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Randomized Controlled Trial
. 2024 Oct;15(5):1357-1367.
doi: 10.1007/s41999-024-01025-7. Epub 2024 Aug 2.

A descriptive analysis of drug-drug interactions and corresponding adverse drug reactions in multimorbid older inpatients: findings from the SENATOR trial

Ine Simal  1   2 , Annemie Somers  3   4 , Cheima Amrouch  5 , Andreas Capiau  3   4 , Antonio Cherubini  6   7 , Alfonso J Cruz-Jentoft  8 , Adalsteinn Gudmundsson  9   10 , Roy L Soiza  11 , Denis O 'Mahony  12   13 , Mirko Petrovic  5   14
Affiliations
Randomized Controlled Trial

A descriptive analysis of drug-drug interactions and corresponding adverse drug reactions in multimorbid older inpatients: findings from the SENATOR trial

Ine Simal et al. Eur Geriatr Med. 2024 Oct.

Abstract

Purpose: Drug-drug interactions (DDIs) are prevalent among multimorbid and polymedicated older adults and can increase the risk of adverse drug reactions (ADRs), hospital admissions, and mortality. This study describes the incidence and prevalence of 66 clinically relevant DDIs and analyses the occurrence of 12 corresponding predefined ADRs in older inpatients enrolled in the SENATOR trial.

Methods: The sub-study of the SENATOR trial that involved 1537 multimorbid older inpatients, recruited from 2016 to 2018 in six academic teaching hospitals in Belgium, Iceland, Ireland, Italy, Scotland, and Spain respectively, and analysed 66 potentially clinically significant DDIs. Descriptive analysis determined DDI and corresponding ADR prevalence/incidence.

Results: At baseline (median age: 78 [72, 84], 52.8% male), the prevalence of patients with DDIs was high (50.9%), increased during hospitalisation (55.2%) and reduced to 49.7% after 12 weeks. The most common DDIs were: ≥ 2 potassium reducing drugs (17.1%), ≥ 3 centrally acting drugs (9.0%), and SSRI + loop/thiazide diuretic (7.2%). Of all participants, one-third experienced a prevalent (36.6%)/incident (35.8%) ADR. Major serum electrolyte disturbance had the highest incidence (10.7%)/prevalence (11.5%). Incident ADRs were more common in patients with DDIs (p = 0.013). A higher prevalence of new onset falls (p = 0.013), major constipation (p = 0.004), and major serum electrolyte disturbances (p = 0.006) was observed in patients with related and thus potentially causal DDIs.

Conclusions: Clinicians should, be aware of DDIs and the involved drug classes that can lead to an increased rate of ADRs in older multimorbid inpatients. Regularly reevaluating the appropriateness of the frequently prescribed drug classes and initiating judicious deprescribing is recommended.

Keywords: Adverse drug reactions; Drug-drug-interactions; Multimorbidity; Older adults; Polypharmacy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no competing interests. Ethics approval and consent to participate: The present study was approved by the Ethical Committee of Ghent University Hospital on 20/01/2023 (THE-2022–0401).

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