Hospitalisations and emergency department visits due to drug–drug interactions: a literature review

Authors

  • Matthijs L Becker PharmD,

    1. Pharmaco-epidemiology Unit, Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
    2. National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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  • Marjon Kallewaard PhD,

    1. National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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  • Peter WJ Caspers PharmD,

    1. National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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  • Loes E Visser PharmD, PhD,

    1. Pharmaco-epidemiology Unit, Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
    2. Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
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  • Hubert GM Leufkens PharmD, PhD,

    1. Department of Pharmaco-epidemiology and Pharmacotherapy, Utrecht University, Utrecht, The Netherlands
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  • Bruno HCh Stricker MD, PhD

    Corresponding author
    1. Pharmaco-epidemiology Unit, Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
    2. Drug Safety Unit, Inspectorate for Health Care, The Hague, The Netherlands
    • Department of Epidemiology & Biostatistics, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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  • No conflict of interest was declared.

Abstract

Purpose

Our objective was to evaluate the incidence of adverse patient outcomes due to drug–drug interactions (D–DIs), the type of drugs involved and the underlying reason. As a proxy for adverse patient outcomes, emergency department (ED) visits, hospital admissions and re-hospitalisations were assessed.

Methods

A literature search in the Medline and Embase database (1990–2006) was performed and references were tracked. An overall cumulative incidence was estimated by dividing the sum of the cases by the sum of the study populations.

Results

Twenty-three studies were found assessing the relationship between D–DIs and ED-visits, hospitalisations or re-hospitalisations. The studies with a large study size showed low incidences and vice versa. D–DIs were held responsible for 0.054% of the ED-visits, 0.57% of the hospital admissions and 0.12% of the re-hospitalisations. In the elderly population, D–DIs were held responsible for 4.8% of the admissions. Drugs most often involved were NSAIDs and cardiovascular drugs. The reasons for admissions or ED-visits, which were most often found were GI-tract bleeding, hyper- or hypotension and cardiac rhythm disturbances.

Conclusion

This review provides information on the overall incidence of D–DIs as a cause of adverse patient outcomes, although there is still uncertainty about the impact of D–DIs on adverse patient outcomes. Our results suggest that a limited number of drugs are involved in the majority of cases and that the number of reasons for admission as a consequence of D–DIs seems to be modest. Copyright © 2006 John Wiley & Sons, Ltd.

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