Drug–drug interactions involving CYP3A4 and p-glycoprotein in hospitalized elderly patients

Gallo, Paolo; Vincentis, Antonio De; Pedone, Claudio; Nobili, Alessandro; Tettamanti, Mauro; Gentilucci, Umberto Vespasiani; Picardi, Antonio; Mannucci, Pier Mannuccio; Incalzi, Raffaele Antonelli; Investigators, Reposi

doi:10.1016/j.ejim.2019.05.002

Cited by 28 publications

(36 citation statements)

References 43 publications

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“…Third, an analysis of cause-specific mortality could not be performed because the causes of death at long-term follow-up could not be consistently identified. Fourth, observational and registry data show that the hospital admission is associated with an increased prevalence of drug interactions and polypharmacy (the use of five or more prescribed drugs at the same time) in older patients, with potential negative prognostic effects [44,45]. Although polypharmacy could be an appealing variable to be included in a prognostic model for an elderly population with a high comorbidity index, this data is lacking for most of our patients.…”

Section: Discussionmentioning

confidence: 95%

RDW-based clinical score to predict long-term survival in community-acquired pneumonia: a European derivation and validation study

et al. 2021

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Section: Discussionmentioning

confidence: 95%

RDW-based clinical score to predict long-term survival in community-acquired pneumonia: a European derivation and validation study

et al. 2021

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“…This confirms the polypharmacy trend in the older population. Drug–drug interactions and associated adverse events are frequent in individuals treated with several different molecules [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older

Manckoundia

Nuemi

Hacquin³

et al. 2021

IJERPH

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The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than those taking DOACs (87.11 vs. 86.35 years). In the DOAC group, there were more women (51.92% vs. 48.25%) (p = 0.043), less RCD (89.60% vs. 92.73%) (p = 0.002), less VTE (1.80% vs. 6.59%), less severe heart failure (58.09% vs. 67.87%), less severe hypertension (18.22% vs. 23.60%), less severe kidney diseases (1.49% vs. 3.82%), and fewer drugs per prescription (6.15 vs. 6.66) (p < 0.01 for all). The DOAC group were also less likely to be taking angiotensin receptor blockers (10.79% vs. 13.97%), furosemide (40.81% vs. 49.66%) or digoxin (10.32% vs. 13.66%) than the VKA group (p = 0.009, p < 0.001, and p = 0.005). DOACs were less prescribed than VKAs. Individuals taking VKAs were older and had more severe comorbidities and more drugs per prescription than those taking DOACs.

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“…Moreover, the mean number of drugs/prescription was more than 5 in both groups, confirming the polypharmacy trend in the elderly. Drug–drug interactions and associated side effects are common in individuals who take multiple drugs [ 27 ]. In addition, polypharmacy is associated with nonadherence to treatment [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years

Manckoundia

Rosay

et al. 2020

IJERPH

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We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, registered chronic diseases (RCD), number of drugs per prescription and cardiovascular medications. The three VKA subgroups were compared for the same items plus laboratory monitoring, novel and refill VKA prescriptions, and prescriber specialty. Of the 8696 included individuals, 1157 (13.30%) were prescribed VKA. Mean age was 90 years. The noVKA group had fewer women (53.67 vs 66.08%), more RCD (93.43 vs. 71.96%) and more drugs per prescription (6.65 vs. 5.18) than the VKA group (all p < 0.01). Except for direct oral anticoagulants and platelet aggregation inhibitors, the VKA group took significantly more cardiovascular medications. The most commonly prescribed VKA was fluindione (59.46%). Mean age was higher in the warfarin (90.42) than in the acenocoumarol (89.83) or fluindione (89.71) subgroups (p < 0.01). No differences were observed for sex (women were predominant) or RCD. 13% of subjects in this population had a VKA prescription. Fluindione was the most commonly prescribed VKA.

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Drug–drug interactions involving CYP3A4 and p-glycoprotein in hospitalized elderly patients

Cited by 28 publications

References 43 publications

RDW-based clinical score to predict long-term survival in community-acquired pneumonia: a European derivation and validation study

RDW-based clinical score to predict long-term survival in community-acquired pneumonia: a European derivation and validation study

Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older

The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years

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