Background
Methods
Data source
Definition of a potential interaction
Statistical analysis
Results
Participants
All patients (n = 1221) | |
---|---|
Female, n (%) | 846 (69.3) |
Age, mean (SD) | 47.9 (16.2) |
Younger than 35 years, n (%) | 269 (22.0) |
35–55 years old, n (%) | 592 (48.5) |
Older than 55 years, n (%) | 360 (29.5) |
Most common psychiatric diagnosis, n (%) | |
F32 – Major depressive disorder | 338 (27.7) |
F33 – Major depressive disorder, recurrent | 304 (24.9) |
F20 – Schizophrenia | 163 (13.4) |
F41 – Anxiety disorders | 96 (7.9) |
F31 – Bipolar disorder | 66 (5.4) |
Prescriptions
All patients (n = 1221) | ||
---|---|---|
Most commonly prescribed drugs by ATC codes | Single prescriptions | Number of patients (%) |
N06 – Antidepressants | 14,001 | 973 (79.7) |
J01 – Antibacterials | 3812 | 885 (72.5) |
N05 – Antipsychotics | 20,021 | 844 (69.1) |
M01 – Anti-inflammatory/antirheumatic | 3728 | 740 (60.6) |
N02 – Analgesics | 5996 | 553 (45.3) |
A02 – Drugs for acid-related disorders | 3333 | 475 (38.9) |
A03 – Drugs for functional gastrointestinal disorders | 1222 | 366 (30.0) |
D07 – Corticosteroids | 902 | 324 (26.5) |
R06 – Antihistamines | 1573 | 317 (26.0) |
C07 – Beta-blocking agents | 2867 | 307 (25.1) |
… | ||
Sum | 89,361 | N/A |
All patients (n = 1221) | ||
---|---|---|
Prescribed drugs by ATC codes | Frequency | Number of patients (%) |
M01 – Anti-inflammatory/antirheumatic products | 3313 | 713 (58.40) |
N06 – Antidepressants | 6249 | 635 (52.0) |
N05 – Antipsychotics | 5879 | 471 (38.58) |
A02 – Drugs for acid-related disorders | 3050 | 448 (36.69) |
N02 – Analgesics | 1473 | 250 (20.48) |
J01 – Antibacterials for systemic use | 247 | 146 (11.96) |
C10 – Lipid-modifying agents | 941 | 137 (11.22) |
C08 – Calcium channel blockers | 1195 | 131 (10.73) |
R05 – Cough and cold preparations | 165 | 100 (8.19) |
N03 – Antiepileptics | 523 | 80 (6.55) |
… | ||
Sum | 25,211 | N/A |
Number of DDEs
Person-time analyses
Most commonly recorded potential interactions
Potential drug-drug exposure | Frequency | Events per 100 person-years (Poisson exact 95 %–CI) | Number of patients with at least one DDE (%) | Clinical relevance of a potential interaction (as per prescribing information) |
---|---|---|---|---|
diazepam & omeprazole | 52 | 1.00 (0.74–1.31) | 17 (1.39) | Omeprazole may increase systemic exposure to diazepam [31] |
doxepin & venlafaxine | 54 | 1.03 (0.78–1.35) | 15 (1.23) | not mentioned |
doxepin & paroxetine | 44 | 0.84 (0.61–1.13) | 13 (1.06) | not mentioned |
amitriptyline & omeprazole | 58 | 1.11 (0.84–1.44) | 12 (0.98) | not mentioned |
doxepin & tramadol | 51 | 0.98 (0.73–1.28) | 11 (0.90) | Tramadol may increase the potential of seizures related to tricyclic antidepressants. Serotonin syndrome may occur [32] [unclear if due to CYP interactions] |
amitriptyline & paroxetine | 29 | 0.56 (0.37–0.80) | 9 (0.74) | Patients taking SSRIs should only be treated with amitriptyline with particular caution [33] [reason not given] |
amitriptyline & esomeprazole | 31 | 0.59 (0.40–0.84) | 8 (0.66) | not mentioned |
doxepin & risperidone | 95 | 1.82 (1.47–2.22) | 8 (0.66) | Mutual reinforcement of the central depressant effect [34] |
fluoxetine & omeprazole | 11 | 0.21 (0.11–0.38) | 8 (0.66) | not mentioned |
doxepin & duloxetine | 22 | 0.42 (0.26–0.64) | 7 (0.57) | not mentioned |
… | ||||
Sum | 1393 | 26.72 (25.34–28.16) | 330 |
Potential drug-drug exposure (bold = strong inhibitor) | Frequency | Events per 100 person-years (95%CI) | Number of patients with at least one DDE (%) | Clinical relevance of a potential interaction (as per prescribing information) |
---|---|---|---|---|
amitriptyline & paroxetine | 29 | 0.56 (0.37–0.80) | 9 (0.74) | Patients taking SSRIs should only be treated with amitriptyline with particular caution [35] [reason not given] |
paroxetine & risperidone | 21 | 0.40 (0.25–0.62) | 6 (0.49) | Paroxetine increases the plasma-concentration of risperidone [36] |
codeine & fluoxetine | 8 | 0.15 (0.07–0.30) | 5 (0.41) | |
amitriptyline & fluoxetine | 16 | 0.31 (0.18–0.50) | 5 (0.41) | Taking fluoxetine and amitriptyline in parallel might result in an increased plasma-concentration of amitriptyline Dose-reduction might be necessary [33] |
fluoxetine & tramadol | 42 | 0.81 (0.58–1.09) | 5 (0.41) | Taking tramadol and fluoxetine in parallel can induce serotonin syndrome [32] |
amlodipine & clarithromycin | 5 | 0.10 (0.03–0.22) | 4 (0.33) | Taking clarithromycin and amlodipine parallel might result in an increased plasma concentration of amlodipine [39] |
clomipramine & paroxetine | 76 | 1.46 (1.15–1.82) | 4 (0.33) | Paroxetine can increase the plasma concentration of clomipramine [40] |
paroxetine & tramadol | 6 | 0.12 (0.04–0.25) | 4 (0.33) | |
… | ||||
Sum | 380 | 7.29 (6.57–8.06) | 90 |