Gagne J J, Maio V, Rabinowitz C
Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA.
J Clin Pharm Ther. 2008 Apr;33(2):141-51. doi: 10.1111/j.1365-2710.2007.00891.x.
Drug-drug interactions (DDIs) are preventable medication errors associated with potentially serious adverse events and death. Several studies have examined the prevalence of potential DDIs among ambulatory patients in various countries. Limited recent data on the prevalence of potential DDIs in Italy are available in the medical literature. The objective of this study was to estimate the prevalence of clinically important potential DDIs among the approximately 4 million residents of Regione Emilia-Romagna (RER), Italy, and to examine possible predictors of potential DDI exposure.
A retrospective follow-up study of 2004 outpatient prescription data from RER was conducted. A previously published list of clinically important potential DDIs was refined to include only pairs of drugs in which both drugs were reimbursed by the 2004 Italian National Formulary. A potential DDI was defined as the presence of a minimum 5-day overlap in days supply for drugs in an interacting pair. The 1-year period prevalence of each potential DDI was quantified. A logistic regression analysis was conducted to examine patient characteristics as predictors of potential DDIs.
The list of clinically important potential DDIs included 12 drug pairs that could be captured using the RER database. These 12 potential DDIs occurred 8894 times in the RER population in 2004. The most commonly identified potentially interacting medication pairs were warfarin and non-steroidal anti-inflammatory drugs (6824 cases), theophylline/aminophylline and ciprofloxacin/fluvoxamine (930), and warfarin and barbiturates (567). Odds of exposure were highest among those aged 65 years or older, males, and those with more chronic conditions. Odds of exposure increased 1.39 times with each addition of a prescription medication.
A substantial number of clinically important potential DDIs were identified, particularly among warfarin users. Awareness of the most prevalent potential DDIs can help practitioners prevent concomitant use of these dangerous medication combinations.
药物相互作用（DDIs）是可预防的用药错误，与潜在的严重不良事件及死亡相关。多项研究已调查了不同国家门诊患者中潜在药物相互作用的发生率。医学文献中关于意大利潜在药物相互作用发生率的近期数据有限。本研究的目的是估计意大利艾米利亚 - 罗马涅大区（RER）约400万居民中具有临床重要性的潜在药物相互作用的发生率，并探究潜在药物相互作用暴露的可能预测因素。
对RER地区2004年门诊处方数据进行回顾性随访研究。对先前发表的具有临床重要性的潜在药物相互作用列表进行完善，使其仅包括两种药物均被2004年意大利国家处方集报销的药物对。潜在药物相互作用定义为相互作用药物对中药物的供应天数至少有5天重叠。对每种潜在药物相互作用的1年期间患病率进行量化。进行逻辑回归分析以检查患者特征作为潜在药物相互作用的预测因素。
具有临床重要性的潜在药物相互作用列表包括12种可通过RER数据库获取的药物对。这12种潜在药物相互作用在2004年RER人群中发生了8894次。最常发现的潜在相互作用药物对是华法林与非甾体抗炎药（6824例）、茶碱/氨茶碱与环丙沙星/氟伏沙明（930例）以及华法林与巴比妥类药物（567例）。65岁及以上人群、男性以及患有更多慢性病的人群暴露几率最高。每增加一种处方药，暴露几率增加1.39倍。
识别出了大量具有临床重要性的潜在药物相互作用，尤其是在华法林使用者中。了解最常见的潜在药物相互作用有助于从业者预防这些危险药物组合的同时使用。
