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“During 2013-2014, one-fifth of children and adolescents used at least one prescription medication and [about] 1 in 10 concurrently used two [or more] prescription medications,” Dima M. Qato, PharmD, MPH, PhD, of the University of Illinois at Chicago, and her colleagues wrote in Pediatrics. “Among children and adolescents concurrently using two [or more] prescription medications, 1 in 12 was at risk for a major DDI.”
The researchers used data from the six most recent cycles of the National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics, beginning with the 2003-2004 cycle through the 2013-2014 cycle, yielding a sample of 23,152 participants aged 0-19 years across the 10-year period. The survey differentiated between prescriptions for acute use (used for 30 days or less) or for chronic use. Concurrent use was defined as using two or more prescription drugs within the 30 days prior to taking the survey. The Micromedex was used to determine the possibility of having a DDI.
The investigators noted a “notable” decrease in the use of acute drug treatments from 11% at the beginning to 7% at the end of the 10-year cycle (P less than .01). This was “driven largely by a decrease in the use of antibiotics.”
They identified the most commonly used prescription drugs, including respiratory agents, especially bronchodilators (the most common type was albuterol); psychotherapeutic agents, especially CNS stimulants (most commonly methylphenidate); and antidepressants (most commonly fluoxetine).
“Among concurrent users of prescription medications, combinations that involved respiratory agents, such as bronchodilators and leukotriene modifiers, and psychotropic medications, including antidepressants, atypical antipsychotics, and CNS stimulants, were the most prevalent,” Dr. Qato and her colleagues wrote. Of the 301 concurrent users in the 2013-2014 survey cycle, 156 unique drugs were used.
Of the children and adolescents who were concurrently using prescription medications, 8% were at risk for major DDIs, the researchers noted. “Nearly half of interacting regimens used involved psychotropic agents, primarily antidepressants, the most common adverse interaction effect being QT prolongation.” About 68% of these regimens included use of at least one acute medication.
They also found that “prescription medications associated with an increased risk of suicidality are commonly used in children and adolescents and are often used together. For example, more than half of adolescent girls taking antidepressants concurrently use at least two additional psychotropic medications or hormonal contraceptives. Although there is some evidence that the combined use of these drugs may increase the onset and severity of suicidal thoughts and behavior, we found no cases of DDIs associated with suicidality.”
Dr. Qato and her colleagues noted some limitations to their study, including using the potential for DDI rather than actual adverse events, survey data being limited to prescription medications and not over-the-counter treatments, and the possible misclassification of chronic medications as acute medications depending on when treatments were initiated.
That being said, the investigators concluded that treatment “and prevention efforts to reduce the burden of adverse drug events in younger populations should be used to consider the role of interacting drug combinations, especially among these individuals.”
Funding for the study was provided by the Robert Woods Johnson Foundation. No relevant financial disclosures were reported.
SOURCE: Qato DM et al. Pediatrics. 2018 Aug 27. doi: 10.1542/peds.2018-1042.