03.06.2020 | Research Article | Ausgabe 4/2020 Open Access

Prevalence of potential drug–drug interactions in outpatients of a general hospital in China: a retrospective investigation
- Zeitschrift:
- International Journal of Clinical Pharmacy > Ausgabe 4/2020
Electronic supplementary material
Publisher's Note
Impacts on practice
-
Drug–drug interactions are frequent in outpatients. Health professionals including physicians and pharmacists should raise awareness of the potential impact of drug–drug interactions.
-
It is important to incorporate the clinical pharmacists into the healthcare team to routinely screen the potential drug–drug interactions.
-
A computerized warning systems with smarter screening software may be beneficial in reducing the potential risk of drug–drug interactions.
-
Further research is needed to develop clinical guidelines regarding the widespread potential drug–drug interactions along with their potential adverse outcomes and management strategies.
Introduction
Aim of the study
Ethics approval
Method
Results
Population characteristics
Characteristics
|
No. of patients (%)
|
No. of patients with pDDIs (%)
|
%
a
|
Adjusted OR (95% CI)
|
p value
|
---|---|---|---|---|---|
Sex
|
|||||
Male
|
7847(48.68)
|
2526(51.74)
|
32.20
|
Reference
|
|
Female
|
8273(51.32)
|
2356(48.26)
|
28.47
|
0.85(0.79-0.91)
|
< 0.01
|
Age(years)
|
|||||
Young (18–39)
|
2687(16.67)
|
509(10.43)
|
18.94
|
Reference
|
|
Middle-aged(40–64)
|
7612(47.22)
|
2389(48.93)
|
31.38
|
2.03(1.82–2.26)
|
< 0.01
|
Elderly (≥ 65)
|
5821(36.11)
|
1984(40.64)
|
34.08
|
2.22(1.98–2.49)
|
< 0.01
|
Numbers of prescribed medicines
|
|||||
≤ 3
|
10,264(63.67)
|
2463(50.45)
|
23.98
|
Reference
|
|
4–6
|
5032(31.22)
|
2114(43.30)
|
42.07
|
2.26(2.10–2.43)
|
< 0.01
|
≥ 7
|
824(5.11)
|
305(6.25)
|
36.89
|
2.10(1.81–2.45)
|
< 0.01
|
Prevalence of pDDIs and factors associated with pDDIs
Characteristics
|
No. of pDDIs per prescription,
n (%)
|
|||||
---|---|---|---|---|---|---|
1
|
2
|
3
|
4
|
5
|
6
|
|
Sex
|
||||||
Male
|
1840
|
435
|
200
|
32
|
18
|
1
|
Female
|
1841
|
326
|
141
|
28
|
15
|
5
|
Age(years)
|
||||||
Young (18–39)
|
437
|
48
|
23
|
1
|
0
|
0
|
Middle-aged (40–64)
|
1830
|
376
|
141
|
24
|
16
|
2
|
Elderly (≥ 65)
|
1414
|
337
|
177
|
35
|
17
|
4
|
Number of prescribed medicines
|
||||||
≤ 3
|
2055
|
308
|
100
|
0
|
0
|
0
|
4–6
|
1360
|
424
|
234
|
58
|
32
|
6
|
≥ 7
|
266
|
29
|
7
|
2
|
1
|
0
|
Total
|
3681
|
761
|
341
|
60
|
33
|
6
|
(75.40)
|
(15.59)
|
(6.98)
|
(1.23)
|
(0.68)
|
(0.12)
|
Potential clinical consequences and mechanisms of pDDIs
Interacting pair
|
Patients: n (%)
|
Potential clinical consequences
|
Mechanism of interaction
|
---|---|---|---|
Pioglitazone–glimepiride
|
34(6.01)
|
Hypoglycemia
|
Reinforced pharmacological effects (pharmacodynamics)
|
Pioglitazone–insulin
|
24(4.24)
|
Hypoglycemia, increased fluid retention and heart failure effect
|
Reinforced pharmacological effects (pharmacodynamics)
|
Propafenone–sotalol
|
23(4.06)
|
QT-interval prolongation
|
Metabolic inhibition (pharmacokinetic)
|
Baclofen–dihydrocodeine
|
23(4.06)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Amiodarone–warfarin
|
22(3.89)
|
Potentiated warfarin plasma concentrations and anticoagulant effect
|
Metabolic inhibition (pharmacokinetic)
|
Eperisone–dihydrocodeine
|
20(3.53)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Flunarizine-codeine
|
19(3.36)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Fluoxetine–perphenazine
|
19(3.36)
|
Increased plasma concentrations of perphenazine
|
Metabolic inhibition (pharmacokinetic)
|
Tizanidine–dihydrocodeine
|
18(3.18)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Chlorpheniramine–dihydrocodeine
|
17(3.00)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Simvastatin–amlodipine
|
16(2.83)
|
Increased plasma concentrations of simvastatin, risk of myopathy and rhabdomyolysis
|
Metabolic inhibition (pharmacokinetic)
|
Calcium acetate–alendronate sodium
|
15(2.65)
|
Decreased absorption and plasma concentrations of alendronate sodium.
|
Formed insoluble compounds (pharmacokinetic)
|
Valproate–lamotrigine
|
14(2.47)
|
Enhanced lamotrigine plasma concentrations.
|
Metabolic inhibition (pharmacokinetic)
|
Tizanidine–codeine
|
12(2.12)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Testosterone undecanoate-ciclosporin
|
12(2.12)
|
Increased hepatotoxicity and plasma concentrations of testosterone undecanoate
|
Unknown
|
Fluoxetine–clopidogrel
|
11(1.94)
|
Decreased plasma concentrations of clopidogrel active metabolite
|
Metabolic inhibition (pharmacokinetic)
|
Interacting pair
|
Patients:
n (%)
|
Potential clinical consequences
|
Mechanism of interaction
|
---|---|---|---|
Ebastine–thalidomide
|
7(14.89)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Levocetirizine–thalidomide
|
5(10.64)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Doxazosin–tamsulosin
|
4(8.51)
|
Antihypertensive effects
|
Reinforced pharmacological effects (pharmacodynamics)
|
Sotalol–flupenthixol
|
4(8.51)
|
QT-interval prolongation
|
Reinforced pharmacological effects (pharmacodynamics)
|
Ketotifen–thalidomide
|
4(8.51)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Mizolastine–thalidomide
|
3(6.38)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Cetirizine–thalidomide
|
3(6.38)
|
Enhanced central nervous system suppression function
|
Reinforced pharmacological effects (pharmacodynamics)
|
Urokinase–heparin
|
3(6.38)
|
Potentiated anticoagulant effect
|
Reinforced pharmacological effects (pharmacodynamics)
|
Amiodarone–flupentixol
|
2(4.26)
|
QT-interval prolongation
|
Metabolic inhibition (pharmacokinetic)
|
Ibuprofen–celecoxib
|
2(4.26)
|
Increased toxicity
|
Reinforced pharmacological effects (pharmacodynamics)
|