Clinically relevant potential drug–drug interactions among outpatients: A nationwide database study

Jazbar, Janja; Locatelli, Igor; Horvat, Nejc; Kos, Mitja

doi:10.1016/j.sapharm.2017.07.004

Cited by 42 publications

(50 citation statements)

References 43 publications

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“…Multiple resources were used to select the 125 drug interaction pairs. These include studies of potential DDI detected in various healthcare settings [11,[39][40][41][42][43][44], reviews of potential DDI involving psychiatric drugs [23,27,28,[45][46][47], lists of serious drug interactions used in prior testing of drug interaction database programs [48][49][50], and lists of frequently prescribed drugs [51,52]. All 125 drug interaction pairs had at least 1 category rating of major from at least one of the 6 drug interaction database programs.…”

Section: Drug Interaction Pairsmentioning

confidence: 99%

Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs

Monteith

Glenn²,

Gitlin

et al. 2020

Pharmacopsychiatry

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Background Patients with bipolar disorder frequently experience polypharmacy, putting them at risk for clinically significant drug-drug interactions (DDI). Online drug interaction database programs are used to alert physicians, but there are no internationally recognized standards to define DDI. This study compared the category of potential DDI returned by 6 commercial drug interaction database programs for drug interaction pairs involving drugs commonly prescribed for bipolar disorder. Methods The category of potential DDI provided by 6 drug interaction database programs (3 subscription, 3 open access) was obtained for 125 drug interaction pairs. The pairs involved 103 drugs (38 psychiatric, 65 nonpsychiatric); 88 pairs included a psychiatric and nonpsychiatric drug; 37 pairs included 2 psychiatric drugs. Every pair contained at least 1 mood stabilizer or antidepressant. The category provided by 6 drug interaction database programs was compared using percent agreement and Fleiss kappa statistic of interrater reliability. Results For the 125 drug pairs, the overall percent agreement among the 6 drug interaction database programs was 60%; the Fleiss kappa agreement was slight. For drug interaction pairs with any category rating of severe (contraindicated), the kappa agreement was moderate. For drug interaction pairs with any category rating of major, the kappa agreement was slight. Conclusion There is poor agreement among drug interaction database programs for the category of potential DDI involving psychiatric drugs. Drug interaction database programs provide valuable information, but the lack of consistency should be recognized as a limitation. When assistance is needed, physicians should check more than 1 drug interaction database program.

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Section: Drug Interaction Pairsmentioning

confidence: 99%

Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs

Monteith

Glenn²,

Gitlin

et al. 2020

Pharmacopsychiatry

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“… 8 , 9 , 11 , 30 We opted for a short time frame of 7 days to increase the probability of concomitant intake. In line with findings from other claims data-based studies, 8 - 11 we identified higher frequencies of pDDIs associated with female gender, increasing age, and number of different drugs. Because the study population was older and included a higher proportion of female patients compared with the general Swiss population ( Supplement 1 ), the frequencies of pDDIs may be overestimated when generalized to Switzerland.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent possible adverse effects of pDDIs in our study were the risk of bleeding, CNS depression, and cardiac toxicity, which was comparable with previous findings. 8 , 9 …”

Section: Discussionmentioning

confidence: 99%

“…Although precautionary measures, such as DDI alert systems, are well established, coprescribing of drug combinations that potentially cause severe DDIs, 6 - 11 such as tizanidine and ciprofloxacin, 12 persists. Tizanidine is a central α 2 -adrenoceptor agonist with a narrow therapeutic range, which is approved in Switzerland for the treatment of spasticity.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Drug-Drug Interactions in Swiss Claims Data Using Tizanidine and Ciprofloxacin as a Prototypical Contraindicated Combination

et al. 2018

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Background: Potential drug-drug interactions (pDDIs) are described in various case reports, but few studies have evaluated the impact of specific combinations on a population level. Objective: To analyze the type and frequency of multiple contraindicated (X-pDDIs) and major interactions (D-pDDIs) and to subsequently assess the impact of the particular combination of tizanidine and ciprofloxacin on outpatient physician visits and hospitalizations. Methods: Anonymized Swiss claims data from 524 797 patients in 2014-2015 were analyzed. First, frequencies of X- and D-pDDIs were calculated. Next, a retrospective cohort study was conducted among patients prescribed tizanidine and ciprofloxacin (exposed, n = 199) or tizanidine and other antibiotics (unexposed, n = 960). Hospitalizations and outpatient physician visits within 7, 14, and 30 days after initiation of antibiotic therapy were evaluated using multiple binary logistic regression and multiple linear regression. Results: The relative frequencies of X- and D-pDDIs were 0.4% and 6.65%, respectively. In the cohort study, significant associations between exposure to tizanidine and ciprofloxacin and outpatient physician visits were identified for 14 and 30 days (odds ratio [OR] = 1.61 [95% CI = 1.17-2.24], P = 0.004, and OR = 1.59 [95% CI = 1.1-2.34], P = 0.016). A trend for increased risk of hospitalization was found for all evaluated time periods (OR = 1.68 [95% CI = 0.84-3.17], OR = 1.52 [95% CI = 0.63-3.33], and OR = 2.19 [95% CI = 0.88-5.02]). Conclusion and Relevance: The interaction between tizanidine and ciprofloxacin is not only relevant for individual patients, but also at the population level. Further investigation of the impact of other clinically relevant DDIs is necessary to improve patient safety and reduce avoidable health care utilization.

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“…Self-medication when adolescents do not follow the recommended dosage might cause liver failure and hepatocellular necrosis when paracetamol is taken in overdose [15] [16] [17]. Several studies have shown that ibuprofen (ibux) can give gastrointestinal symptoms [18] [19] [20] [21], cardiovascular [22] and renal events [23].…”

mentioning

confidence: 99%

Gender Differences in Usage of Over-the-Counter Analgesics among Norwegian Adolescents

Lorentzen¹,

Lorentzen²,

Wikström³

2018

OJN

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Introduction: Usage of over-the-counter (OTC) analgesic has increased among Norwegian adolescents since 2001. It has been noted that females tend to have a higher usage compared to males. In this paper we explore this gender difference. Data: Our dataset consists of 284,674 from Norwegian adolescents attending junior high school and high school between 2014 and 2017. Methods: The econometric approach consists of applying ordered logistic regressions with usage of OTC analgesics as the dependent variable and a dichotomous gender variable as the independent variable. Control variables include variables such as frequency of physical and mental health problems and other sociodemographic variables. Results: Gender, physical and mental health problems and various sociodemographic variables are found to have a significant effect on usage of OTC analgesics. Females are predicted to use significantly more analgesics. A large proportion of the gender difference evaporates when controlling for various other determinants. Conclusion: A considerable part of the observed gender difference in OTC analgesic usage can be traced back to differences in frequency and severity of physical and mental health problems. Part of the gender difference in usage, however remains unexplained.

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Clinically relevant potential drug–drug interactions among outpatients: A nationwide database study

Cited by 42 publications

References 43 publications

Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs

Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs

Analysis of Drug-Drug Interactions in Swiss Claims Data Using Tizanidine and Ciprofloxacin as a Prototypical Contraindicated Combination

Gender Differences in Usage of Over-the-Counter Analgesics among Norwegian Adolescents

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