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MAYSAA MAHMOOD, M.S., is Graduate Associate, Department of Pharmaceutical Sciences; DANIEL C. MALONE, PH.D., is Professor, Department of Pharmacy Practice and Science, and Professor, College of Public Health; and GRANT H. SKREPNEK, PH.D., is Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona (UA), Tucson. JACOB ABARCA, PHARM.D., is Clinical Analyst Manager, WellPoint NextRx, West Hills, CA. EDWARD P. ARMSTRONG, PHARM.D., is Professor, Department of Pharmacy Practice and Science, and Professor, Department of Pharmaceutical Sciences; JOHN E. MURPHY, PHARM.D., is Associate Dean and Department Head, Department of Pharmacy Practice and Science; AMY J. GRIZZLE, PHARM.D., is Assistant Director, Center for Health Outcomes and Pharmacoeconomic Research; and YU KO, M.S., is Graduate Associate, Department of Pharmaceutical Sciences, College of Pharmacy, UA. RAYMOND L. WOOSLEY, PH.D., M.D., is President, The Critical Path Institute, Tucson, and Professor of Medicine and Pharmacology, College of Medicine, UA.

Address correspondence to Dr. Malone at the Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 North Martin Avenue, P.O. Box 210202, Tucson, AZ 85721-0202 (malone{at}pharmacy.arizona.edu).

Purpose. This study assessed the prevalence of 25 clinically important drug–drug interactions (DDIs) in the ambulatory care clinics of the Department of Veterans Affairs medical centers (VAMCs). Methods. This study was a retrospective, cross-sectional database analysis of pharmacy records to assess the prevalence of 25 clinically important DDIs. For each DDI, the object drug was defined as the medication that has its therapeutic effect modified by the drug interaction process. The precipitant drug was defined as the medication responsible for affecting the pharmacologic action or the pharmacokinetic properties of the object drug. Rates of interactions for each VAMC facility were calculated as the number of patients with a DDI divided by the total number of individual patients exposed to the object or precipitant medications. The 25 DDIs were categorized into four main categories on the basis of the therapeutic classification of the medications involved in the drug pairs. Results. The study population included 2,795,345 patients who filled prescriptions for medications involved in potential DDIs across 128 VAMCs. The highest DDI exposure rate was 129.2 per 1,000 recipients of monoamine oxidase inhibitors (MAOIs) that occurred with combinations of selective serotonin-reuptake inhibitors (SSRIs). The lowest DDI exposure rate was 0.01 per 1,000 warfarin recipients who had the warfarin and sulfinpyrazone combination. Conclusion. The analysis of pharmacy records of veterans who filled prescriptions at the outpatient settings within VAMC found an overall rate of 2.15% for potential DDIs. Case–exposure rates were greatest for veterans receiving SSRIs and MAOIs, ganciclovir and zidovudine, anticoagulants and thyroid hormones, and warfarin and nonsteroidal antiinflammatory drugs. Index terms: Anticoagulants; Antidepressants; Antiinflammatory agents; Antiretroviral agents; Antivirals; Drug interactions; Ganciclovir; Monoamine oxidase inhibitors; Pharmacokinetics; Prescriptions; Sulfinpyrazone; Thyroid drugs; Uricosuric agents; Warfarin; Zidovudine

 

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				M. H. Mahmood, E. P. Armstrong, D. C. Malone, and G. H. Skrepnek Relationship between pharmaceutical services characteristics and exposure rates to drug-drug interactions in Veterans Affairs medical centers Am. J. Health Syst. Pharm., September 15, 2008; 65(18): 1744 - 1749. [Abstract] [Full Text] [PDF]