Guédon-Moreau Laurence, Ducrocq Dominique, Duc Marie-Francoise, Quieureux Yves, L'Hôte Catherine, Deligne Jean, Caron Jacques
Faculte de Medecine, Service de Pharmacologie, 2 Avenue Oscar Lambret, 59037 Lille, France.
Eur J Clin Pharmacol. 2004 Feb;59(12):899-904. doi: 10.1007/s00228-003-0709-9. Epub 2003 Dec 19.
Adverse drug interactions increase morbidity and mortality. To prevent these, situations leading to adverse prescriptions must be clarified. This study quantifies and analyses prescriptions with potential adverse drug interactions in primary health care in the North of France over a 3-month period.
All prescriptions administered between 1 January 1999 and 31 March 1999 were analysed to identify potential interactions amongst drugs appearing on the same prescription sheet. The regional French healthcare database was compiled to further classify contraindications.
There were 5,358,374 prescriptions administered to 44% of the overall population of the Nord-Pas de Calais area (1,754,372 patients per 3,990,167 general population). There were 14,390 prescriptions classified as either absolute (26%) or relative contraindications (74%). Nine drug categories accounted for most of the absolute contraindications: dopaminergic antiparkinsonians, neuroleptic agents, migraine treatments (such as ergot alkaloids, sumatriptan and other triptan derivatives), prokinetic drugs (cisapride), antibacterial drugs (macrolides), antifungals (imidazoles), antiarrhythmics, beta-blockers and analgesics (opioids and floctafenine). In 54% of patients exposed, the incurred risk was either QT prolongation/Torsade de Pointes or antagonism of dopaminergic antiparkinson agents with dopamine receptor antagonists prescribed as antipsychotic agents.
Among a non-selected population of ambulatory outpatients, the number of quarterly prescriptions with contraindications with potentially harmful drug interactions is 27 in 10,000 prescriptions. This would extrapolate to nearly 200,000 contraindications on same-prescription sheets in France in the first quarter of 1999.
药物不良相互作用会增加发病率和死亡率。为预防这些情况，必须明确导致不良处方的情形。本研究对法国北部初级医疗保健机构在3个月期间存在潜在药物不良相互作用的处方进行了量化和分析。
对1999年1月1日至1999年3月31日期间开具的所有处方进行分析，以确定同一张处方单上药物之间的潜在相互作用。汇编法国地区医疗保健数据库以进一步分类禁忌情况。
加来海峡大区总人口的44%（3990167名普通人群中的1754372名患者）接受了5358374张处方。有14390张处方被归类为绝对禁忌（26%）或相对禁忌（74%）。九类药物占了大部分绝对禁忌：多巴胺能抗帕金森病药物、抗精神病药物、偏头痛治疗药物（如麦角生物碱、舒马曲坦和其他曲坦衍生物）、促动力药物（西沙必利）、抗菌药物（大环内酯类）、抗真菌药物（咪唑类）、抗心律失常药物、β受体阻滞剂和镇痛药（阿片类药物和氟洛芬）。在暴露的患者中，54%面临的风险是QT间期延长/尖端扭转型室性心动过速，或是多巴胺能抗帕金森病药物与作为抗精神病药物开具的多巴胺受体拮抗剂之间的拮抗作用。
在未经过挑选的门诊患者群体中，每10000张处方中有27张存在具有潜在有害药物相互作用的禁忌情况。这可以推断在1999年第一季度法国同一张处方单上有近200000种禁忌情况。
