Potential drug-drug interactions in the outpatient setting

Background: Although medication safety research has tended to focus on inpatients, the safety of drug use among outpatients is also a concern. Objective: We estimate the frequency of potentially interacting concomitant medication dispensing among outpatients. Research Design: We report the number and percent of patients annually dispensed an object drug of interest (ie, warfarin, digoxin, cyclosporine, or lovastatin/simvastatin) with a potentially interacting drug among a random sample of insured adults receiving care from 10 integrated delivery systems. We use 2 definitions of concomitant dispensing: medications dispensed: 1) during the time period for which the patient had the other medication available ('days supply') and 2) on the same day. We also estimate the number of insured U.S. population codispensed these medication pairs. Results: Among patients dispensed a drug of interest, between 17.8% (95% confidence interval [CI] = 17.1-18.6%) and 28.0% (95% CI = 24.0-32.1%) were concomitantly dispensed a potentially interacting drug using the "days supply" definition, and between 7.1% (95% CI = 6.6-7.7%) and 17.7% (95% CI = 14.42 1.1%) using the "same day" definition. Extrapolating to the insured U.S. population, between 1.29 (95% CI = 1.25-1.33; same day) and 2.67 (95% CI = 2.62-2.72; days supply) million insured adults are dispensed I of these 4 potentially interacting pairs. Conclusions: We found evidence of potentially interacting concomitant medication dispensing among outpatients. An opportunity exists to better understand how such dispensing translates into adverse events and ultimately to improved medication safety.