Aims The aim was to assess the impact of a campaign for general practitioners (GPs) to reduce clinically‐important drug–drug interactions (DDIs) in poly‐treated elderly patients. Methods We compiled a list of 53 DDIs and analyzed reimbursed prescriptions dispensed to poly‐treated (≥four drugs) elderly (>65 years) patients in the Emilia Romagna region during January 2011–June 2011 (first pre‐intervention period), January 2012–June 2012 (second pre‐intervention period) and January 2013–June 2013 (post‐intervention period). Educational initiatives to GPs were completed in July 2012–December 2012. Pre‐test/post‐test analysis (2013 vs. 2012) was performed, also using predicted 2013 data (P < 0.01 for statistical significance). Results Despite the slight increase in poly‐therapy rate (16% in 2013, +1.5% from 2011), we found a stable or slightly declining number of potential DDIs for each elderly poly‐treated patient (~1.5). In 2013, 11 DDIs exceeded 5% of prevalence rate: antidiabetics‐β‐adrenoceptor blockers ranked first (20.3%), followed by ACE Inhibitors (ACEIs)/sartans‐non steroidal anti‐inflammatory drugs (NSAIDs) (16.4%), diuretics‐NSAIDs (13.6%), selective serotonin re‐uptake inhibitors (SSRIs)‐NSAIDs/acetyl salicylic acid (ASA) (12.7%) and corticosteroids‐NSAIDs/ASA (9.7%). A remarkable reduction emerged for NSAID‐related DDIs (diuretics‐NSAIDs peaked −14.5%; P < 0.01), whereas prevalence of antidiabetics‐β‐adrenoceptor blockers increased (+7.9%; P < 0.01). When using predicted values, the statistical significance disappeared for antidiabetics‐β‐adrenoceptor blockers (+1.3%; P = 0.04), whereas it persisted for almost all NSAIDs‐related DDIs: ACEIs/sartans‐NSAIDs (−3.0%), diuretics‐NSAIDs (−6.0%), SSRIs‐NSAIDs/ASA (−5.9%). Conclusions This campaign contained the burden of DDIs in poly‐treated elderly patients by 1) reducing most prevalent DDIs, especially NSAIDs‐related DDIs and 2) balancing the observed rise in poly‐therapy rate with stable rate in overall prescriptions of potentially interacting drugs per patient.

Backround: We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies.Methods: We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated.Results: In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants—anxiolytics (11.9%) ranked first, followed by antidepressants—aspirin (7.4%). In outpatients, ACE-inhibitors—non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers—α-blockers (2.4%).Discussion: Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized.

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BackgroundDrug-drug interactions (DDIs) are one of the main causes of adverse drug reactions in polytreated elderly patients.PurposeUnder the supervision of the Pharmacological Department of the University of Bologna, 7 hospitals in the Emilia Romagna Region participated in a multicentre pharmacovigilance study to evaluate the prevalence of 53 DDIs in the study population and their modifications after appropriate educational interventions for general practitioners (GPs).Material and methodsDrug prescriptions for elderly patients (aged ≥65 years) chronically treated with 5 or more drugs were collected during the first 6 months of the years 2011, 2012 and 2013. The study was divided into three periods: data collection during the first 6 months of the years 2011 and 2012 (first period); educational interventions for GPs during the last 6 months of the year 2012 (second period); and data collection after educational interventions during the first 6 months of the year 2013 (third period).ResultsPercentages of polytreated elderly patients in the first 6 months of 2011, 2012 and 2013 were, respectively, 15.2%, 15.6% and 16.7%. For each patient the mean number of DDIs was 1.5 in the entire period. The most common DDIs (prevalence more than 10%) showed the following modifications between the first and third periods: antidiabetics and beta blockers +1.5%; ACE inhibitors/Sartans and NSAIDs -1.9%; diuretics and NSAIDs -2.3%; SSRI and NSAIDs/acetylsalicylic acid -0.8%; and triple whammy interactions (ACE inhibitors, diuretics, NSAIDs) -1%.ConclusionFrom our results, the educational interventions for GPs showed efficacy in limiting the mean number of DDIs for polytreated elderly patients, especially for DDIs regarding NSAIDs.References and/or AcknowledgementsLapi F, Azoulay L, Yin H, et al. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study, BMJ2013;346:e8525. doi: 10.1136/bmj.e8525.:e8525:e8525Laroche ML, Charmes JP, Nouaille Y, et al. Impact of hospitalisation in an acute medical geriatric unit on potentially inappropriate medication use. Drugs Aging 2006;23:49-59Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther 2008;33:141-51No conflict of interest.