Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, United States.
Center for Health Outcomes, Policy, and Economics (HOPE), Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, United States.
J Geriatr Oncol. 2018 Sep;9(5):526-533. doi: 10.1016/j.jgo.2018.02.001. Epub 2018 Apr 13.
Drug-drug interactions (DDIs) represent an escalating concern for older adults attributed to polypharmacy, multi-morbidity and organ dysfunction. Few studies have evaluated the prevalence of major DDIs and the variability between DDI detection software which confuses management.
Prevalence of major DDIs was examined as a secondary analysis of outpatients aged ≥65 years. Demographic and clinical information was collected from electronic health records including age, sex, race, cancer type, comorbidities, and medications. All DDIs were screened by a clinical pharmacist using Lexi-Interact® and Micromedex®. Major DDIs were defined as Lexi-Interact® category D or X and/or Micromedex® category major or contraindication. Summary statistics of patient characteristics and DDIs were computed.
Our cohort included 142 patients (mean age, 77.7 years; 56% women, 73% Caucasian). The mean medications was 9.8 including 6.7 prescriptions, 2.6 non-prescriptions, and 0.5 herbals. Lexi-Interact® identified 310 major DDIs in 69% of patients (n = 98) with an average of 2.2 DDIs per patient. Micromedex® identified 315 major DDIs in 61% of patients (n = 87) with an average of 2.2 DDIs per patient. DDIs mostly involved opioids, antiplatelets, electrolyte supplements, antiemetics, and antidepressants. Variability existed with the severity rating reporting of the clinical decision support software.
There was a high prevalence of major DDIs in older adults with cancer. Utilizing clinical decision support software was beneficial for detecting DDIs however, variability existed with severity reporting. Future studies need to identify the relevant DDIs with clinical implications in order to optimize medication safety in this population.
药物-药物相互作用（DDI）是老年人越来越关注的问题，这归因于多药治疗、多种疾病和器官功能障碍。很少有研究评估主要 DDI 的患病率以及混淆管理的 DDI 检测软件之间的差异。
对年龄≥65 岁的门诊患者进行了主要 DDI 患病率的二次分析。从电子健康记录中收集人口统计学和临床信息，包括年龄、性别、种族、癌症类型、合并症和药物。临床药剂师使用 Lexi-Interact®和 Micromedex®筛选所有 DDI。主要 DDI 定义为 Lexi-Interact®类别 D 或 X 和/或 Micromedex®类别主要或禁忌。计算了患者特征和 DDI 的汇总统计数据。
我们的队列包括 142 名患者（平均年龄 77.7 岁；56%为女性，73%为白种人）。平均用药 9.8 种，包括 6.7 种处方、2.6 种非处方和 0.5 种草药。Lexi-Interact®在 69%的患者（n=98）中发现了 310 种主要 DDI，平均每个患者有 2.2 种 DDI。Micromedex®在 61%的患者（n=87）中发现了 315 种主要 DDI，平均每个患者有 2.2 种 DDI。DDI 主要涉及阿片类药物、抗血小板药物、电解质补充剂、止吐药和抗抑郁药。临床决策支持软件的严重程度报告存在差异。
癌症老年患者中主要 DDI 的患病率较高。使用临床决策支持软件有助于检测 DDI，但严重程度报告存在差异。未来的研究需要确定具有临床意义的相关 DDI，以优化该人群的药物安全性。
