Countrywide prevalence of critical drug interactions in Hungarian outpatients: a retrospective analysis of pharmacy dispensing data

Somogyi-Végh, Anna; Ludányi, Zsófia; Erdős, Ábel; Botz, Lajos

doi:10.1186/s40360-019-0311-0

Table 4 Prevalence of the selected DDIs (‘List B’)

From: Countrywide prevalence of critical drug interactions in Hungarian outpatients: a retrospective analysis of pharmacy dispensing data

Drug 1 - Drug 2	Potential adverse consequence of the interaction	Prevalence per 100000 prescriptions (Number of cases)				R²	Change 2013–2016 (%)	Interaction rate*
Drug 1 - Drug 2	Potential adverse consequence of the interaction	2013	2014	2015	2016			2013	2014	2015	2016
Potassium chloride - ACE inhibitors^a	Hyperkalemia	352.04 (612284)	355.89 (622256)	334.14 (588480)	338.53 (597064)	0.46	DNF	373.23, 38.45	390.52, 39.05	385.01, 36.60	396.43, 36.35
Potassium sparing diuretics^b - ACE inhibitors^c	Hyperkalemia	241.56 (420132)	247.91 (433452)	240.62 (423769)	246.54 (434824)	0.38	DNF	319.27, 27.79	336.72, 28.45	335.44, 27.41	348.54, 27.38
Potassium chloride - Potassium sparing diuretics^b	Hyperkalemia	85.93 (149452)	86.99 (152093)	81.10 (142823)	82.82 (146061)	0.39	DNF	91.10, 113.57	95.45, 118.15	93.44, 113.05	96.98, 117.08
Sulfamethoxazole/ trimethoprim - ACE inhibitors^c	Hyperkalemia	11.40 (19822)	10.64 (18603)	10.28 (18099)	9.86 (17394)	0.97	−12	64.28, 1.24	70.11, 1.17	65.97, 1.13	67.05, 1.06
Vitamin K antagonists^d - Platelet aggregation inhibitors^e	Bleeding	93.62 (162828)	97.67 (170779)	102.49 (180508)	98.27 (173316)	0.53	DNF	87.00, 22.48	92.15, 23.83	99.36, 25.02	97.40, 24.71
NOACs^f - Platelet aggregation inhibitors^e	Bleeding	0.77 (1334)	2.84 (4961)	7.18 (12651)	12.90 (22748)	0.96	+ 1605	23.25, 0.18	36.63, 0.69	51.11, 1.75	57.70, 3.24
NOACs^f - NSAIDs^g	Bleeding	0.48 (830)	2.06 (3607)	5.08 (8944)	8.77 (15472)	0.97	+ 1764	14.47, 0.12	26.64, 0.51	36.13, 1.22	39.24, 2.09
Vitamin K antagonists^d - Amiodarone	Bleeding	17.65 (30690)	17.96 (31398)	18.02 (31741)	17.47 (30813)	0.03	DNF	16.40, 276.48	16.94, 279.31	17.47, 281.21	17.32, 267.92
Vitamin K antagonists^d - Azole antifungals^h	Bleeding	0.56 (971)	0.67 (1175)	0.57 (998)	0.66 (1164)	0.23	DNF	0.52, 4.00	0.63, 4.52	0.55, 3.70	0.65, 4.48
Vitamin K antagonists^d - Sulfamethoxazole/ trimethoprim	Bleeding	1.51 (2618)	1.37 (2387)	1.26 (2216)	1.21 (2127)	0.96	−19	1.40, 8.49	1.29, 9.00	1.22, 8.08	1.20, 8.20
Vitamin K antagonists^d - Metronidazole	Bleeding	0.42 (730)	0.39 (678)	0.44 (770)	0.45 (798)	0.54	DNF	0.39, 5.27	0.37, 4.70	0.42, 5.39	0.45, 5.77
Vitamin K antagonists^d - Ciprofloxacin	Bleeding	2.36 (4107)	2.37 (4152)	2.50 (4408)	2.09 (3681)	0.19	DNF	2.19, 7.45	2.24, 7.40	2.43, 8.09	2.07, 7.42
Narcotic analgesicsⁱ - Benzodiazepines^j	Respiratory depression and sedation	101.23 (176057)	109.39 (191260)	112.79 (198647)	114.47 (201896)	0.91	+ 15	125.09, 27.06	127.73, 28.70	135.34, 30.64	137.90, 31.57
Verapamil - Beta-blockers^k	Cardiovascular adverse effects (e.g. bradycardia)	6.14 (10677)	5.77 (10093)	5.45 (9593)	4.93 (8697)	0.98	−19	36.00, 3.22	38.03, 3.29	39.67, 3.32	39.18, 3.21
Carbamazepine - Clarithromycin	Carbamazepine toxicity, reduced clarithromycin effect	0.16 (274)	0.15 (256)	0.11 (199)	0.11 (197)	0.89	−28	0.54, 0.64	0.52, 0.57	0.43, 0.44	0.43, 0.56
Colchicine - Clarithromycin	Colchicine toxicity (e.g. pancytopenia)	0.00 (5)	0.00 (4)	0.02 (28)	0.01 (11)	LP	LP	0.10, 0.01	0.09, 0.01	0.61, 0.06	0.24, 0.03
Digoxin - Amiodarone	Digoxin toxicity	0.81 (1406)	0.75 (1318)	0.67 (1179)	0.49 (864)	0.92	−39	7.39, 12.67	7.82, 11.72	7.59, 10.44	6.27, 7.52
Digoxin - Verapamil	Digoxin toxicity	1.26 (2190)	1.10 (1927)	0.83 (1456)	0.64 (1121)	0.99	−49	11.51, 7.38	11.44, 7.26	9.37, 6.02	8.12, 5.05
HMG CoA reductase inhibitors^l - Ciclosporin	Statin toxicity (e.g. rhabdomyolysis)	0.08 (136)	0.08 (134)	0.10 (175)	0.08 (145)	0.22	DNF	0.03, 15.84	0.03, 15.50	0.04, 17.73	0.04, 14.10
Tamoxifen - CYP2D6 inhibitors^m	Reduced tamoxifen effect	0.04 (70)	0.02 (43)	0.03 (60)	0.01 (22)	LP	LP	5.63, 0.10	3.78, 0.06	4.71, 0.08	1.68, 0.03
	Total	918.02 (1596613)	944.04 (1650576)	923.84 (1626745)	940.37 (1658416)	0.56	DNF

LP – not calculated because of low prevalence (< 100 cases/year), DNF – not calculated because the linear model does not fit (R² < 0.7)
*number of interaction cases per 1000 prescriptions of Drug 1 and Drug 2, respectively
^abenazepril, captopril, cilazapril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril
^bamiloride, eplerenone, spironolactone
^ccaptopril, enalapril, lisinopril, perindopril, ramipril
^dacenocoumarol, warfarin
^eacetylsalicylic acid, cilostazol, clopidogrel, prasugrel, ticlopidine
^fdabigatran, apixaban, rivaroxaban
^gaceclofenac, acemetacin, dexibuprofen, diclofenac, indometacin, lornoxicam, meloxicam, naproxen, niflumic acid, nimesulide
^hfluconazole
ⁱfentanyl, tramadol
^jalprazolam, clonazepam
^kmetoprolol
^latorvastatin, simvastatin
^mbupropion, duloxetine, fluoxetine, paroxetine

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