Schjøtt Jan, Heitmann Kristine, Bakkebø Tina, Jahnsen Jan Anker
Regional Medicines Information and Pharmacovigilance Centres (RELIS Vest), Haukeland University Hospital, Bergen, Norway.
Department of Clinical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
Front Pharmacol. 2020 Dec 18;11:607915. doi: 10.3389/fphar.2020.607915. eCollection 2020.
Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) is challenging due to a wide age span among patients, risk of reduced adherence, and comorbidities like psychiatric disorders and drug addiction. Drugs used for ADHD are associated with risk of interactions and adverse drug reactions due to their potent pharmacological effect. In this brief report we aimed to describe real-world problem areas concerning interactions in pharmacotherapy of ADHD. We reviewed questions to a Norwegian drug information center from physicians concerning drug-drug interactions involving ADHD drugs in the last 10-year period. Questions were retrieved by a combination of indexed and Boolean database searches, in addition to manual inspection. ADHD drugs and interacting drugs were defined according to the Anatomical Therapeutic Chemical (ATC) classification system. Interactions were classified by use of Stockley's Interactions Checker (SIC). Answers were examined with regard to whether the advice from the drug information center was more restrictive, similar or more liberal than SIC when assessing drug combinations. We retrieved 61 questions that included assessment of 96 drug combinations, and found 33 potential interactions according to SIC. Methylphenidate was involved in more than 50% of the interactions, and interacting drugs were in nearly 70% of the cases from ATC-group N (Nervous system) with antidepressants most frequently involved. Seventy percent of the interactions were pharmacodynamic, and interactions were frequently described as potentially severe although they were based on theoretical evidence. All the 33 interactions could be handled with monitoring or adjusting dose or with informative measures, and none was contraindicated according to SIC. More than 90% of the questions came from physicians in hospitals or outpatient specialist practice, and questions mainly concerned adults. In 75% of the drug combinations that involved ADHD drugs, we found similar advice from SIC and the drug information center. Our results suggest that future drug information efforts in ADHD treatment to clinicians, including specialists in the field, should focus on psychotropic interactions.
注意缺陷多动障碍（ADHD）的药物治疗颇具挑战性，这是因为患者年龄跨度大、存在依从性降低的风险以及诸如精神障碍和药物成瘾等合并症。用于治疗ADHD的药物因其强大的药理作用而具有相互作用和药物不良反应的风险。在本简要报告中，我们旨在描述ADHD药物治疗中有关相互作用的实际问题领域。我们回顾了过去10年中医生向挪威药物信息中心提出的关于涉及ADHD药物的药物相互作用的问题。除人工检查外，还通过索引和布尔数据库搜索相结合的方式检索问题。ADHD药物和相互作用药物根据解剖治疗学化学（ATC）分类系统进行定义。相互作用通过使用斯托克利相互作用检查器（SIC）进行分类。在评估药物组合时，就药物信息中心的建议比SIC更具限制性、相似还是更宽松方面对答案进行了检查。我们检索到61个问题，其中包括对96种药物组合的评估，并根据SIC发现了33种潜在相互作用。哌甲酯参与了超过50%的相互作用，且在近70%的案例中，相互作用药物来自ATC组N（神经系统），其中抗抑郁药最为常见。70%的相互作用是药效学方面的，尽管这些相互作用基于理论证据，但经常被描述为可能很严重。所有这33种相互作用都可以通过监测或调整剂量或采取告知性措施来处理，根据SIC没有一种是禁忌的。超过90%的问题来自医院或门诊专科实践的医生，且问题主要涉及成年人。在涉及ADHD药物的75%的药物组合中，我们发现SIC和药物信息中心给出了相似的建议。我们的结果表明，未来针对临床医生（包括该领域的专家）在ADHD治疗方面的药物信息工作应侧重于精神药物相互作用。
