Skip to main content
Erschienen in: Drugs & Aging 10/2015

01.10.2015 | Original Research Article

Prevalence of Potential and Clinically Relevant Statin–Drug Interactions in Frail and Robust Older Inpatients

verfasst von: Michele Thai, Sarah Hilmer, Sallie-Anne Pearson, Emily Reeve, Danijela Gnjidic

Erschienen in: Drugs & Aging | Ausgabe 10/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

A significant proportion of older people are prescribed statins and are also exposed to polypharmacy, placing them at increased risk of statin–drug interactions.

Objective

To describe the prevalence rates of potential and clinically relevant statin–drug interactions in older inpatients according to frailty status.

Methods

A cross-sectional study of patients aged ≥65 years who were prescribed a statin and were admitted to a teaching hospital between 30 July and 10 October 2014 in Sydney, Australia, was conducted. Data on socio-demographics, comorbidities and medications were collected using a standardized questionnaire. Potential statin–drug interactions were defined if listed in the Australian Medicines Handbook and three international drug information sources: the British National Formulary, Drug Interaction Facts and Drug-Reax®. Clinically relevant statin–drug interactions were defined as interactions with the highest severity rating in at least two of the three international drug information sources. Frailty was assessed using the Reported Edmonton Frail Scale.

Results

A total of 180 participants were recruited (median age 78 years, interquartile range 14), 35.0 % frail and 65.0 % robust. Potential statin–drug interactions were identified in 10 % of participants, 12.7 % of frail participants and 8.5 % of robust participants. Clinically relevant statin–drug interactions were identified in 7.8 % of participants, 9.5 % of frail participants and 6.8 % of robust participants. Depending on the drug information source used, the prevalence rates of potential and clinically relevant statin–drug interactions ranged between 14.4 and 35.6 % and between 14.4 and 20.6 %, respectively.

Conclusion

In our study of frail and robust older inpatients taking statins, the overall prevalence of potential statin–drug interactions was low and varied significantly according to the drug information source used.
Literatur
1.
Zurück zum Zitat Morgan TK, Williamson M, Pirotta M, et al. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust. 2012;196(1):50–3.CrossRefPubMed Morgan TK, Williamson M, Pirotta M, et al. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust. 2012;196(1):50–3.CrossRefPubMed
2.
Zurück zum Zitat Doan J, Zakrzewski-Jakubiak H, Roy J, Turgeon J, Tannenbaum C. Prevalence and risk of potential cytochrome P450-mediated drug–drug interactions in older hospitalized patients with polypharmacy. Ann Pharmacother. 2013;47(3):324–32.CrossRefPubMed Doan J, Zakrzewski-Jakubiak H, Roy J, Turgeon J, Tannenbaum C. Prevalence and risk of potential cytochrome P450-mediated drug–drug interactions in older hospitalized patients with polypharmacy. Ann Pharmacother. 2013;47(3):324–32.CrossRefPubMed
3.
Zurück zum Zitat Johnell K, Klarin I. The relationship between number of drugs and potential drug–drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug Saf. 2007;30(10):911–8.CrossRefPubMed Johnell K, Klarin I. The relationship between number of drugs and potential drug–drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug Saf. 2007;30(10):911–8.CrossRefPubMed
4.
Zurück zum Zitat Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharmacother. 2011;9(6):364–77.CrossRefPubMed Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharmacother. 2011;9(6):364–77.CrossRefPubMed
5.
Zurück zum Zitat Becker ML, Kallewaard M, Caspers PW, et al. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16(6):641–51.CrossRefPubMed Becker ML, Kallewaard M, Caspers PW, et al. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16(6):641–51.CrossRefPubMed
6.
Zurück zum Zitat Gnjidic D, Johnell K. Clinical implications from drug–drug and drug–disease interactions in older people. Clin Exp Pharmacol Physiol. 2013;40(5):320–5.CrossRefPubMed Gnjidic D, Johnell K. Clinical implications from drug–drug and drug–disease interactions in older people. Clin Exp Pharmacol Physiol. 2013;40(5):320–5.CrossRefPubMed
7.
Zurück zum Zitat Hilmer SN, McLachlan AJ, Le Couteur DG. Clinical pharmacology in the geriatric patient. Fundam Clin Pharmacol. 2007;21(3):217–30.CrossRefPubMed Hilmer SN, McLachlan AJ, Le Couteur DG. Clinical pharmacology in the geriatric patient. Fundam Clin Pharmacol. 2007;21(3):217–30.CrossRefPubMed
8.
Zurück zum Zitat Bennett A, Gnjidic D, Gillett M, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug–drug interactions in robust versus frail hospitalised falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225–32.CrossRefPubMed Bennett A, Gnjidic D, Gillett M, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug–drug interactions in robust versus frail hospitalised falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225–32.CrossRefPubMed
9.
Zurück zum Zitat Gnjidic D, Hilmer SN, Blyth FM, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther. 2012;91(3):521–8.CrossRefPubMed Gnjidic D, Hilmer SN, Blyth FM, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther. 2012;91(3):521–8.CrossRefPubMed
10.
Zurück zum Zitat Wynne HA, Cope LH, Herd B, et al. The association of age and frailty with paracetamol conjugation in man. Age Ageing. 1990;19(6):419–24.CrossRefPubMed Wynne HA, Cope LH, Herd B, et al. The association of age and frailty with paracetamol conjugation in man. Age Ageing. 1990;19(6):419–24.CrossRefPubMed
11.
Zurück zum Zitat Johnston C, Hilmer SN, McLachlan AJ, et al. The impact of frailty on pharmacokinetics in older people: using gentamicin population pharmacokinetic modeling to investigate changes in renal drug clearance by glomerular filtration. Eur J Clin Pharmacol. 2014;70(5):549–55.CrossRefPubMed Johnston C, Hilmer SN, McLachlan AJ, et al. The impact of frailty on pharmacokinetics in older people: using gentamicin population pharmacokinetic modeling to investigate changes in renal drug clearance by glomerular filtration. Eur J Clin Pharmacol. 2014;70(5):549–55.CrossRefPubMed
12.
Zurück zum Zitat Abarca J, Malone DC, Armstrong EP, et al. Concordance of severity ratings provided in four drug interaction compendia. J Am Pharm Assoc. 2004;44(2):136–41.CrossRef Abarca J, Malone DC, Armstrong EP, et al. Concordance of severity ratings provided in four drug interaction compendia. J Am Pharm Assoc. 2004;44(2):136–41.CrossRef
13.
Zurück zum Zitat Olvey EL, Clauschee S, Malone DC. Comparison of critical drug–drug interaction listings: the Department of Veterans Affairs medical system and standard reference compendia. Clin Pharmacol Ther. 2010;87(1):48–51.CrossRefPubMed Olvey EL, Clauschee S, Malone DC. Comparison of critical drug–drug interaction listings: the Department of Veterans Affairs medical system and standard reference compendia. Clin Pharmacol Ther. 2010;87(1):48–51.CrossRefPubMed
14.
Zurück zum Zitat Sweidan M, Reeve JF, Brien JA, et al. Quality of drug interaction alerts in prescribing and dispensing software. Med J Aust. 2009;190(5):251–4.PubMed Sweidan M, Reeve JF, Brien JA, et al. Quality of drug interaction alerts in prescribing and dispensing software. Med J Aust. 2009;190(5):251–4.PubMed
17.
Zurück zum Zitat Afilalo J, Duque G, Steele R, et al. Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analysis. J Am Coll Cardiol. 2008;51(1):37–45.CrossRefPubMed Afilalo J, Duque G, Steele R, et al. Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analysis. J Am Coll Cardiol. 2008;51(1):37–45.CrossRefPubMed
18.
Zurück zum Zitat Roberts CG, Guallar E, Rodriguez A. Efficacy and safety of statin monotherapy in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2007;62(8):879–87.CrossRefPubMed Roberts CG, Guallar E, Rodriguez A. Efficacy and safety of statin monotherapy in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2007;62(8):879–87.CrossRefPubMed
19.
Zurück zum Zitat Paoletti R, Corsini A, Bellosta S. Pharmacological interactions of statins. Atheroscler Suppl. 2002;3:35–40.CrossRefPubMed Paoletti R, Corsini A, Bellosta S. Pharmacological interactions of statins. Atheroscler Suppl. 2002;3:35–40.CrossRefPubMed
20.
Zurück zum Zitat Bellosta S, Corsini A. Statin drug interactions and related adverse reactions. Expert Opin Drug Saf. 2012;11(6):933–46.CrossRefPubMed Bellosta S, Corsini A. Statin drug interactions and related adverse reactions. Expert Opin Drug Saf. 2012;11(6):933–46.CrossRefPubMed
21.
Zurück zum Zitat Bottorff MB. Statin safety and drug interactions: clinical implications. Am J Cardiol. 2006;97(8A):27C–31C.CrossRefPubMed Bottorff MB. Statin safety and drug interactions: clinical implications. Am J Cardiol. 2006;97(8A):27C–31C.CrossRefPubMed
22.
Zurück zum Zitat Neuvonen PJ, Niemi M, Backman JT. Drug interactions with lipid-lowering drugs: mechanisms and clinical relevance. Clin Pharmacol Ther. 2006;80(6):565–81.CrossRefPubMed Neuvonen PJ, Niemi M, Backman JT. Drug interactions with lipid-lowering drugs: mechanisms and clinical relevance. Clin Pharmacol Ther. 2006;80(6):565–81.CrossRefPubMed
23.
Zurück zum Zitat Bellosta S, Paoletti R, Corsini A. Safety of statins: focus on clinical pharmacokinetics and drug interactions. Circulation. 2004;109(23 Suppl 1):Iii50–7.PubMed Bellosta S, Paoletti R, Corsini A. Safety of statins: focus on clinical pharmacokinetics and drug interactions. Circulation. 2004;109(23 Suppl 1):Iii50–7.PubMed
24.
Zurück zum Zitat Patel AM, Shariff S, Bailey DG, et al. Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study. Ann Intern Med. 2013;158(12):869–76.CrossRefPubMed Patel AM, Shariff S, Bailey DG, et al. Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study. Ann Intern Med. 2013;158(12):869–76.CrossRefPubMed
25.
Zurück zum Zitat Bakhai A, Rigney U, Hollis S, Emmas C. Co-administration of statins with cytochrome P450 3A4 inhibitors in a UK primary care population. Pharmacoepidemiol Drug Saf. 2012;21(5):485–93.CrossRefPubMed Bakhai A, Rigney U, Hollis S, Emmas C. Co-administration of statins with cytochrome P450 3A4 inhibitors in a UK primary care population. Pharmacoepidemiol Drug Saf. 2012;21(5):485–93.CrossRefPubMed
26.
Zurück zum Zitat Karimi S, Hough A, Beckey C, Parra D. Results of a safety initiative for patients on concomitant amiodarone and simvastatin therapy in a Veterans Affairs medical center. J Manag Care Pharm. 2010;16(7):472–81.PubMed Karimi S, Hough A, Beckey C, Parra D. Results of a safety initiative for patients on concomitant amiodarone and simvastatin therapy in a Veterans Affairs medical center. J Manag Care Pharm. 2010;16(7):472–81.PubMed
27.
Zurück zum Zitat Ming EE, Davidson MH, Gandhi SK, et al. Concomitant use of statins and CYP3A4 inhibitors in administrative claims and electronic medical records databases. J Clin Lipidol. 2008;2(6):453–63.CrossRefPubMed Ming EE, Davidson MH, Gandhi SK, et al. Concomitant use of statins and CYP3A4 inhibitors in administrative claims and electronic medical records databases. J Clin Lipidol. 2008;2(6):453–63.CrossRefPubMed
28.
Zurück zum Zitat Petropoulos JB, Bello-Quintero CE. Frequency of simvastatin prescriptions with potentially interacting medications in a Veterans Affairs health care system. J Manag Care Pharm. 2004;10(3):239–43.PubMed Petropoulos JB, Bello-Quintero CE. Frequency of simvastatin prescriptions with potentially interacting medications in a Veterans Affairs health care system. J Manag Care Pharm. 2004;10(3):239–43.PubMed
29.
Zurück zum Zitat Piacentini N, Trifiro G, Tari M, Moretti S, Arcoraci V. Statin-macrolide interaction risk: a population-based study throughout a general practice database. Eur J Clin Pharmacol. 2005;61(8):615–20.CrossRefPubMed Piacentini N, Trifiro G, Tari M, Moretti S, Arcoraci V. Statin-macrolide interaction risk: a population-based study throughout a general practice database. Eur J Clin Pharmacol. 2005;61(8):615–20.CrossRefPubMed
30.
Zurück zum Zitat Egger SS, Bravo AER, Hess L, Schlienger RG, Krahenbuhl S. Age-related differences in the prevalence of potential drug–drug interactions in ambulatory dyslipidaemic patients treated with statins. Drugs Aging. 2007;24(5):429–40.CrossRefPubMed Egger SS, Bravo AER, Hess L, Schlienger RG, Krahenbuhl S. Age-related differences in the prevalence of potential drug–drug interactions in ambulatory dyslipidaemic patients treated with statins. Drugs Aging. 2007;24(5):429–40.CrossRefPubMed
31.
Zurück zum Zitat Elliott RA. Problems with medication use in the elderly: an Australian perspective. J Pharm Pract Res. 2006;36(1):58–66.CrossRef Elliott RA. Problems with medication use in the elderly: an Australian perspective. J Pharm Pract Res. 2006;36(1):58–66.CrossRef
32.
Zurück zum Zitat Australian medicines handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2014. Australian medicines handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2014.
33.
Zurück zum Zitat Joint Formulary Committee. British national formulary. 68th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2014. Joint Formulary Committee. British national formulary. 68th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2014.
34.
Zurück zum Zitat Tatro D, editor. Drug interaction facts. Facts and comparisons [database online]. St Louis: Wolters Kluwer Health; 2012. Tatro D, editor. Drug interaction facts. Facts and comparisons [database online]. St Louis: Wolters Kluwer Health; 2012.
35.
Zurück zum Zitat Klasko R, editor. Drug-Reax® system [database on CD-ROM]. Greenwood Village: Thomson Micromedex; 2003. Klasko R, editor. Drug-Reax® system [database on CD-ROM]. Greenwood Village: Thomson Micromedex; 2003.
36.
Zurück zum Zitat Roughead EE, Kalisch LM, Barratt JD, Gilbert AL. Prevalence of potentially hazardous drug interactions amongst Australian veterans. Br J Clin Pharmacol. 2010;70(2):252–7.PubMedCentralCrossRefPubMed Roughead EE, Kalisch LM, Barratt JD, Gilbert AL. Prevalence of potentially hazardous drug interactions amongst Australian veterans. Br J Clin Pharmacol. 2010;70(2):252–7.PubMedCentralCrossRefPubMed
37.
Zurück zum Zitat Dolton MJ, Pont L, Stevens G, McLachlan AJ. Prevalence of potentially harmful drug interactions in older people in Australian aged-care facilities. J Pharm Pract Res. 2012;42(1):33–6.CrossRef Dolton MJ, Pont L, Stevens G, McLachlan AJ. Prevalence of potentially harmful drug interactions in older people in Australian aged-care facilities. J Pharm Pract Res. 2012;42(1):33–6.CrossRef
38.
Zurück zum Zitat Hilmer SN, Perera V, Mitchell S, et al. The assessment of frailty in older people in acute care. Australas J Ageing. 2009;28(4):182–8.CrossRefPubMed Hilmer SN, Perera V, Mitchell S, et al. The assessment of frailty in older people in acute care. Australas J Ageing. 2009;28(4):182–8.CrossRefPubMed
39.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed
40.
Zurück zum Zitat Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed
41.
Zurück zum Zitat Einarson TR, Metge CJ, Iskedjian M, Mukherjee J. An examination of the effect of cytochrome P450 drug interactions of hydroxymethylglutaryl-coenzyme a reductase inhibitors on health care utilization: a Canadian population-based study. Clin Ther. 2002;24:2126–36.CrossRefPubMed Einarson TR, Metge CJ, Iskedjian M, Mukherjee J. An examination of the effect of cytochrome P450 drug interactions of hydroxymethylglutaryl-coenzyme a reductase inhibitors on health care utilization: a Canadian population-based study. Clin Ther. 2002;24:2126–36.CrossRefPubMed
43.
Zurück zum Zitat Kerr KP, Mate KE, Magin PJ, et al. The prevalence of co-prescription of clinically relevant CYP enzyme inhibitor and substrate drugs in community-dwelling elderly Australians. J Clin Pharm Ther. 2014;39(4):383–9.CrossRefPubMed Kerr KP, Mate KE, Magin PJ, et al. The prevalence of co-prescription of clinically relevant CYP enzyme inhibitor and substrate drugs in community-dwelling elderly Australians. J Clin Pharm Ther. 2014;39(4):383–9.CrossRefPubMed
44.
Zurück zum Zitat Westaway KP, Frank OR, Husband AJ, et al. Safe use of statins in elderly people. J Pharm Pract Res. 2014;44(3):138–42.CrossRef Westaway KP, Frank OR, Husband AJ, et al. Safe use of statins in elderly people. J Pharm Pract Res. 2014;44(3):138–42.CrossRef
45.
Zurück zum Zitat Ronaldson KJ, O’Shea JM, Boyd IW. Risk factors for rhabdomyolysis with simvastatin and atorvastatin. Drug Saf. 2006;29(11):1061–7.CrossRefPubMed Ronaldson KJ, O’Shea JM, Boyd IW. Risk factors for rhabdomyolysis with simvastatin and atorvastatin. Drug Saf. 2006;29(11):1061–7.CrossRefPubMed
46.
Zurück zum Zitat Zakrzewski-Jakubiak H, Doan J, Lamoureux P, Singh D, Turgeon J, Tannenbaum C. Detection and prevention of drug–drug interactions in the hospitalized elderly: utility of new cytochrome p450-based software. Am J Geriatr Pharmacother. 2011;9(6):461–70.CrossRefPubMed Zakrzewski-Jakubiak H, Doan J, Lamoureux P, Singh D, Turgeon J, Tannenbaum C. Detection and prevention of drug–drug interactions in the hospitalized elderly: utility of new cytochrome p450-based software. Am J Geriatr Pharmacother. 2011;9(6):461–70.CrossRefPubMed
47.
Zurück zum Zitat Best O, Gnjidic D, Hilmer SN, Naganathan V, McLachlan AJ. Investigating polypharmacy and drug burden index in hospitalised older people. Intern Med J. 2013;43(8):912–8.CrossRefPubMed Best O, Gnjidic D, Hilmer SN, Naganathan V, McLachlan AJ. Investigating polypharmacy and drug burden index in hospitalised older people. Intern Med J. 2013;43(8):912–8.CrossRefPubMed
Metadaten
Titel
Prevalence of Potential and Clinically Relevant Statin–Drug Interactions in Frail and Robust Older Inpatients
verfasst von
Michele Thai
Sarah Hilmer
Sallie-Anne Pearson
Emily Reeve
Danijela Gnjidic
Publikationsdatum
01.10.2015
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 10/2015
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-015-0302-9

Weitere Artikel der Ausgabe 10/2015

Drugs & Aging 10/2015 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.