Prevalence of the prescription of potentially interacting drugs

Elena Tragni, Manuela Casula, Vasco Pieri, Giampiero Favato, Alberico Marcobelli, Maria Giovanna Trotta, Alberico Luigi Catapano, Elena Tragni, Manuela Casula, Vasco Pieri, Giampiero Favato, Alberico Marcobelli, Maria Giovanna Trotta, Alberico Luigi Catapano

Abstract

The use of multiple medications is becoming more common, with a correspondingly increased risk of untoward effects and drug-related morbidity and mortality. We aimed at estimating the prevalence of prescription of relevant potentially interacting drugs and at evaluating possible predictors of potentially interacting drug exposure. We retrospectively analyzed data on prescriptions dispensed from January 2004 to August 2005 to individuals of two Italian regions with a population of almost 2.1 million individuals. We identified 27 pairs of potentially interacting drugs by examining clinical relevance, documentation, and volume of use in Italy. Subjects who received at least one prescription of both drugs were selected. Co-prescribing denotes "two prescriptions in the same day", and concomitant medication "the prescription of two drugs with overlapping coverage". A logistic regression analysis was conducted to examine the predictors of potential Drug-Drug Interaction (pDDIs). 957,553 subjects (45.3% of study population) were exposed to at least one of the drugs/classes of the 27 pairs. Overall, pDDIs occurred 2,465,819 times. The highest rates of concomitant prescription and of co-prescription were for ACE inhibitors+NSAIDs (6,253 and 4,621/100,000 plan participants). Considering concomitance, the male/female ratio was <1 in 17/27 pairs (from 0.31 for NSAIDs-ASA+SSRI to 0.74 for omeprazole+clopidogrel). The mean age was lowest for methotrexate pairs (+omeprazole, 59.9 years; +NSAIDs-ASA, 59.1 years) and highest for digoxin+verapamil (75.4 years). In 13/27 pairs, the mean ages were ≥70 years. On average, subjects involved in pDDIs received ≥10 drugs. The odds of exposure were more frequently higher for age ≥65 years, males, and those taking a large number of drugs. A substantial number of clinically important pDDIs were observed, particularly among warfarin users. Awareness of the most prevalent pDDIs could help practitioners in preventing concomitant use, resulting in a better quality of drug prescription and potentially avoiding unwanted side effects.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Number and proportion of patients…
Figure 1. Number and proportion of patients involved in pDDIs.

References

    1. Astrand B, Astrand E, Antonov K, Petersson G (2006) Detection of potential drug interactions - a model for a national pharmacy register. Eur J Clin Pharmacol 62: 749-756. doi:10.1007/s00228-006-0143-x. PubMed: .
    1. Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA (2003) Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 289: 1652-1658. doi:10.1001/jama.289.13.1652. PubMed: .
    1. Grymonpre RE, Mitenko PA, Sitar DS, Aoki FY, Montgomery PR (1988) Drug-associated hospital admissions in older medical patients. J Am Geriatr Soc 36: 1092-1098. PubMed: .
    1. Miranda V, Fede A, Nobuo M, Ayres V, Giglio A et al. (2011) Adverse drug reactions and drug interactions as causes of hospital admission in oncology. J Pain Symptom Manage 42: 342-353. doi:10.1016/j.jpainsymman.2010.11.014. PubMed: .
    1. McDonnell PJ, Jacobs MR (2002) Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother 36: 1331-1336. doi:10.1345/aph.1A333. PubMed: .
    1. Shad MU, Marsh C, Preskorn SH (2001) The economic consequences of a drug-drug interaction. J Clin Psychopharmacol 21: 119-120. doi:10.1097/00004714-200102000-00027. PubMed: .
    1. Ernst FR, Grizzle AJ (2001) Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash) 41: 192-199. PubMed: .
    1. van Roon EN, Flikweert S, le Comte M, Langendijk PN, Kwee-Zuiderwijk WJ et al. (2005) Clinical relevance of drug-drug interactions : a structured assessment procedure. Drug Saf 28: 1131-1139. doi:10.2165/00002018-200528120-00007. PubMed: .
    1. Glassman PA, Simon B, Belperio P, Lanto A (2002) Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care 40: 1161-1171. doi:10.1097/00005650-200212000-00004. PubMed: .
    1. Langdorf MI, Fox JC, Marwah RS, Montague BJ, Hart MM (2000) Physician versus computer knowledge of potential drug interactions in the emergency department. Acad Emerg Med 7: 1321-1329. doi:10.1111/j.1553-2712.2000.tb00483.x. PubMed: .
    1. Ko Y, Malone DC, Skrepnek GH, Armstrong EP, Murphy JE et al. (2008) Prescribers' knowledge of and sources of information for potential drug-drug interactions: a postal survey of US prescribers. Drug Saf 31: 525-536. doi:10.2165/00002018-200831060-00007. PubMed: .
    1. Becker ML, Kallewaard M, Caspers PW, Schalekamp T, Stricker BH (2005) Potential determinants of drug-drug interaction associated dispensing in community pharmacies. Drug Saf 28: 371-378. doi:10.2165/00002018-200528050-00001. PubMed: .
    1. Malone DC, Abarca J, Skrepnek GH, Murphy JE, Armstrong EP et al. (2007) Pharmacist workload and pharmacy characteristics associated with the dispensing of potentially clinically important drug-drug interactions. Med Care 45: 456-462. doi:10.1097/01.mlr.0000257839.83765.07. PubMed: .
    1. Malone DC, Hutchins DS, Haupert H, Hansten P, Duncan B et al. (2005) Assessment of potential drug-drug interactions with a prescription claims database. Am J Health Syst Pharm 62: 1983-1991. doi:10.2146/ajhp040567. PubMed: .
    1. Zhan C, Correa-de-Araujo R, Bierman AS, Sangl J, Miller MR et al. (2005) Suboptimal prescribing in elderly outpatients: potentially harmful drug-drug and drug-disease combinations. J Am Geriatr Soc 53: 262-267. doi:10.1111/j.1532-5415.2005.53112.x. PubMed: .
    1. Favato G, Mariani P, Mills RW, Capone A, Pelagatti M et al. (2007) ASSET (Age/Sex Standardised Estimates of Treatment): a research model to improve the governance of prescribing funds in Italy. PLOS ONE 2: e592. doi:10.1371/journal.pone.0000592. PubMed: .
    1. (2008) AIFA. Linee guida per la classificazione e conduzione degli studi osservazionali sui farmaci. GU n. 76. Italy: AIFA.
    1. World Health Organization W ATC/DDD Index 2009.
    1. AIFA (2005) Rapporto OSMED 2004. Roma: Ministero della Salute.
    1. Tobi H, Faber A, van den Berg PB, Drane JW, de Jong-van den Berg LT (2007) Studying co-medication patterns: the impact of definitions. Pharmacoepidemiol Drug Saf 16: 405-411. doi:10.1002/pds.1304. PubMed: .
    1. Gagne JJ, Maio V, Rabinowitz C (2008) Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther 33: 141-151. doi:10.1111/j.1365-2710.2007.00891.x. PubMed: .
    1. Bjerrum L, Lopez-Valcarcel Gonzalez. B, Petersen G (2008) Risk factors for potential drug interactions in general practice. Eur J Gen Pract 14: 23-29.
    1. Smith DR, L'Abbate N, Lorusso A (2008) Tobacco smoking among Italian physicians and the role of occupational medicine. Med Lav 99: 3-7. PubMed: .
    1. Bjerrum L, Andersen M, Petersen G, Kragstrup J (2003) Exposure to potential drug interactions in primary health care. Scand J Prim Health Care 21: 153-158. doi:10.1080/02813430310001806. PubMed: .
    1. Guédon-Moreau L, Ducrocq D, Duc MF, Quieureux Y, L’Hôte C et al. (2004) Absolute contraindications in relation to potential drug interactions in outpatient prescriptions: analysis of the first five million prescriptions in 1999. Eur J Clin Pharmacol 59: 899-904. doi:10.1007/s00228-003-0709-9. PubMed: .
    1. Chen YF, Avery AJ, Neil KE, Johnson C, Dewey ME et al. (2005) Incidence and possible causes of prescribing potentially hazardous/contraindicated drug combinations in general practice. Drug Saf 28: 67-80. doi:10.2165/00002018-200528010-00005. PubMed: .
    1. Magro L, Conforti A, Del Zotti F, Leone R, Iorio ML et al. (2008) Identification of severe potential drug-drug interactions using an Italian general-practitioner database. Eur J Clin Pharmacol 64: 303-309. doi:10.1007/s00228-007-0394-1. PubMed: .
    1. Malone DC, Abarca J, Hansten PD, Grizzle AJ, Armstrong EP et al. (2004) Identification of serious drug-drug interactions: results of the partnership to prevent drug-drug interactions. J Am Pharm Assoc (2003) 44: 142-151
    1. Peng CC, Glassman PA, Marks IR, Fowler C, Castiglione B et al. (2003) Retrospective drug utilization review: incidence of clinically relevant potential drug-drug interactions in a large ambulatory population. J Manag Care Pharm 9: 513-522. PubMed: .
    1. Zwart-van Rijkom JE, Uijtendaal EV, ten Berg MJ, van Solinge WW, Egberts AC (2009) Frequency and nature of drug-drug interactions in a Dutch university hospital. Br J Clin Pharmacol 68: 187-193. doi:10.1111/j.1365-2125.2009.03443.x. PubMed: .
    1. Hatton RC, Rosenberg AF, Morris CT, McKelvey RP, Lewis JR. (2011) Evaluation of contraindicated drug-drug interaction alerts in a hospital setting. Ann Pharmacother 45: 297-308. doi:10.1345/aph.1P533. PubMed: .
    1. Oertle M. (2012) Frequency and nature of drug-drug interactions in a Swiss primary and secondary acute care hospital. Swiss Med Wkly 142: 0 PubMed: .
    1. Hohl CM, Dankoff J, Colacone A, Afilalo M (2001) Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 38: 666-671. doi:10.1067/mem.2001.119456. PubMed: .
    1. Puckett WH Jr., Visconti JA (1971) An epidemiological study of the clinical significance of drug-drug interactions in a private community hospital. Am J Hosp Pharm 28: 247-253. PubMed: .
    1. Jonville-Béra AP, Béra F, Autret-Leca E (2005) Are incorrectly used drugs more frequently involved in adverse drug reactions? A prospective study. Eur J Clin Pharmacol 61: 231-236. doi:10.1007/s00228-004-0881-6. PubMed: .
    1. Jankel CA, Fitterman LK (1993) Epidemiology of drug-drug interactions as a cause of hospital admissions. Drug Saf 9: 51-59. doi:10.2165/00002018-199309010-00005. PubMed: .
    1. Jankel CA, Speedie SM (1990) Detecting drug interactions: a review of the literature. DICP 24: 982-989. PubMed: .
    1. Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG et al. (2007) Hospitalisations and emergency department visits due to drug-drug interactions: a literature review. Pharmacoepidemiol Drug Saf 16: 641-651. doi:10.1002/pds.1351. PubMed: .
    1. Warholak TL, Hines LE, Song MC, Gessay A, Menke JM et al. (2011) Medical, nursing, and pharmacy students' ability to recognize potential drug-drug interactions: a comparison of healthcare professional students. J Am Acad Nurse Pract 23: 216-221. doi:10.1111/j.1745-7599.2011.00599.x. PubMed: .
    1. Sorensen TD, Traynor AP, Janke KK (2009) A pharmacy course on leadership and leading change. Am J Pharm Educ 73: 23. doi:10.5688/aj730223. PubMed: .
    1. AIFA (2006) Rapporto OSMED 2005. Roma: Ministero della Salute.
    1. Oates JA (1988) Antagonism of antihypertensive drug therapy by nonsteroidal anti-inflammatory drugs. Hypertension 11: II4-II6. doi:10.1161/01.HYP.11.3_Pt_2.II4. PubMed: .
    1. Pavlicević I, Kuzmanić M, Rumboldt M, Rumboldt Z (2008) Interaction between antihypertensives and NSAIDs in primary care: a controlled trial. Can J Clin Pharmacol 15: e372-e382. PubMed: .
    1. Hersh EV, Pinto A, Moore PA (2007) Adverse drug interactions involving common prescription and over-the-counter analgesic agents. Clin Ther 29 Suppl: 2477-2497. doi:10.1016/j.clinthera.2007.12.003. PubMed: .
    1. Mehlhorn AJ, Brown DA (2007) Safety concerns with fluoroquinolones. Ann Pharmacother 41: 1859-1866. doi:10.1345/aph.1K347. PubMed: .
    1. Weideman RA, Bernstein IH, McKinney WP (1999) Pharmacist recognition of potential drug interactions. Am J Health Syst Pharm 56: 1524-1529. PubMed: .
    1. Cavuto NJ, Woosley RL, Sale M (1996) Pharmacies and prevention of potentially fatal drug interactions. JAMA 275: 1086-1087. doi:10.1001/jama.1996.03530380028022. PubMed: .
    1. Karas S Jr. (1981) The potential for drug interactions. Ann Emerg Med 10: 627-630. doi:10.1016/S0196-0644(81)80085-6. PubMed: .
    1. Shah NR, Seger AC, Seger DL, Fiskio JM, Kuperman GJ et al. (2006) Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc 13: 5-11. doi:10.1197/jamia.M1868. PubMed: .
    1. Weingart SN, Simchowitz B, Shiman L, Brouillard D, Cyrulik A et al. (2009) Clinicians' assessments of electronic medication safety alerts in ambulatory care. Arch Intern Med 169: 1627-1632. doi:10.1001/archinternmed.2009.300. PubMed: .
    1. Cruciol-Souza JM, Thomson JC (2006) Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci 9: 427-433. PubMed: .

Source: PubMed

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