and warfarin doses were calculated week-by-week during co-treatment. Data were obtained from two large Swedish warfarin registers and from the Swedish Prescribed Drug Register. RESULTS INR increased from 2.43 at baseline to 2.58, 4 weeks after simvastatin initiation, and did not stabilize until the last quarter of the year studied. Consequently, the proportion of patients with an INR above 3 increased from around 8 to 15%. CONCLUSIONS In conclusion, initiation of simvastatin resulted in moderately increased INR values and subsequent dose decreases in patients already on warfarin. In order to avoid the increased risk of bleeding, the initiation of simvastatin may be accompanied by closer INR monitoring.
Collapse
Affiliation(s)
- Marine L Andersson
- Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Buster Mannheimer
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Section of Diabetes and Endocrinology, Department of Internal Medicine, Södersjukhuset, Sjukhusbacken 8-10, 118 82, Stockholm, Sweden.
| | - Jonatan D Lindh
- Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| |
Collapse
|
20
|
Somogyi-Végh A, Ludányi Z, Erdős Á, Botz L. Countrywide prevalence of critical drug interactions in Hungarian outpatients: a retrospective analysis of pharmacy dispensing data. BMC Pharmacol Toxicol 2019; 20:36. [PMID: 31151485 PMCID: PMC6544909 DOI: 10.1186/s40360-019-0311-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022] Open
Abstract
Background Drug-drug interactions (DDIs) present a significant source of adverse drug reactions. Despite being one of the commonly cited risks to patient safety, prevention of DDIs still poses a challenge to healthcare systems. The prevalence of DDIs can be used as a quality indicator for the safety of prescribing. With the analysis of drug utilization databases, real-world data on critical DDIs can be obtained. The aim of this study was to establish a list of critical DDIs and estimate their prevalence in the Hungarian outpatient population. Methods Since there is no conclusive and generally accepted repository of high-risk DDIs, a systematic search of the literature for consensus-based lists was performed. Based on these results and their analysis with 5 interaction compendia, we propose a simple methodology to identify critical combinations. Present study focused on DDIs which are (1) of high clinical importance thus being most likely to cause significant harm if not detected, (2) well-supported by available evidence and (3) affect drugs which are routinely dispensed in the community pharmacy setting. A retrospective analysis of prescriptions filled between 2013 and 2016 was performed. The source of drug utilization data was the IQVIA’s national prescription fill database. The number of interacting drug pairs dispensed at the same time to the same patient was established. Results After excluding drugs with low dispensing rates, the analysis covered 39 DDIs. The distribution of risk categories of the analysed DDIs was inconsistent among different drug interaction compendia. The total number of prescriptions filled varied between 173924449 and 176368468 per year. The prevalence of the selected potential DDIs ranged from 0.00 to 355.89 per 100000 prescriptions per year. There was significant variation between how the number of cases had changed for each DDI throughout the study period, no general tendency could have been described. Conclusions There were 1.8 million cases of co-dispensing each year, where prescribers’ and community pharmacists’ role in recognizing and managing potentially serious interactions was or would have been critical. The method presented to identify high-risk DDIs can serve as a starting point for the much-needed improvement of routine interaction screening. Electronic supplementary material The online version of this article (10.1186/s40360-019-0311-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna Somogyi-Végh
- Department of Pharmaceutics and Central Clinical Pharmacy, Clinical Centre, University of Pécs, Honvéd u. 3, Pécs, H-7624, Hungary.
| | - Zsófia Ludányi
- IQVIA Solutions Services Kft., Váci út 1-3, Budapest, H-1062, Hungary
| | - Ábel Erdős
- IQVIA Solutions Services Kft., Váci út 1-3, Budapest, H-1062, Hungary
| | - Lajos Botz
- Department of Pharmaceutics and Central Clinical Pharmacy, Clinical Centre, University of Pécs, Honvéd u. 3, Pécs, H-7624, Hungary
| |
Collapse
|
21
|
A comparison of potential psychiatric drug interactions from six drug interaction database programs. Psychiatry Res 2019; 275:366-372. [PMID: 31003063 DOI: 10.1016/j.psychres.2019.03.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/24/2019] [Accepted: 03/24/2019] [Indexed: 11/20/2022]
Abstract
Harmful drug-drug interactions (DDI) frequently include psychiatric drugs. Drug interaction database programs are viewed as a primary tool to alert physicians of potential DDI, but may provide different results as there is no standard to define DDI. This study compared the category of potential DDI provided by 6 commercial drug interaction database programs (3 subscription, 3 open access) for 100 drug interaction pairs. The pairs involved 94 different drugs; 67 included a psychiatric and non-psychiatric drug, and 33 included two psychiatric drugs. The category assigned to the potential DDI by the 6 programs was compared using percent agreement and Fleiss' kappa interrater reliability measure. The overall percent agreement for the category of potential DDI for the 100 drug interaction pairs was 66%. The Fleiss kappa overall interrater agreement was fair. The kappa agreement was substantial for interaction pairs with any severe category rating, and fair for interaction pairs with any major category rating. The category of potential DDI for drug interaction pairs including psychiatric drugs often differs among drug interaction database programs. Modern technology allows easy access to several interaction database programs. When assistance from a drug interaction database program is needed, the physician should check more than one program.
Collapse
|
22
|
Jödicke AM, Curkovic I, Zellweger U, Tomka IT, Neuer T, Kullak-Ublick GA, Roos M, Egbring M. Analysis of Drug-Drug Interactions in Swiss Claims Data Using Tizanidine and Ciprofloxacin as a Prototypical Contraindicated Combination. Ann Pharmacother 2018; 52:983-991. [PMID: 29749261 PMCID: PMC6136070 DOI: 10.1177/1060028018775914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Potential drug-drug interactions (pDDIs) are described in various case reports, but few studies have evaluated the impact of specific combinations on a population level. OBJECTIVE To analyze the type and frequency of multiple contraindicated (X-pDDIs) and major interactions (D-pDDIs) and to subsequently assess the impact of the particular combination of tizanidine and ciprofloxacin on outpatient physician visits and hospitalizations. METHODS Anonymized Swiss claims data from 524 797 patients in 2014-2015 were analyzed. First, frequencies of X- and D-pDDIs were calculated. Next, a retrospective cohort study was conducted among patients prescribed tizanidine and ciprofloxacin (exposed, n = 199) or tizanidine and other antibiotics (unexposed, n = 960). Hospitalizations and outpatient physician visits within 7, 14, and 30 days after initiation of antibiotic therapy were evaluated using multiple binary logistic regression and multiple linear regression. RESULTS The relative frequencies of X- and D-pDDIs were 0.4% and 6.65%, respectively. In the cohort study, significant associations between exposure to tizanidine and ciprofloxacin and outpatient physician visits were identified for 14 and 30 days (odds ratio [OR] = 1.61 [95% CI = 1.17-2.24], P = 0.004, and OR = 1.59 [95% CI = 1.1-2.34], P = 0.016). A trend for increased risk of hospitalization was found for all evaluated time periods (OR = 1.68 [95% CI = 0.84-3.17], OR = 1.52 [95% CI = 0.63-3.33], and OR = 2.19 [95% CI = 0.88-5.02]). Conclusion and Relevance: The interaction between tizanidine and ciprofloxacin is not only relevant for individual patients, but also at the population level. Further investigation of the impact of other clinically relevant DDIs is necessary to improve patient safety and reduce avoidable health care utilization.
Collapse
Affiliation(s)
- Annika M Jödicke
- 1 Department of Clinical Pharmacology and Toxicology, University Hospital Zurich and University of Zurich, Switzerland.,2 Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - Ivanka Curkovic
- 1 Department of Clinical Pharmacology and Toxicology, University Hospital Zurich and University of Zurich, Switzerland.,3 EPha.ch AG, Project Drug Safety, Zurich, Switzerland
| | - Urs Zellweger
- 4 Department of Client Services & Benefits, Helsana Group, Zurich, Switzerland
| | - Ivan T Tomka
- 4 Department of Client Services & Benefits, Helsana Group, Zurich, Switzerland
| | - Thomas Neuer
- 1 Department of Clinical Pharmacology and Toxicology, University Hospital Zurich and University of Zurich, Switzerland
| | - Gerd A Kullak-Ublick
- 1 Department of Clinical Pharmacology and Toxicology, University Hospital Zurich and University of Zurich, Switzerland
| | - Malgorzata Roos
- 5 EBPI, Department of Biostatistics, University of Zurich, Switzerland
| | - Marco Egbring
- 1 Department of Clinical Pharmacology and Toxicology, University Hospital Zurich and University of Zurich, Switzerland.,3 EPha.ch AG, Project Drug Safety, Zurich, Switzerland
| |
Collapse
|
23
|
Andersson ML, Böttiger Y, Kockum H, Eiermann B. High Prevalence of Drug-Drug Interactions in Primary Health Care is Caused by Prescriptions from other Healthcare Units. Basic Clin Pharmacol Toxicol 2017; 122:512-516. [DOI: 10.1111/bcpt.12939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/07/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Marine L. Andersson
- Division of Clinical Pharmacology; Department of Laboratory Medicine; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Ylva Böttiger
- Division of Drug Research; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Henrik Kockum
- Department of Anaesthesiology and Intensive Care; Östersund Hospital; Östersund Sweden
| | - Birgit Eiermann
- Division of Clinical Pharmacology; Department of Laboratory Medicine; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
24
|
Jazbar J, Locatelli I, Horvat N, Kos M. Clinically relevant potential drug-drug interactions among outpatients: A nationwide database study. Res Social Adm Pharm 2017; 14:572-580. [PMID: 28716467 DOI: 10.1016/j.sapharm.2017.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/06/2017] [Accepted: 07/10/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Adverse drug events due to drug-drug interactions (DDIs) represent a considerable public health burden, also in Slovenia. A better understanding of the most frequently occurring potential DDIs may enable safer pharmacotherapy and minimize drug-related problems. OBJECTIVES The aim of this study was to evaluate the prevalence and predictors of potential DDIs among outpatients in Slovenia. METHODS An analysis of potential DDIs was performed using health claims data on prescription drugs from a nationwide database. The Lexi-Interact Module was used as the reference source of interactions. The influence of patient-specific predictors on the risk of potential clinically relevant DDIs was evaluated using logistic regression model. RESULTS The study population included 1,179,803 outpatients who received 15,811,979 prescriptions. The total number of potential DDI cases identified was 3,974,994, of which 15.6% were potentially clinically relevant. Altogether, 9.3% (N = 191,213) of the total population in Slovenia is exposed to clinically relevant potential DDIs, and the proportion is higher among women and the elderly. After adjustment for cofactors, higher number of medications and older age are associated with higher odds of clinically relevant potential DDIs. The burden of DDIs is highest with drug combinations that increase risk of bleeding, enhance CNS depression or anticholinergic effects or cause cardiovascular complications. CONCLUSION The current study revealed that 1 in 10 individuals in the total Slovenian population is exposed to clinically relevant potential DDIs yearly. Taking into account the literature based conservative estimate that approximately 1% of potential DDIs result in negative health outcomes, roughly 1800 individuals in Slovenia experience an adverse health outcome each year as a result of clinically relevant potential interactions alone.
Collapse
Affiliation(s)
- Janja Jazbar
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Igor Locatelli
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Nejc Horvat
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Mitja Kos
- Chair of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia.
| |
Collapse
|
25
|
Day RO, Snowden L, McLachlan AJ. Life‐threatening drug interactions: what the physician needs to know. Intern Med J 2017; 47:501-512. [DOI: 10.1111/imj.13404] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Richard O. Day
- Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Sydney New South Wales Australia
- School of Medical Sciences, Medicine University of New South Wales Sydney New South Wales Australia
- St Vincent's Clinical School, Medicine University of New South Wales Sydney New South Wales Australia
| | - Leone Snowden
- New South Wales Medicines Information Centre Sydney New South Wales Australia
| | - Andrew J. McLachlan
- Faculty of Pharmacy University of Sydney and Centre for Education and Research on Ageing, Concord Hospital Sydney New South Wales Australia
| |
Collapse
|
26
|
Elzagallaai AA, Greff M, Rieder MJ. Adverse Drug Reactions in Children: The Double-Edged Sword of Therapeutics. Clin Pharmacol Ther 2017; 101:725-735. [PMID: 28295234 DOI: 10.1002/cpt.677] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 12/14/2022]
Abstract
Adverse drug reactions (ADRs) represent a major health problem worldwide, with high morbidity and mortality rates. ADRs are classified into Type A (augmented) and Type B (bizarre) ADRs, with the former group being more common and the latter less common but often severe and clinically more problematic due to their unpredictable nature and occurrence at any dose. Pediatric populations are especially vulnerable to ADRs due to the lack of data for this age group from the drug development process and because of the wide use of off-label and unlicensed use of drugs. Children are more prone to specific types of ADRs because of the level of maturity of body systems involved in absorption, metabolism, transportation, and elimination of drugs. This state-of-the-art review provides an overview of definitions, classifications, epidemiology, and pathophysiology of ADRs and discusses the available evidence for related risk factors and causes of ADRs in the pediatric population.
Collapse
Affiliation(s)
- A A Elzagallaai
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada.,Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Mje Greff
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - M J Rieder
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada.,Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| |
Collapse
|
27
|
Number of medications and adverse drug events by unintentional poisoning among older adults in consideration of inappropriate drug use: a Swedish population-based matched case-control study. Eur J Clin Pharmacol 2017; 73:743-749. [PMID: 28280891 PMCID: PMC5423926 DOI: 10.1007/s00228-017-2220-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/16/2017] [Indexed: 10/31/2022]
Abstract
PURPOSE This national, population-based study aims to determine the association between the number of prescribed medications and adverse drug events (ADE) by unintentional poisoning and examine this risk when known indicators of inappropriate drug use (IDU) are accounted for. METHODS We employed a matched case-control design among people living in Sweden who were 50 years and older. Cases experiencing an ADE by unintentional poisoning resulting in hospitalization or death (n = 5336) were extracted from the National Health and Death Registers from January 2006 to December 2009. Four controls per case matched by age, sex and residential area were randomly selected among those without an ADE (n = 21,344). Prescribed medications dispensed during the 4-month period prior to the ADE were identified via the Swedish Prescribed Drug Register and coded according to the number of different dispensed medications (NDDM) (0 to 10 medications) and IDU indicators (one single-drug, and three drug-combinations). Conditional logistic regression was used. RESULTS Each of the IDU indicators was significantly associated with very high risks of ADE. For NDDM, we found a lower but graded positive association from two to ten or more medications (adjusted OR, 1.5; 95% CI, 1.2-1.8). Exclusion of IDU from the NDDM decreased the risk of ADE, but the effects remained significant for three or more medications (adjusted OR excl. IDU, 1.5; 95% CI, 1.2-2.0). CONCLUSION At population level, the number of different dispensed medications starting from three or more remains associated with ADE even after adjusting for known IDUs. Clinicians and patients need to be made aware of the increased likelihood of serious ADE, not only in case of documented inappropriate medications but also in the case of an increasing number of medications.
Collapse
|
28
|
Meid AD, Heider D, Adler JB, Quinzler R, Brenner H, Günster C, König HH, Haefeli WE. Comparative evaluation of methods approximating drug prescription durations in claims data: modeling, simulation, and application to real data. Pharmacoepidemiol Drug Saf 2016; 25:1434-1442. [PMID: 27633276 DOI: 10.1002/pds.4091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/18/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to compare the predictive accuracy of different methods suggested for approximation of drug prescription durations in claims data. METHODS We expanded a well-established modeling and simulation framework to compare approximated drug prescription durations with 'true' (i.e., simulated) durations. Real claims data of persons aged ≥65 years insured by the German nationwide 'Statutory Health Insurance Fund' AOK between 2010 and 2012 provided empiric input parameters that were completed with missing information on actual dosing patterns from an observational cohort. The distinct approximation methods were based on crude measures (one tablet a day), population-averaged measures (defined daily doses), or individually-derived measures (longitudinal coverage approximation of the applied dose, COV). As a proof-of-principle, we assessed the methods' performance to predict the well-characterized bleeding risks of anticoagulant, antiplatelet, and/or non-steroidal anti-inflammatory drugs. RESULTS When applied to modeling and simulation data sets, the closest, least biased, and thus most accurate approximation was observed using the COV approximation. In a real-data example, rather similar results to an external reference were obtained for all methods. However, some of the differences between methods were meaningful, and the most reasonable and consistent results were obtained with the COV approach. CONCLUSION Based on theoretically most accurate approximations and practically reasonable estimates, the individual COV approach was preferable over the population-averaged defined daily dose technique, although the latter might be justified in certain situations. Advantages of the COV approach are expected to be even bigger for drug therapies with particularly large dosing heterogeneity. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Herrmann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|