Balk T E, van der Sijs I H, van Gelder T, Janssen J J B, van der Sluis I M, van Leeuwen R W F, Engels F K
Department of Pharmacy, Erasmus MC, Rotterdam, The Netherlands.
Faculty of Pharmacy, Utrecht University, Utrecht, The Netherlands.
Pediatr Blood Cancer. 2017 Jul;64(7). doi: 10.1002/pbc.26410. Epub 2017 Feb 16.
Drug-drug interactions (DDIs) can negatively affect pharmacotherapy. However, pediatric DDI studies are scarce. We undertook an exploratory study to investigate prevalence and clinical relevance of DDIs between cytostatic and noncytostatic drugs in outpatient pediatric oncology patients.
After informed consent and inclusion, the following information was collected: currently prescribed noncytostatic and cytostatic drugs, comorbidities, and use of over-the-counter (OTC) drugs, complementary and alternative medicines (CAMs), and dietary supplements. All medication was screened for DDIs according to two databases: Micromedex Solutions and the Dutch drug database G-Standard. The researcher presented DDIs with an associated potential for adverse outcome and a proposal for intervention to three independent experts. If the experts considered a DDI to be potentially clinically relevant and requiring intervention, the physician was notified.
Seventy-three patients were included (median age 8.9 years). A total of 67 different DDIs were counted (66 in Micromedex Solutions, 14 in G-Standard, and 13 DDIs in both databases). The medication reviews resulted in 35 interventions related to 11 different DDIs. The majority of DDIs concerned noncytostatic drugs (25/35) and one third occurred between cytostatic and noncytostatic drugs (10/35). The use of QTc-interval-prolonging drugs resulted in one intervention. The use of OTC drugs, CAM, or dietary supplements did not lead to DDIs.
This study resulted in a selection of 11 potentially clinically relevant DDIs for 73 outpatients in our pediatric oncology department. Interventions were formulated in close collaboration between physicians and clinical pharmacists. Future research should focus on assessing DDIs concerning QTc-interval prolongation.
药物相互作用（DDIs）会对药物治疗产生负面影响。然而，儿科药物相互作用研究较少。我们开展了一项探索性研究，以调查门诊儿科肿瘤患者中细胞毒性药物与非细胞毒性药物之间药物相互作用的发生率及临床相关性。
在获得知情同意并纳入研究后，收集了以下信息：当前开具的非细胞毒性和细胞毒性药物、合并症以及非处方（OTC）药物、补充和替代药物（CAMs）及膳食补充剂的使用情况。根据两个数据库（Micromedex Solutions和荷兰药物数据库G-Standard）对所有药物进行药物相互作用筛查。研究人员向三位独立专家展示了具有不良后果潜在可能性的药物相互作用以及干预建议。如果专家认为某药物相互作用具有潜在临床相关性且需要干预，则通知医生。
纳入73例患者（中位年龄8.9岁）。共统计出67种不同的药物相互作用（Micromedex Solutions中有66种，G-Standard中有14种，两个数据库中均有的有13种）。药物审查导致了与11种不同药物相互作用相关的35项干预措施。大多数药物相互作用涉及非细胞毒性药物（25/35），三分之一发生在细胞毒性药物与非细胞毒性药物之间（10/35）。使用可延长QTc间期的药物导致了一项干预措施。使用非处方药物、补充和替代药物或膳食补充剂未导致药物相互作用。
本研究为我们儿科肿瘤科的73名门诊患者筛选出了11种潜在临床相关的药物相互作用。干预措施是在医生和临床药师密切合作下制定的。未来研究应侧重于评估与QTc间期延长有关的药物相互作用。
