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

Abstract

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.

Prevalence and management of drug interactions between nonsteroidal anti‐inflammatory drugs and antithrombotics in ambulatory care

“…For most interactions (60%), both the NSAID and the antithrombotic agent were prescribed by the same physician. High rates of coprescription of interacting drugs have also been reported in Italy (71% of drug–drug interactions), 15 France (up to 58%) 16 and Poland (77%) 17 . Coprescription can be a conscious act, driven by the absence of therapeutic alternatives, but may also indicate a lack of alertness or knowledge on interactions of the physician.…”

“…High rates of coprescription of interacting drugs have also been reported in Italy (71% of drug-drug interactions), 15 France (up to 58%) 16 and Poland (77%). 17 Coprescription can be a conscious act, driven by the absence of therapeutic alternatives, but may also indicate a lack of alertness or knowledge on interactions of the physician. We can only speculate whether the coprescribers in our study were well aware of the interaction and its associated risks when prescribing.…”

Prevalence and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city, southwestern Uganda

“…From real-world data, there is proof of high prevalence of potential drug-drug interactions worldwide. Nearly 74,000 emergency room visits and 195,000 hospitalizations in the USA every year are caused by drug-drug interactions, resulting from the ineffectiveness of current approaches to DDI identi cation [11,12].…”

Risk of major adverse events associated with gabapentinoid and opioid combination therapy: A systematic review and meta-analysis

“…Gabapentinoids have some safety concerns regarding central nervous system (CNS) depression in that they can cause sedation and dizziness and may lead to cognitive impairment in some patients ( Goodman and Brett, 2017 ). Also, simultaneous use of gabapentinoids with an opioid may change the risk of adverse events associated with opioid use ( Kardas et al, 2020 ). A recent meta-analysis showed that the perioperative therapy of administering a gabapentinoid with an opioid in patients with lower limb arthroplasty reduced the risk of postoperative nausea, vomiting, and pruritus, but not sedation ( Campbell et al, 2021 ).…”