Nils von Hentig1,2,3*, Carola Koch3, Rupert Falk3, Barbara Trulzsch3, Hans-Peter Raab3, Klaus Winckler3, Ulrich Klinsing3, Layla Khanlari3, Jorg Odewald3, Susanne Götz3, Angelika Bayer3 and Sebastian Harder4
1Sachsenhausen Practice for General Medicine, Germany 2Medical Clinic II, Goethe University Clinic, Germany 3Health Network Frankfurt eG, Germany 4Goethe University Hospital, GermanyFulltext PDF
Background: In general, management of patients with polypharmacy is a challenge for medical practice. Polypharmacy often is accompanied by Adverse Drug Reactions (ADRs) due to Drug- Drug Interactions (DDIs). Objective: This study aimed to identify, categorize and appraise potentially harmful DDIs in patients with polypharmacy in the ambulatory setting. Patients and Methods: A non-interventional cross-sectional study including 500 patients with a mean (± SD) age of 67, 4 years (± 13.3) (male, n=248; female, n=252). The sample was obtained from n=12 general practitioners in Frankfurt, Germany. Results: The number of prescribed drugs significantly correlates with comorbidities (p<0.001), pharmacodynamic DDIs (p<0.001) and DDIs, categorized as potentially harmful (category “A”; p=0.003). DDIs categorized as “A” were correlated to age, cardiac arrhythmias, renal insufficiency, Type II diabetes mellitus, intake of oral anticoagulants, antiarrhythmics, Proton Pump Inhibitors (PPI)/antiacids, analgesics and systemic corticoids (univariate analysis, p ≤ 0.05). A multivariate regression analysis revealed a significant correlation to the drug strata (p<0.001), Type II Diabetes mellitus (p=0.033) and intake of PPI/antacids (p=0.047). Of all DDIs (n=1465), the majority were (n=1311, 89.5%) pharmakodynamic DDIs, n=634, 48.4% of these categorized as clinically relevant, i.e. (1) alterations of serum Natrium/Potassium, affecting (2) anti-diabetic therapy, (3) antihypertensive treatment, (4) blood coagulation or (5) the ECG (n ≥ 50). N=154 DDIs (10.5%) were of pharmacokinetic origin. Conclusion: The number of detected pharmacokinetic DDIs was low; the majority of clinically relevant DDIs were pharmacodynamic. Training of medical staff should focus on pharmacodynamic DDIs in patients with polypharmacy, especially those with Type II diabetes mellitus.
Drug-drug interactions; Polypharmacy; Diabetes mellitus
von Hentig N, Koch C, Falk R, Trulzsch B, Raab H-P, Winckler K, et al. Pharmacological Investigation of Potential Drug-Drug Interactions in the Context of Polypharmacy and Medical Communication in a German Health Network. Ann Clin Pharmacol Ther. 2022; 3(1): 1009.