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DANIEL C. MALONE, B.S.PHARM., PH.D., is Associate Professor, College of Pharmacy, University of Arizona, Tucson. DAVID S. HUTCHINS, M.B.A., is Research Advisor, and HEATHER HAUPERT, M.S., is Director of Actuarial Services, Caremark, Scottsdale, AZ. PHILIP HANSTEN, PHARM.D., is Professor, School of Pharmacy, University of Washington, Seattle. BABETTE DUNCAN, PHARM.D., is Director, Division of Finance and Operations, Centers for Medicare and Medicaid Services, Reisterstown, MD. ROBIN C. VAN BERGEN, B.S., was Center Manager, Center for Healthier Aging, Caremark, Elkridge, MD, at the time of writing. STEVE L. SOLOMON, M.D., is Acting Director, Health Systems, Centers for Disease Control and Prevention, Atlanta, GA. RICHARD B. LIPTON, M.D., is Professor and Vice Chair of Neurology, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.
Address correspondence to Dr. Malone at the College of Pharmacy, University of Arizona, 1703 E. Mabel, Tucson, AZ 85721 (malone{at}pharmacy.arizon.edu).
Methods. A retrospective cross-sectional analysis of pharmaceutical claims for almost 46 million participants in a PBM was conducted to determine the frequency of 25 DDIs previously identified as clinically important. A DDI was counted when drugs in potentially interacting combinations were dispensed within 30 days of each other during a 25-month period between April 2000 and June 2002.
Results. The number of DDIs ranged from 37 for pimozide and an azole antifungal to 127,684 for warfarin and a nonsteroidal antiinflammatory drug (NSAID). The highest prevalence (278.56 per 100,000 persons) and highest case-exposure rate (242.7 per 1,000 warfarin recipients) occurred with the warfarin–NSAID combination. The combination with the lowest overall prevalence (cyclosporine and a rifamycin, 0.10/100,000) differed from the combination with the lowest case-exposure rate (pimozide and an azole antifungal, 0.028 per 1,000 azole antifungal recipients). Number of cases, prevalence, and case-exposure rates for both sexes generally increased with age. An estimated 374,000 plan participants were exposed to a clinically important DDI during a 25-month period. Between 20% and 46% of prescription drug claims were reversed (canceled) for a medication with a drug interaction when a warning about the interaction was sent to the pharmacy.
Conclusion. Analysis of prescription claims data from a major PBM found that 374,000 of 46 million plan participants had been exposed to a potential DDI of clinical importance.
Index terms: Age; Anticoagulants; Antifungals; Antiinflammatory agents; Antipsychotic agents; Cyclosporine; Drug interactions; Immunosuppressive agents; Interventions; Pharmacy benefit management companies; Pimozide; Prescriptions; Rifamycins; Toxicity; Warfarin
Purpose. The prevalence of 25 clinically important potential drug–drug interactions (DDIs) in a population represented by the drug claims database of a pharmacy benefit management company (PBM) was studied.
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