Abstract
Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the inappropriate character of PIM. The aim of this study was (1) to describe the prevalence and severity of DDI in patients with PIM and (2) to evaluate the DDI specifically regarding PIM. This systematic review is based on a search carried out on PubMed and Web-of-Science from inception to June 30, 2020. We extracted data of original studies that assessed the prevalence of both DDI and PIM in elderly patients in primary care, nursing home and hospital settings. Four hundred and forty unique studies were identified: 91 were included in the qualitative analysis and 66 were included in the quantitative analysis. The prevalence of PIM in primary care, nursing home and hospital were 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% (95% CI: 27.8–31.6%) and 44.6% (95% CI: 28.3–60.9%), respectively. Clinically significant severe risk-rated DDI averaged 28.9% (95% CI: 17.2–40.6), in a hospital setting; and were approximately 7-to-9 lower in primary care and nursing home, respectively. Surprisingly, only four of these studies investigated DDI involving specifically PIM. Hence, given the high prevalence of severe DDI in patients with PIM, further investigations should be carried out on DDI involving specifically PIM which may increase their inappropriate character, and the risk of adverse drug reactions.
Highlights
A drug–drug interaction (DDI) is usually defined as a clinically significant unintended modification in the exposure and/or response to a medication that occurs with the co-administration of another medication [1]
The aim of this study was to perform a systematic review in hospital, nursing home and primary care settings to evaluate the prevalence and severity of DDI occurring in elderly patients for whom potentially inappropriate medications (PIM) are prescribed, and to evaluate the DDI involving PIM
The current paper presents an in-depth review of the literature regarding the topic of DDI in elderly patients using PIM
Summary
A drug–drug interaction (DDI) is usually defined as a clinically significant unintended modification in the exposure and/or response to a medication (i.e., victim) that occurs with the co-administration of another medication (i.e., perpetrator) [1]. Studies in the field of DDIs usually refer to a potential DDI, defined as the co-prescription of two medications known to interact, that may occur in exposed patients. A pharmacokinetic DDI results from alterations in the processes involved in drug disposition when two drugs are co-administered. These DDI are due to either metabolic enzymes and/or transporters localized in membranes and tissues involved
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