Co-prescription trends in a large cohort of subjects predict substantial drug-drug interactions.
Co-prescription trends in a large cohort of subjects predict substantial drug-drug interactions.
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DOI：
10.1371/journal.pone.0118991
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Ryan TP
中科院分区：
文献类型：
--
作者：
Sutherland JJ;Daly TM;Liu X;Goldstein K;Johnston JA;Ryan TP
药物处方和药物-药物相互作用数据是处方者应避免或密切监测的药物组合建议的基础。由于服用多种药物的患者数量正在增加，因此全面了解患者的处方模式对于更好地评估真实世界的药物反应和评估多种药物相互作用的可能性非常重要。我们从1999年至2010年的NHANES调查中获得了自我报告的处方数据，并证实了先前报道的老年人用药增加的发现。我们通过2009-2010年的调查研究了共同处方药的趋势，该调查包含10537名受试者使用的690种药物的处方数据。我们发现65岁或以上的个体的用药情况是独特的，每100名服用3种或更多药物的受试者中遇到≥98种独特的药物方案。当按治疗类别查看药物时，发现最常用的处方药并不是被调查的16种药物类别中最常用的共同处方药。我们将这些药物清单与Drugs.com上的药物相互作用数据进行交叉对照，以评估药物相互作用的可能性。药物警报的数量与共同处方药物的数量成比例地增加，从处方5种药物的3.3个警报增加到处方10种药物的11.7个警报。我们发现22%的老年受试者同时服用给定细胞色素P450酶的底物和抑制剂，4%同时服用同一酶的多种抑制剂。通过检查0.1%或更多人群中处方的药物对，我们发现文献中共同处方率和共同讨论之间的一致性很低。这些数据表明，治疗中的处方趋势可以在很大程度上驱动药物反应的个体差异，并且目前评估药物-药物相互作用的两两方法可能不足以预测现实世界的结果。
Pharmaceutical prescribing and drug-drug interaction data underlie recommendations on drug combinations that should be avoided or closely monitored by prescribers. Because the number of patients taking multiple medications is increasing, a comprehensive view of prescribing patterns in patients is important to better assess real world pharmaceutical response and evaluate the potential for multi-drug interactions. We obtained self-reported prescription data from NHANES surveys between 1999 and 2010, and confirm the previously reported finding of increasing drug use in the elderly. We studied co-prescription drug trends by focusing on the 2009-2010 survey, which contains prescription data on 690 drugs used by 10,537 subjects. We found that medication profiles were unique for individuals aged 65 years or more, with ≥98 unique drug regimens encountered per 100 subjects taking 3 or more medications. When drugs were viewed by therapeutic class, it was found that the most commonly prescribed drugs were not the most commonly co-prescribed drugs for any of the 16 drug classes investigated. We cross-referenced these medication lists with drug interaction data from Drugs.com to evaluate the potential for drug interactions. The number of drug alerts rose proportionally with the number of co-prescribed medications, rising from 3.3 alerts for individuals prescribed 5 medications to 11.7 alerts for individuals prescribed 10 medications. We found 22% of elderly subjects taking both a substrate and inhibitor of a given cytochrome P450 enzyme, and 4% taking multiple inhibitors of the same enzyme simultaneously. By examining drug pairs prescribed in 0.1% of the population or more, we found low agreement between co-prescription rate and co-discussion in the literature. These data show that prescribing trends in treatment could drive a large extent of individual variability in drug response, and that current pairwise approaches to assessing drug-drug interactions may be inadequate for predicting real world outcomes.
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影响因子：
4.3
作者：
Duke JD;Han X;Wang Z;Subhadarshini A;Karnik SD;Li X;Hall SD;Jin Y;Callaghan JT;Overhage MJ;Flockhart DA;Strother RM;Quinney SK;Li L
通讯作者：
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影响因子：
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作者：
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影响因子：
3.7
作者：
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通讯作者：
Catapano, Alberico Luigi
影响因子：
17.1
作者：
Zhao S;Nishimura T;Chen Y;Azeloglu EU;Gottesman O;Giannarelli C;Zafar MU;Benard L;Badimon JJ;Hajjar RJ;Goldfarb J;Iyengar R
通讯作者：
Iyengar R
DOI：
10.1197/jamia.m2808
发表时间：
2009-01-01
影响因子：
6.4
作者：
Paterno, Marilyn D.;Maviclia, Saverio M.;Gandhi, Tejal K.
通讯作者：
Gandhi, Tejal K.