Prevalence of contraindicated combinations amid behavioral and mental health medications filled in a pediatric population.

Autor: Borgelt LM; University of Colorado Anschutz Medical Campus, 1890 N Revere Ct., Mailstop L606, Aurora, CO, 80045, USA. laura.borgelt@cuanschutz.edu., Bliss K; New York State Department of Health, Albany, NY, USA., Matson J; New York State Department of Health, Albany, NY, USA., Cajuste B; New York State Department of Health, Albany, NY, USA., Kuang X; New York State Department of Health, Albany, NY, USA., Toohey M; New York State Department of Health, Albany, NY, USA., Pace W; DARTNet Institute, Aurora, CO, USA., Shemesh E; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA., Lo S; Case Western Reserve University, Rainbow Babies & Children's Hospital, Cleveland, OH, USA., Olczyk A; Case Western Reserve University, Rainbow Babies & Children's Hospital, Cleveland, OH, USA., Gleason K; Advent Health, Hinsdale, IL, USA., Pincus H; New York Presbyterian Hospital, Columbia University, New York City, NY, USA., Kleinman LC; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Jazyk: angličtina
Zdroj: BMC primary care [BMC Prim Care] 2024 Jul 30; Vol. 25 (1), pp. 276. Date of Electronic Publication: 2024 Jul 30.
DOI: 10.1186/s12875-024-02528-9
Abstrakt: Background: Behavioral or mental health disorders are common in children, adolescents, and young adults. Medication use is increasingly common, with few data describing drug-drug combinations in ambulatory settings. The objectives of this study were to describe the pharmaco-epidemiology of behavioral and mental health (BMH) medications among children, adolescents, and young adults in New York Medicaid and assess the prevalence of contraindicated drug pairs within this population.
Methods: This observational cross-sectional study evaluated New York State Medicaid managed care and fee-for-service enrollees under 21 years of age dispensed BMH medications in 2014. Main outcomes included number of members with prescriptions filled; number filling > 1 medication prescription concurrently for ≥ 30 days (polypharmacy), and number and nature of potentially contraindicated drug pairs.
Results: Of 2,430,434 children, adolescents, and young adults, 422,486 (17.4%) had a visit associated with a BMH diagnosis and 141,363 (5.8%) received one or more BMH medications. With 84 distinct medications evaluated, polypharmacy was common, experienced by 53,388 individuals (37.8% of those with a prescription filled), generating 11,115 distinct drug combinations. 392 individuals filled prescriptions for a contraindicated pair of ≥ 2 BMH medications for 30 days or longer. With ≥ 1 day overlap, 651 were exposed to contraindicated medications. The most common contraindicated pairs increased potential risk for prolonged QT interval and serotonin syndrome (n = 378 and n = 250 patients, respectively). Most combinations involved ziprasidone (3247.1 per 10,000 ziprasidone prescriptions filled).
Conclusions: With nearly 6% of members dispensed a BMH medication, contraindicated drug pairs were uncommon. However, any of those combinations represent a potential risk. Clinicians should attend to the balance of potential risks and benefits before contraindicated pairs are dispensed. The methodology described could serve as a basis for monitoring such rare instances and might reduce harm.
(© 2024. The Author(s).)
Databáze: MEDLINE
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