Studying co‐medication patterns: the impact of definitions

Tobi, Hilde; Faber, Adrianne; Berg, Paul B. van den; Drane, J. Wanzer; Berg, Lolkje Theodora Wilhelmina de Jong-van den

doi:10.1002/pds.1304

Cited by 47 publications

(46 citation statements)

References 17 publications

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“…Consequently, the use of antibiotics was not associated with lower volumes of CV drugs at the individual level as might be expected from the previous study using aggregated data [1]. This is in accordance with reported observations where patients with CV disease were likely to be frequent attenders [3] of health care centres and to receive prescriptions of antibiotics as comedication [4]. …”

supporting

confidence: 80%

Aggregated and individual pharmacy record data. Association between antibiotic and antihypertensive drug use

Nilsson¹,

Lindberg²,

Weitoft³

et al. 2008

Eur J Clin Pharmacol

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In a previous attempt to relate drug use to morbidity we compared "sickness numbers" and dispensed drug volumes in Swedish municipalities and found positive correlations between sickness numbers and dispensed volumes of most drug types. Antibiotics were an exception; higher antibiotics volumes were associated with lower sickness numbers [1].Aggregated pharmacy record data showed that municipalities with antibiotics volumes above the national average had lower volumes of cardiovascular (CV) drugs, primarily of antihypertensives [1], indicating a possible link between infection and hypertension. However, the employed aggregated pharmacy record data gave no information regarding the relation between the dispensed volumes of antibiotics and CV drugs for individuals. The present study aimed at obtaining such information.The dispensed drug volumes in Sweden (2006) in DDD of antibiotics (ATC code J01) and the CV drugs diuretics (C03), beta-blocking agents (C07), calcium antagonists (C08) and ACE-inhibitors (C09) per 10-year age groups for patients aged ≥ 40 years were extracted from the Swedish Prescribed Drug Register [2]. The number of individuals and percentages of the population with antibiotics or CV drugs were determined. The expected percentage with both antibiotics and CV drugs was calculated as the product of the proportion of the population with antibiotics times the proportion with CV drugs. The ratios of observed percentage/expected percentage were calculated for each age group.To determine if the use of antibiotics influenced the CV drug volume per individual, we compared for each age group the average volumes of CV drugs (DDDs of C03-C09) for patients with both antibiotics and CV drugs with the average volumes of CV drugs for patients with no antibiotics.The extracted data comprised 2.35 million individuals or between 347,000 and 597,000 individuals per age group. The ratios of observed/expected percentages of patients with both antibiotics and CV drugs were higher than 1 in four of the five age groups, indicating that more patients than expected had acquired both types of drugs. The average volumes of CV drugs (average DDD/patient) were 5-6% higher per patient treated with antibiotics than for those not treated with antibiotics.The present study showed that the proportion of the population with both antibiotics and CV drugs was higher than expected and that the groups of individuals treated with antibiotics on average had 5-6% higher volumes of CV drugs than those without antibiotics. Consequently, the use of antibiotics was not associated with lower volumes of CV drugs at the individual level as might be expected from the previous study using aggregated data [1]. This is in accordance with reported observations where patients with CV disease were likely to be frequent attenders [3] of health care centres and to receive prescriptions of antibiotics as comedication [4].

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supporting

confidence: 80%

Aggregated and individual pharmacy record data. Association between antibiotic and antihypertensive drug use

Nilsson¹,

Lindberg²,

Weitoft³

et al. 2008

Eur J Clin Pharmacol

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“…Use of the nationwide NorPD eliminates the possibility of selection and recall bias. Several other countries have healthcare databases containing information on drug prescriptions [20,[26][27][28]. However, many of these are based on insurance plans that cover only parts of the population, which may introduce selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…The term co-medication was used to describe possibly concomitant drug use according to the definition of Tobi et al [20].The drugs could be prescribed from one or more physician and dispensed at the same or a different date (but within the time period for statin use).…”

Section: Study Populationmentioning

confidence: 99%

Co‐medication of statins and CYP3A4 inhibitors before and after introduction of new reimbursement policy

Devold

Molden

Furu

2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • HMG‐CoA reductase inhibitors (statins) are frequently used drugs in the treatment of dyslipidaemia. • Co‐medication with interacting drugs increases the risk of statin‐induced muscular side‐effects. • Simvastatin exhibits particularly high interaction potential due to substantial metabolism via cytochrome P450 3A4 (CYP3A4). WHAT THIS STUDY ADDS • In June 2005, a new reimbursement policy was introduced by the Norwegian Medicines Agency stating that simvastatin should be prescribed as first‐line lipid‐lowering therapy. • Following introduction of the new policy, the number of patients co‐medicated with simvastatin and CYP3A4 inhibitors almost doubled. • A potential consequence is increased incidence of muscular side‐effects in the statin‐treated population. AIMS To assess the prevalence of co‐medication of statins and CYP3A4 inhibitors before and after introduction of a new Norwegian reimbursement policy, which states that all patients should be prescribed simvastatin as first‐line lipid‐lowering therapy. METHODS Data from patients receiving simvastatin, lovastatin, pravastatin, fluvastatin or atorvastatin in 2004 and 2006, including co‐medication of potent CYP3A4 inhibitors, were retrieved from the Norwegian Prescription Database covering the total population of Norway. Key measurements were prevalence of continuous statin use (two or more prescriptions on one statin) and proportions of different statin types among all patients and those co‐medicated with CYP3A4 inhibitors. RESULTS In 2004, 5.9% (n= 272 342) of the Norwegian population received two or more prescriptions on one statin compared with 7.0% (n= 324 267) in 2006. The relative number of simvastatin users increased from 39.7% (n= 112 122) in 2004 to 63.1% (n= 226 672) in 2006. A parallel increase was observed within the subpopulation co‐medicated with statins and CYP3A4 inhibitors, i.e. from 42.9% (n= 7706) in 2004 to 63.6% (n= 13 367) in 2006. For all other statins the number of overall users decreased to a similar extent to those co‐medicated with CYP3A4 inhibitors. CONCLUSIONS In both 2004 and 2006, the choice of statin type did not depend on whether the patient used a CYP3A4 inhibitor or not. Considering the pronounced interaction potential of simvastatin with CYP3A4 inhibitors, a negative influence of the new policy on overall statin safety seems likely.

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“…To explore possible concurrent use of other potential drugs of abuse, we identified individuals who filled prescriptions for benzodiazepines and carisoprodol (a muscle relaxant with recognized abuse potential, often used together with benzodiazepines) in 2006 (12). High consumers of benzodiazepines and carisoprodol were identified as those who received 100 DDD or more and 15 DDD or more in 2006, respectively, as previously defined by others (6).…”

Section: Study Populationmentioning

confidence: 99%

Repeated dispensing of codeine is associated with high consumption of benzodiazepines

Bachs¹,

Bramness²,

Engeland³

2009

Nor J Epidemiol

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Aims: Our objective was to explore the use of codeine analgesics in individual patients in Norway, giving special attention to the 10% who consume the highest amounts. Methods: We retrieved data from the Norwegian Prescription Database on patients who were dispensed at least one codeine analgesic prescription during 2006. We looked at age and gender specific 1-year periodic prevalence. The 10% of codeine users who were prescribed the highest amounts of the drug that year were further characterized. Age and gender distribution and concurrent high consumption of other potential drugs of abuse were also considered. Results: In the year 2006, a total of 386,836 individuals filled at least one prescription for codeine analgesics from Norwegian pharmacies, excluding cancer patients. The crude prevalence for the use of codeine analgesics was 7.3% and 9.3% of the male and female Norwegian population, respectively. Twelve percent of women and 9% of men who filled a codeine prescription received 120 defined daily doses (DDD) or more of codeine analgesics in 2006 (moderate to high consumers). Fifty percent of those patients (21,759) were also dispensed large amounts of benzodiazepines or carisoprodol over the same period. In comparison, only ten percent of patients who received fewer than 120 DDD of codeine analgesics were dispensed large amounts of benzodiazepines or carisoprodol. Conclusions: A high percentage of the Norwegian population used codeine analgesics. One-year prevalence use of codeine increased with age and was higher for women at all ages. Our study showed that codeine use was mainly sporadic, but that a relatively large sub-group of users were dispensed repeated prescriptions of the drug in combination with other potential drugs of abuse.

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Studying co‐medication patterns: the impact of definitions

Cited by 47 publications

References 17 publications

Aggregated and individual pharmacy record data. Association between antibiotic and antihypertensive drug use

Aggregated and individual pharmacy record data. Association between antibiotic and antihypertensive drug use

Co‐medication of statins and CYP3A4 inhibitors before and after introduction of new reimbursement policy

Repeated dispensing of codeine is associated with high consumption of benzodiazepines

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