Prevalence of potential drug–drug interactions in outpatients of a general hospital in China: a retrospective investigation

Abstract

Background Potential drug-drug interactions are important factors resulting in adverse drug reactions or therapeutic failure. Therefore, potential drug-drug interactions need to be identified to prevent the related risk and improve drug safety. Objective This study was designed to determine the prevalence of potential drug-drug interactions and investigate the association of potential drug-drug interactions with characteristics in outpatient prescriptions. Setting A large-scale general university hospital in Jinshan District of Shanghai, China. Method The retrospective study was conducted on data obtained from prescriptions containing two or more drugs, written for outpatients older than 18 years. They were screened for potential drug-drug interactions using Lexi-Interact in UpToDate, Stockley's Drug Interactions and Medicine Specification in the order of priority. Main outcome measure Drug-drug interactions with C, D, X risk rating and clinical parameters recorded at the prescriptions. Results 16,120 prescriptions were screened for the presence of potential drug-drug interactions and 4882 (30.29%) prescriptions containing 6667 potential drug-drug interactions were identified. Among 6667 potential drug-drug interactions, 90.81% (6054/6667), 8.49% (566/6667), 0.70% (47/6667) potential drug-drug interactions belonged to the risk category of C, D and X, respectively. Male, old age and polypharmacy increased the likelihood of potential drug-drug interactions. The most frequently prescribed drugs responsible for potential drug-drug interactions included pioglitazone, dihydrocodeine, thalidomide, sotalol, amiodarone and amlodipine. The predominant potential adverse outcome of potential drug-drug interactions was the increased central nervous system suppression function with the mechanism of reinforced pharmacological effects. Conclusion This study showed that potentially significant drug-drug interactions in outpatients were prevalent in real-world practice. Considering the risk of potential clinical consequences related to potential drug-drug interactions, it is necessary to implement the computerized surveillance and warning systems with drug-drug interactions databases as well as develop the clinical guidelines regarding the widespread potential drug-drug interactions.

Assessment of Physician's Knowledge of Potential Drug-Drug Interactions: An Online Survey in China

“…The interactions between two or more drugs may exist antagonistic or synergistic effect, both of which lead to drug toxicity or undesired therapeutic effect with harmful outcomes to patients ( 3 – 5 ). The potential drug-drug interactions (PDDIs) were identified in around 30% of the prescriptions in the outpatient ( 6 ) and oncology departments in China ( 6 , 7 ). Even though the prevalence data is largely lacking in China, the PDDIs may be more prevalent in intensive care settings ( 8 ) and hematology ( 9 , 10 ), based on the data from other countries.…”

The Prevalence of Selected Potential Drug-Drug Interactions of Analgesic Drugs and Possible Methods of Preventing Them: Lessons Learned From the Analysis of the Real-World National Database of 38 Million Citizens of Poland

“…A study assessing outpatients in Taiwan over a period of 3 months reported prevalence of pDDIs as high as 25.6% ( Lin et al, 2011 ). A recent analysis of prescriptions issued to outpatients of a general hospital in China revealed that as many as 30.29% of them contained pDDI with C, D or X risk rating (of which category C stands for ‘monitor therapy,’ D – ‘consider therapy modification,’ and X – ‘avoid combination,’ respectively) ( Ren et al, 2020 ). Finally, among prescriptions filled at a university health center pharmacy in Jamaica, prevalence of pDDIs was 49.8% (of which 4.7% were classified as major, 80.8% as moderate and 14.5% as minor pDDIs) ( Kennedy-Dixon et al, 2015 ).…”

Potential drug interactions in adults living in the Brazilian Amazon: A population-based case-control study, 2019

“…In China, researchers observed 30% of potential drug interactions in 2019, in 16,120 outpatient prescriptions, using Lexicomp UpToDate database and Stockley's drug interaction checker. 11 A national database analysis of prescribed drugs in Slovenia in 2015 identified 42% of potential drug interactions in almost 1,2 million outpatients, and estimated that 9% of the country's population was exposed to clinically relevant potential drug interactions using Lexicomp UpToDate database. 26 …”

“…Drug-drug interaction investigations – regardless of the country or region – are mainly focused on hospitalized patients, with serious illnesses, older age, and under chronic therapeutic regimens. 10 , 11 Representativeness is also limited by restriction to a single health setting or reduced number of participants, being concentrated on drugs prescribed by physicians – thus excluding self-medication, for example – or for institutionalized individuals. 11 , 12 , 13 …”

“… 10 , 11 Representativeness is also limited by restriction to a single health setting or reduced number of participants, being concentrated on drugs prescribed by physicians – thus excluding self-medication, for example – or for institutionalized individuals. 11 , 12 , 13 …”