Department of Pharmacology and Therapeutics, State University of Maringá, Maringá, PR, Brazil.
J Pharm Pharm Sci. 2012;15(2):344-54. doi: 10.18433/j37k5w.
The primary objective of this study was to investigate the prevalence of clinically important potential drug-drug interactions (DDIs) in elderly patients attending the public primary health care system in Brazil. The secondary objective was to investigate possible predictors of potential DDIs.
A cross-sectional study was carried out in 5 Brazilian cities located in the Ourinhos Micro-region, Sao Paulo State, between November 2010 and April 2011. The selected sample was divided according to the presence (exposed) or absence (unexposed) of one or more potential DDIs (defined as the presence of a minimum 5-day overlap in supply of an interacting drug pair). Data were collected from medical prescriptions and patients' medical records. Potential DDIs (rated major or moderate) were identified using 4 DDI-checker programs. Logistic regression analysis was used to study potential DDI predictors.
The prevalence of clinically important potential DDIs found during the study period was 47.4%. Female sex (OR = 2.49 [95% CI 2.29-2.75]), diagnosis of ≥ 3 diseases (OR = 6.43 [95% CI 3.25-12.44]), and diagnosis of hypertension (OR = 1.68 [95% CI 1.23-2.41]) were associated with potential DDIs. The adjusted OR increased from 0.90 [95% CI 0.82-1.03] in patients aged 60 - 64 years to 4.03 [95% CI 3.79 - 4.28] in those aged 75 years or older. Drug therapy regimens involving ≥ 2 prescribers (OR = 1.39 [95% CI 1.17-1.67]), ≥ 3 drugs (OR = 3.21 [95% CI 2.78-3.59]), ≥ 2 ATC codes (OR = 1.19 [95% CI 1.12-1.29]), ≥ 2 drugs acting on cytochrome P450 (OR = 2.24 [95% CI 2.07-2.46]), and ATC codes B (OR = 1.89 [95% CI 1.05-2.08]) and C (OR = 4.01 [95% CI 3.55-4.57]) were associated with potential DDIs.
Special care should be taken with the prescription and therapeutic follow-up of patients who present characteristics identified as predictors. Knowledge of potential DDI predictors could aid in developing preventive practices and policies that allow public health services to better manage this situation.
本研究的主要目的是调查巴西公立初级卫生保健系统就诊的老年患者中临床显著潜在药物-药物相互作用（DDI）的流行情况。次要目的是研究潜在 DDI 的可能预测因素。
2010 年 11 月至 2011 年 4 月，在巴西圣保罗州奥里纽斯微区的 5 个城市进行了一项横断面研究。根据是否存在（暴露）或不存在（未暴露）一种或多种潜在 DDI（定义为供应相互作用药物对的最小 5 天重叠），对所选样本进行了分组。数据来自医嘱和患者病历。使用 4 个 DDI 检查程序识别潜在的 DDI（评为主要或中度）。使用逻辑回归分析研究潜在 DDI 的预测因素。
研究期间发现，临床显著潜在 DDI 的患病率为 47.4%。女性（OR=2.49[95%CI 2.29-2.75]）、≥3 种疾病诊断（OR=6.43[95%CI 3.25-12.44]）和高血压诊断（OR=1.68[95%CI 1.23-2.41]）与潜在 DDI 相关。调整后的 OR 从 60-64 岁患者的 0.90[95%CI 0.82-1.03]增加到 75 岁或以上患者的 4.03[95%CI 3.79-4.28]。涉及≥2 名处方者（OR=1.39[95%CI 1.17-1.67]）、≥3 种药物（OR=3.21[95%CI 2.78-3.59]）、≥2 个 ATC 代码（OR=1.19[95%CI 1.12-1.29]）、≥2 种作用于细胞色素 P450 的药物（OR=2.24[95%CI 2.07-2.46]）和 ATC 代码 B（OR=1.89[95%CI 1.05-2.08]）和 C（OR=4.01[95%CI 3.55-4.57]）与潜在 DDI 相关。
对于表现出确定为预测因素的特征的患者，应特别注意处方和治疗随访。了解潜在 DDI 的预测因素可以帮助制定预防措施和政策，使公共卫生服务能够更好地管理这种情况。
