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.
Keywords
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Article info
Publication history
Published online: April 23, 2021
Footnotes
Funding sources: This work is part of the project “OPERAM: OPtimising thERapy to prevent Avoidable hospital admissions in the Multi-morbid elderly” supported by the European Union's Horizon 2020 research and innovation program under the grant agreement no. 6342388, and by the Swiss State Secretariat for Education, Research, and Innovation (SERI) under contract number 15.0137. The opinions expressed and arguments employed herein are those of the authors and do not necessarily reflect the official views of the EC and the Swiss government. The work of Axel Löwe was partly funded by a grant from the Swiss National Science Foundation (SNSF 320030-172676 to Nicolas Rodondi).
The authors declare no conflics of interest.
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