‘Eye opening’ number of children exposed to major drug interactions, study finds
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Key takeaways:
- Among children on Medicaid, 21.4% were exposed to at least one major drug-drug interaction.
- Major exposures were most frequently associated with clonidine.
More than one in five children on Medicaid are exposed to at least one major drug interaction annually, according to findings from a study published in Pediatrics.
A drug-drug interaction (DDI) occurs when a drug’s effect on the body is altered by taking a second drug, resulting in “either exaggerated or reduced drug effects, or unexpected adverse” drug reactions (ADEs), the authors of the new study explained. DDIs are considered “major” when potential harms of the combination outweigh the benefits, they wrote.
According to one of the authors, the study was inspired by an interest in “improving our understanding of polypharmacy, or how having multiple drugs prescribed at one time in children can affect them.”
“We know that kids are experiencing more and more chronic illnesses in the United States over the last couple of decades,” Kathryn E. Kyler, MD, MSc, FAAP, an assistant professor of pediatrics at the University of Missouri-Kansas City, told Healio.
“These are illnesses that kids have that require treatment with medication — things like mental health conditions, or behavioral conditions like ADHD, or even asthma and allergies — that kids are having a lot more frequently now,” Kyler said. “We wondered what it would mean in terms of exposing kids to medications that could cause drug interactions and increase the risk of having adverse drug events occur.”
They studied data from the MarketScan Medicaid database for children aged 18 years or younger with at least one ambulatory encounter and at least two outpatient prescriptions filled in 2019. They determined drug interactions using the 2019 Drugbank database.
“That's a particular database that includes a ton of drug information, including drug-drug interactions and what kinds of adverse drug events might result from those exposures,” Kyler said. “For our analysis, we only wanted to include major drug-drug interactions.”
In a cohort of 781,019 children with two or more medication exposures, 21.4% experienced one or more major DDI exposure, according to the study. The researchers noted that the odds of DDI exposure increased with age and with medical and mental health complexity.
Frequently implicated drugs in these exposures included clonidine, psychiatric medications and asthma medications, and the highest adverse physiologic effect exposure rate per 100 children included increased drug concentrations (14.6), central nervous system depression (13.6) and heart rate-corrected QT interval prolongation (9.9).
Major DDI exposures were most frequently associated with clonidine, which was named in nearly half of children who had at least one drug-drug interaction.
Major DDIs can affect the cardiovascular and central nervous systems and can result in increased or decreased drug concentrations.
“We had anticipated that a sizeable proportion of kids in our study would have exposure to major drug-drug interactions, but the fact that it was more than 20% ... I think was pretty eye opening,” Kyler said.
The authors said prescribers should consider how and when to counsel patients about the risk for adverse drug interactions.
“Clinicians need to be aware that the medications that they're prescribing pretty frequently can easily be implicated in major drug interactions,” Kyler said.
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