Risk of Drug-Drug Interactions in Out-Hospital Drug Dispensings in France: Results From the DRUG-Drug Interaction Prevalence Study

Létinier, Louis; Cossin, Sébastien; Mansiaux, Yohann; Arnaud, M; Salvo, Francesco; Bezin, Julien; Thiessard, Frantz; Pariente, Alexandre

doi:10.3389/fphar.2019.00265

Cited by 34 publications

(32 citation statements)

References 36 publications

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“…Drugs for psychiatric conditions were the most frequently involved in multidrug interactions, accounting for 23.3% of the drugs involved (Table 3). Several prior studies of two-drug interacting pairs made similar observations [12][13][14][15][16][17]8]. The preponderance of psychotropic drugs in multidrug interactions may reflect the rising incidence of psychotropic polypharmacy [18].…”

Section: Discussionmentioning

confidence: 66%

Potential Multidrug Interactions in Elderly Ambulatory Patients

Anand¹,

Wallace²,

Chase³

2020

Preprint

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Aim. Polypharmacy may increase the prevalence of potential multidrug interactions (pMDIs), where one drug interacts with two or more other drugs, possibly amplifying the risk of a potential adverse drug event (pADE). The major goal of this study was to estimate the prevalence of amplifying pMDIs in an ambulatory cohort of older patients. Methods. Current medication lists of 22033 randomly chosen outpatients ≥50 years old were extracted from the New York Presbyterian Hospital (NYP) data warehouse. Network analysis identified patients prescribed three or more interacting drugs from their current medication lists. Potentially harmful interactions were identified from the NYP drug-drug interaction alerting system. pMDIs were considered amplifying if the interactions increased the probability of a pADE through pharmacokinetic, pharmacodynamic or conditional mechanisms. Results. pMDIs were identified in 5.1% of the medication lists; 3.4% were three-drug and 1.1% were four-drug pMDIs. The most common drugs involved were psychotropic, comprising 23.3% of the total drugs. The most common pADEs associated with the interactions were serotonin syndrome (17.2%), seizures (14.4%), prolonged QT interval (15.8%) and bleeding (14.4%). pADE amplification risk was identified in 71.8% of three-drug pMDIs when one drug interacted with two others, 97.8% when all three interacted with each other, and 93% for four-drug pMDIs. Conclusion. Our data suggest that approximately 5% of elderly ambulatory patients may be exposed to pMDIs which amplify the probability of associated adverse drug events. The recent and persistent rise in polypharmacy will likely increase the prevalence of pMDIs and potential exposure to serious adverse events.

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Section: Discussionmentioning

confidence: 66%

Potential Multidrug Interactions in Elderly Ambulatory Patients

Anand¹,

Wallace²,

Chase³

2020

Preprint

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“…It is not easy to directly compare our observations with the results of other studies conducted in various countries due to diverse frameworks used to define pDDIs in terms of study periods varying from one month ( Merlo et al, 2001 ) to several years ( Linnarsson, 1993 ), different definitions of studied cohorts (e.g., outpatients, elderly, polymedicated patients), severity of pDDIs etc. Therefore, prevalence of pDDIs observed in general populations vary significantly ranging from 1.2 to 1.3% in Switzerland ( Bucher et al, 2016 ), 4% in France ( Létinier et al, 2019 ), 8.5% in Italy ( Tragni et al, 2013 ), up to 9.3% in Slovenia ( Jazbar et al, 2018 ). Out of these studies, the last one is particularly interesting.…”

Section: Discussionmentioning

confidence: 99%

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

Kardas

Urbański²,

Lichwierowicz³

et al. 2021

Front. Pharmacol.

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Introduction: Drug-drug interactions may lead to poor health outcomes, as well as increased costs and utilization of healthcare services. Unfortunately, real-world data continuously prove high prevalence of potential drug-drug interactions (pDDIs) worldwide. Among identified drivers, ageing, multimorbidity and polypharmacy play a very important role. With these factors being widespread, the need for implementation of strategies minimizing the burden of pDDIs becomes an urgency. This, however, requires a better understanding of the prevalence of pDDIs and the underlying causative factors.Aim of study: To assess the real-world prevalence of pDDIs and its characteristics in the general population of Poland, using analgesic drugs as a model, and to find out whether pDDIs are caused by prescribing coming from the very same prescribers (co-prescribing).Methods: A retrospective analysis of the 2018 dispensation data of the National Health Fund (NHF) - the only Polish public healthcare payer organization with nationwide coverage. We searched for selected pDDIs of non-steroidal anti-inflammatory drugs (NSAIDs) with antihypertensives, other NSAIDs (double use), oral glucocorticoids, oral anticoagulants, selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and antiplatelet drugs; as well as opioides with SSRIs, SNRIs, gabapentinoids, and benzodiazepines. A pDDI was deemed present if two drugs standing in a possible conflict were dispensed within the same calendar month.Results: Out of 38.4 million citizens of Poland, 23.3 million were dispensed prescribed drugs reimbursed by NHF in 2018. In this cohort, we have identified 2,485,787 cases of analgesic drug pDDIs, corresponding with 6.47% of the Polish population. Out of these, the most prevalent pDDI was caused by “NSAIDs + antihypertensives” (1,583,575 cases, i.e., 4.12% of the Polish population), followed by “NSAIDs + NSAIDs” (538,640, 1.40%) and “NSAIDs + glucocorticoids” (213,504, 0.56%). The most persistent pDDIs among those studied were caused by “Opioids + Gabapentinoids” (2.19, 95%CI: 2.16–2.22 months). On average, 76.63% of all cases of pDDIs were caused by drugs prescribed by the very same prescribers.Conclusion: Based on high-quality, nationwide data, we have found a high prevalence of analgesic drugs-related pDDIs in Poland. Over ¾ of the identified pDDIs were caused by co-prescribing, i.e., prescriptions issued by the same prescribers. The significance of the problem, illustrated with our findings on analgesic drugs-related pDDIs in Poland, deserves much more scientific and policymaker attention.

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“…In a 2019 French study of a health insurance database, the prevalence of interaction effects at contraindication levels was found to be 0.2%, which is significantly lower than the rate of 0.76% found in this study. The much higher rate of prevalence in this study may be accounted for by the fact that the sample population consisted of patients with high healthcare utilization of medical services, many of whom used excessive polypharmacy [27]. Patients may use a variety of drugs with similar side effects, which could result in intolerance or serious adverse drug events.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pharmacist Intervention on a Population in Taiwan with High Healthcare Utilization and Excessive Polypharmacy

Wang

Trezise

et al. 2019

IJERPH

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Patients with high healthcare utilization are at increased risk of polypharmacy and drug interactions. This study investigated the changes in the number of medications, drug interactions and interaction severity in high frequency outpatients with polypharmacy at hospitals and clinics in Taiwan after home pharmaceutical care, to understand the effectiveness of interventions by pharmacists. This was a retrospective observational study. Cases with excessive polypharmacy (10+ drugs) were selected from the Pharmaceutical Care Practice System database of the Taiwan Pharmacist Association in 2017. After the home care intervention, the number of drug types used decreased 1.89-fold (p < 0.001), and the number of medications fell 61.6%. The incidence of drug interaction was 93.82%. In an average case, the incidence of drug interaction after the pharmacist intervention decreased 0.6-fold (p < 0.001). The drug most commonly causing interactions was aspirin, followed by diclofenac; also common were three used in diabetes, two psycholeptics and two beta blockers. Among 22 cases of severe drug interaction, seven resulted in increased risk of extrapyramidal symptoms and neuroleptic malignant syndrome. By analyzing the relationship between the side effects of individual drugs and the pharmacokinetic Tmax, a sequential thermal zone model of adverse drug reactions can be established, the value of which could prompt physicians and pharmacists to intervene in order to prevent adverse events. It is concluded that home pharmaceutical care by pharmacists can significantly reduce the number of medications and interactions in patients with excessive polypharmacy and high healthcare utilization.

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Risk of Drug-Drug Interactions in Out-Hospital Drug Dispensings in France: Results From the DRUG-Drug Interaction Prevalence Study

Cited by 34 publications

References 36 publications

Potential Multidrug Interactions in Elderly Ambulatory Patients

Potential Multidrug Interactions in Elderly Ambulatory Patients

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

Effect of Pharmacist Intervention on a Population in Taiwan with High Healthcare Utilization and Excessive Polypharmacy

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