Pauline Anrys1, Anne-Elisabeth Petit1, Stefanie Thevelin1, Bastiaan Sallevelt2, Clara Drenth3, Roy L Soiza4, Andrea Correa-Pérez5, Olivia Dalleur6, Isabelle De Brauwer7, Mirko Petrovic8, Jamie J Coleman9, Kieran Dalton10, Denis O'Mahony11, Axel Löwe12, Silvan Thürig13, Aðalsteinn Gudmundsson14, Antonio Cherubini15, Agapios Panos16, Dimitris Mavridis16, Nicolas Rodondi17, Anne Spinewine18. 1. Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium. 2. Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands. 4. Ageing Clinical & Experimental Research (ACER), University of Aberdeen, United Kingdom. 5. Geriatrics Department, Hospital Universitario Ramón y Cajal (IRYCIS) and Faculty of Health Sciences, Universidad Francisco Vitoria, Madrid, Spain. 6. Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium; Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 7. Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium. 8. Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium. 9. Institute of Clinical Sciences, College of Medical and Dental Sciences (CMDS), University of Birmingham, Birmingham, United Kingdom. 10. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland. 11. Department of Medicine, University College Cork, & Consultant Physician (Geriatric & Stroke Medicine), Cork University Hospital, Wilton, Cork, Ireland. 12. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Department of Internal Medicine, Hirslanden Bern Clinical Consortium, Schänzlihalde 11, Bern, Switzerland. 13. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 14. Landspitali University Hospital, Department of Geriatrics, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 15. Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy. 16. Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece. 17. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. 18. Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium; Pharmacy Department, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium. Electronic address: anne.spinewine@uclouvain.be.
Abstract
OBJECTIVES: We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged ≥65 years. DESIGN: A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided. SETTING AND PARTICIPANTS: Twenty nine experts, including geriatricians and clinical pharmacists from 8 European countries. MEASURES: For each DDI, in the first 2 rounds, experts were asked to score the severity of potential harm on a 5-point Likert-type scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round. RESULTS: Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs. CONCLUSION AND IMPLICATIONS: We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiologic and intervention studies.
OBJECTIVES: We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged ≥65 years. DESIGN: A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided. SETTING AND PARTICIPANTS: Twenty nine experts, including geriatricians and clinical pharmacists from 8 European countries. MEASURES: For each DDI, in the first 2 rounds, experts were asked to score the severity of potential harm on a 5-point Likert-type scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round. RESULTS: Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs. CONCLUSION AND IMPLICATIONS: We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiologic and intervention studies.