About 21% of children covered by Medicaid in 2019 were exposed to a potentially major interaction between multiple prescription drugs, according to a new study.
Researchers analyzed data from the 2019 Marketscan Medicaid database on more than 781,000 children under 19 years of age who had received at least two outpatient prescriptions and reported their findings in “Major Drug-Drug Interaction Exposure Among Medicaid-Insured Children in the Outpatient Setting,” (Kyler KE, et al. Pediatrics. Jan. 4, 2024). They excluded vaccines, topical drugs and over-the-counter drugs.
The DrugBank database provided the team with information about potential adverse effects of taking drugs together. Researchers focused on those deemed “major,” which DrugBank defined as those where the harms could outweigh the benefits.
Just over one in five children had been prescribed a drug combination that fell into the category of potentially having major effects. The rate of exposure to one of those combinations was four times higher for adolescents than for infants. Children with more complex medical or mental health conditions also had higher rates of exposure than children with less complex conditions, according to the study.
Clonidine, psychiatric medications, asthma/allergy medications and attention-deficit/hyperactivity disorder (ADHD) medications were the drugs most frequently linked to major drug-drug interaction (DDI) exposures.
“Overall, our results show that exposure to major DDIs is common among children receiving multiple prescription medications in the outpatient setting,” author Kathyrn E. Kyler, M.D., M.S., FAAP, a pediatric hospitalist and clinical pharmacology fellow at Children’s Mercy Kansas City, said in a video abstract. “Additionally, some of the drugs most frequently implicated are prescribed for very common pediatric conditions like ADHD, mental health problems and asthma or allergies.”
The greatest health risks identified were impacts on the drug concentrations, neurological effects and cardiovascular effects.
Authors called on health care providers who are prescribing drugs to be aware of possible interactions. They said more research on drug interactions specific to children is needed as well as creative solutions to improve recognition and monitoring.
“It’s important for providers in the outpatient setting to know which drugs they prescribe are frequently implicated in DDIs and which reactions may be the most serious,” Dr. Kyler said. “Future work is needed to determine which of these common DDIs carries the greatest risk of actual adverse drug events or which populations are most at risk.”
