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Potential Drug Interactions in Medication Regimens of Adults Who Have Intellectual and Developmental Disabilities

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Title: Potential Drug Interactions in Medication Regimens of Adults Who Have Intellectual and Developmental Disabilities
Language: English
Authors: Steven R. Erickson (ORCID 0000-0002-1855-3645), Jennifer L. Jones, Kami L. Gallus, Amy Esler, James Houseworth
Source: Journal of Developmental and Physical Disabilities. 2022 34(5):795-828.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 34
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Drug Use, Adults, Intellectual Disability, Developmental Disabilities, At Risk Persons, Correlation, Interaction
Geographic Terms: Oklahoma
DOI: 10.1007/s10882-021-09824-7
ISSN: 1056-263X
1573-3580
Abstract: Polypharmacy is a risk factor for drug interactions (DI). Adults with intellectual and developmental disabilities (IDD) are at increased risk for polypharmacy and as such increased risk for potential DIs. The objectives of this study were to determine the number of potential DIs present in medication regimens of adults with IDD as well as factors associated with the number of potential DIs. Community-based cross sectional study. Retrospective analysis of data obtained from the cross-sectional National Core Indicators survey in the state of Oklahoma in the United States. 598 respondents were included. The number of medications prescribed, the number of potential DIs, and the association between participant factors with the total number of potential DIs present. 598 adults with IDD were studied. In this sample, over 80% had at least one DI present in their current medication regimen. There were 8.9 ± 9.7 potential DIs in the medication regimens, with 29.8% of participants having 12 or more. Greater number of medications was significantly associated with a greater number of potential drug interactions. People with IDD who take medications are exposed to potential drug interactions. Health care professionals must have clear goals and endpoints in mind when prescribing medications for this vulnerable population. Potential drug interactions are common in the medication regimens of adults with intellectual or developmental disabilities. Polypharmacy is associated with a greater number of potential drug interactions. Health care professionals must have clear goals and endpoints in mind when prescribing medications for adults with IDD to minimize the occurrence of drug interactions.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1431394
Database: ERIC
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  Value: <anid>AN0159162291;jdp01oct.22;2022Sep20.02:59;v2.2.500</anid> <title id="AN0159162291-1">Potential Drug Interactions in Medication Regimens of Adults who have Intellectual and Developmental Disabilities </title> <p>Polypharmacy is a risk factor for drug interactions (DI). Adults with intellectual and developmental disabilities (IDD) are at increased risk for polypharmacy and as such increased risk for potential DIs. The objectives of this study were to determine the number of potential DIs present in medication regimens of adults with IDD as well as factors associated with the number of potential DIs. Community-based cross sectional study. Retrospective analysis of data obtained from the cross-sectional National Core Indicators survey in the state of Oklahoma in the United States. 598 respondents were included. The number of medications prescribed, the number of potential DIs, and the association between participant factors with the total number of potential DIs present. 598 adults with IDD were studied. In this sample, over 80% had at least one DI present in their current medication regimen. There were 8.9 ± 9.7 potential DIs in the medication regimens, with 29.8% of participants having 12 or more. Greater number of medications was significantly associated with a greater number of potential drug interactions. People with IDD who take medications are exposed to potential drug interactions. Health care professionals must have clear goals and endpoints in mind when prescribing medications for this vulnerable population. Potential drug interactions are common in the medication regimens of adults with intellectual or developmental disabilities. Polypharmacy is associated with a greater number of potential drug interactions. Health care professionals must have clear goals and endpoints in mind when prescribing medications for adults with IDD to minimize the occurrence of drug interactions.</p> <p>Keywords: Intellectual developmental disabilities; Drug interactions; National core indicators; Polypharmacy</p> <hd id="AN0159162291-2">Introduction</hd> <p>People with intellectual and developmental disabilities (IDD) have multiple risk factors for medication-related problems, including polypharmacy, drug interactions (DI), complex medication regimens, poor communication between clinicians and patients, reliance on caregivers with varying levels of competence in administering and monitoring medication therapy, and excessive use of psychotropic medication to manage behavior (Doan et al., [<reflink idref="bib12" id="ref1">12</reflink>]; Erickson et al., [<reflink idref="bib17" id="ref2">17</reflink>], [<reflink idref="bib15" id="ref3">15</reflink>]; Krahn et al., [<reflink idref="bib27" id="ref4">27</reflink>]). A recent study found that adults with IDD had greater odds of having a hospitalization associated with an adverse medication event than the general adult population. In the multivariate logistic regression model, IDD was significantly associated, with an odds ratio of 1.28 (1.19–1.38) (Erickson et al., [<reflink idref="bib16" id="ref5">16</reflink>]).</p> <p>Drug-drug interactions are events that occur when two or more medications taken simultaneously result in a physiological response that is different from that intended by the use of each drug alone (Hines & Murphy, [<reflink idref="bib22" id="ref6">22</reflink>]). There may be an alteration of the pharmacodynamic or pharmacokinetic characteristics of a drug with the addition of a second drug to a regimen. This in turn may result in either an adverse drug reaction or a reduction in the effectiveness of one or both of the medications (Corrie & Hardman, [<reflink idref="bib9" id="ref7">9</reflink>]). Severity of drug interactions vary from minor or undetectable (clinically not significant) to severe enough to negatively impact health and significantly increase the cost of health-care (Olsen & Sletvold, [<reflink idref="bib39" id="ref8">39</reflink>]).</p> <p>The prevalence of DIs in the general population varies widely, with research findings ranging from 16 to 91% (Aparasu et al., [<reflink idref="bib1" id="ref9">1</reflink>]; Becker et al., [<reflink idref="bib5" id="ref10">5</reflink>]; Björkman et al., [<reflink idref="bib6" id="ref11">6</reflink>]; Bozana et al., [<reflink idref="bib8" id="ref12">8</reflink>]; Costa, [<reflink idref="bib10" id="ref13">10</reflink>]; Holm et al., [<reflink idref="bib23" id="ref14">23</reflink>]; Obreli et al., [<reflink idref="bib36" id="ref15">36</reflink>]). Variability in the study population, design, setting, and drug interaction screening tools used in each study are some reasons for this variability. Factors associated with potential DIs include patients' age, gender (female), education (lower education), greater number of co-morbidities, and number of prescribed medications or polypharmacy (Aparasu et al., [<reflink idref="bib1" id="ref16">1</reflink>]; Becker et al., [<reflink idref="bib4" id="ref17">4</reflink>]; Becker, et al., [<reflink idref="bib5" id="ref18">5</reflink>]; Bjorkman et al., [<reflink idref="bib6" id="ref19">6</reflink>]; Bozana et al., [<reflink idref="bib8" id="ref20">8</reflink>]; Costa, [<reflink idref="bib10" id="ref21">10</reflink>]; Lindblad et al., [<reflink idref="bib29" id="ref22">29</reflink>]; Lopez-Picazo et al., [<reflink idref="bib31" id="ref23">31</reflink>]; Obreli et al., [<reflink idref="bib36" id="ref24">36</reflink>]; Tulner et al., [<reflink idref="bib46" id="ref25">46</reflink>]). Of all risk factors, polypharmacy is the most frequently and, in regression models, strongly associated with the presence of DIs. Polypharmacy is a frequently identified problem for people with IDD, ranging from 11 to 60% (Stortz et al., [<reflink idref="bib43" id="ref26">43</reflink>]). A population-based study of an Australian sample of adults with IDD demonstrated that 27% experienced medication regimens of 5 or more medications (Haider et al., [<reflink idref="bib20" id="ref27">20</reflink>]). Although the risk of DIs being present in medication regimens has been discussed in analyses of polypharmacy in the medication regimens of people with IDD, more specific analysis of the reasons for and types of DIs is under-reported (Schoufour et al., [<reflink idref="bib41" id="ref28">41</reflink>]; Stortz et al., [<reflink idref="bib43" id="ref29">43</reflink>]). A recent study by McMahon et al. ([<reflink idref="bib33" id="ref30">33</reflink>]) studied the prevalence of potential DIs in a population of 217 adults with IDD, finding 519 potential DIs of clinical significance. The present study was undertaken to provide additional assessment of potential drug interactions of adults with IDD.</p> <p>The objectives of this study were to determine the level of polypharmacy among a sample of adults with IDD, to determine the number of potential DIs present per participant, and to determine the association between participant demographics and number of medications with the number of potential DIs for adults with IDD. An important point to note is that the DIs listed in this study should be considered <emph>potentially</emph> clinically significant DIs. The term "drug interaction (DI)" is used to refer to potential drug-drug interactions in this report.</p> <hd id="AN0159162291-3">Methods</hd> <p> <emph>Design</emph>: This is a retrospective cross sectional analysis of potential DIs found in the medication regimens of adults with IDD.</p> <p> <emph>Dataset</emph>: Data used for this study were obtained from the Oklahoma 2017–2018 National Core Indicators Adult In-Person Survey (NCI IPS) dataset provided by the Institute for Developmental Disabilities at Oklahoma State University (OSU) in the United States. The NCI IPS is a component of a national quality enhancement program designed to improve long-term supports and services for adults with IDD in the United States. The dataset used for this analysis did not contain information that would provide evidence of actual clinical effect of a DI present in a subject's medication regimen. Medications intended for regular administration as well as those intended for "as needed" use were included. Nonprescription medication taken regularly were included, such as aspirin, for example. Alternative medications such as herbal substances were not included. Other interactions can occur, such as drug-food and drug-laboratory interactions. These were not assessed in this current project. Data collection procedures were approved by the human subjects review board (IRB) at OSU and a data use agreement was used between universities for secondary data analysis in the current study.</p> <p> <emph>Procedures:</emph> Since 2013, the Oklahoma Department of Human Services Developmental Disabilities Services agency has contracted with researchers at Institute for Developmental Disabilities at OSU to collect the NCI IPS. The NCI IPS is administered in face-to-face interviews with adults with disabilities and people actively involved in their lives. The survey has three components. The first component is the "Background Section," which contains information related to the individual's demographic characteristics, health issues, diagnoses, use of services, behavioral support needs, and daily activities and employment. Background data is gathered from a combination case management records, service provider records, or state Developmental Disability agency database, but can also come from other sources such as the individuals themselves. State database records are also used, if necessary, to obtain exam and health history and employment status. The second component, "Section I," focuses on personal experiences regarding home and employment/daily activities environments, relationships with friends and family members, satisfaction with supports and services, and self-directed supports. This information comes directly from interviewing the individual receiving services. The third component, "Section II" concentrates on the individual's rights, access to services, community involvement, and choice. These questions are objective and answered by the individual receiving services or a proxy.</p> <p> <emph>Subjects:</emph> All adults (age 18 years and older) included in the 2017–2018 dataset had a diagnosis of intellectual disability and received at least one Medicaid Home and Community Based waivered service (e.g., vocational, direct support staff) in addition to case management from Oklahoma DDS. Data collection procedures were approved by the human subjects review board (IRB) at OSU and a data use agreement was used between universities for secondary data analysis in the current study.</p> <p> <emph>Data:</emph> Individual factors of interest included age, gender, race, and severity of intellectual disability (i.e., mild, moderate, or severe/profound). In 2017–2018 a question was added to the Background Section of the Oklahoma specific version of the NCI IPS that recorded the names of all medications taken by the individual on a daily basis, including "as needed" medications. To assure accuracy of medication data collected, surveyors recorded information included on the participants' current medication list and a team of trained graduate students reviewed and entered all medications into the data set.</p> <p> <emph>Determination of pairs of potential drug interactions</emph>: All medications listed as prescribed for each participant were reviewed by one investigator (SE), a clinical pharmacist using the DI software using the Lexicomp Online Interactions module DI software from Lexicomp© (Lexicomp Online, [<reflink idref="bib28" id="ref31">28</reflink>]). All medications documented in the NCI database were entered into the user interface for the DI software. The resultant report was printed, and information regarding the severity of each interaction recorded, along with the names of the drugs involved. Potential DIs include the presence of two potentially interacting drugs, regardless of whether an adverse patient outcome occurs (Hines et al., [<reflink idref="bib22" id="ref32">22</reflink>]).</p> <p>The software program categorizes DIs in to five categories. A-level DIs are drug pairs that do not interact. B-level DIs are those where data demonstrate that the specified agents may interact with each other, but there is little to no evidence of clinical concern resulting from their concomitant use. A- and B-level DIs were not assessed for this study. C-level DIs are those where data demonstrate that the specified agents may interact with each other in a clinically significant manner. The benefits of concomitant use of these two medications usually outweigh the risks. An appropriate monitoring plan should be implemented to identify potential negative effects. Dosage adjustments of one or both agents may be needed in a minority of patients. D-level DIs are those where data demonstrate that the two medications may interact with each other in a clinically significant manner. A patient-specific assessment must be conducted to determine whether the benefits of concomitant therapy outweigh the risks. Specific actions must be taken in order to realize the benefits and/or minimize the toxicity resulting from concomitant use of the agents. These actions may include aggressive monitoring, empiric dosage changes, and/or choosing alternative agents. Finally, X-level DIs are those where data demonstrate that the specified agents may interact with each other in a clinically significant manner. The risks associated with concomitant use of these agents usually outweigh the benefits. For the present study, DIs at C-, D-, and X-levels were considered potentially clinically significant DIs.</p> <p> <emph>Analysis</emph>: Continuous variables are presented as means with standard deviations, while categorical data are presented as frequency with percentages. Univariate analyses were conducted to determine the association between each variable and the dependent variable of the number of potential drug interactions (C,D, and X combined) using Students' t-test or one-way ANOVA.</p> <hd id="AN0159162291-4">Results</hd> <p>Data were available for 598 participants. Participant characteristics, medication variables, and univariate analyses between participant characteristic and total number of potential drug interactions appear in Table 1. The mean age was 48 ± 12.3 years, somewhat more than half were males (57%), over three-quarters were white (76%), and over 60% had either mild or moderate intellectual disability. The average number of medications taken per participant was 8.6 ± 4.8, with 29.8% of the sample taking 12 or more medications. Total number of medications in the participant regimen was significant, with greater number of potential drug interactions found with greater numbers of medications. Race was significant when analyzing all race categories, but when dichotomized to white versus all other groups combined, there was no significant difference. There were no significant differences based on age, gender, or level of cognitive impairment.</p> <p>Summary data of DIs are presented in Table 2, categorized by severity of potential drug interaction. Of the 598 participants, 489 (81.8%) had one or more DIs in their medication regimen. C-level DIs were the most common, with 4633 C-level DIs, with an average of 7.8 ± 8.8 per participant. There were 542 D-level DIs, with an average of 0.91 ± 1.4 per participant. Lastly, there were 105 X-level DIs, for an average of 0.18 ± 0.58 per participant. Refer to Appendix Tables 3 (X-level DIs) and 4 (D-level DIs) for descriptions of the potential drug interaction. Interactions between oral potassium supplements and medications with anticholinergic properties were the most common X-level interactions found (n = 48, 45.3%). Forty-three (40.6%) of the X-level drug interaction pairs included psychotropic medications. The most common D-level interactions included increased central nervous system effects of one or both drugs, increased risk of bleeding, binding of one or both drugs in the gastrointestinal tract leading to decreased effect of either/both drugs, and changes in metabolic enzyme activity in the liver leading to either increased or decreased effect of either/both drugs. The psychotropic class of medications had the highest number of D-level DIs per drug category, with 234 DI pairs. Seizure medications were the next highest, with 133 interaction pairs. Note that seizure medications are also used as treatment for mood stabilization (Hirschfeld, [<reflink idref="bib21" id="ref33">21</reflink>]). Focusing on the site in the body where the interaction occurs, DIs occurring in the gastrointestinal tract known to lead to decreased absorption of either/both medications were present in 130 DI pairs. There were 107 DI pairs that could lead to potentially greater than intended effects on the central nervous system. Eighty-two DI pairs were associated with alterations of drug metabolism in the liver through effects on the cytochrome P-450 system. Another 51 interaction pairs could potentially lead to an increased risk of bleeding, primarily due to increased antiplatelet activity.</p> <hd id="AN0159162291-5">Discussion</hd> <p>This study analyzed data from a statewide survey of 598 adults with IDD. Polypharmacy was common in this sample of adults with IDD, with almost 30% taking 12 or more medications. Previous studies citing rates of polypharmacy in persons with IDD vary depending on the definition of polypharmacy and the sample studied. Rates vary from 20.9% taking 5 or more medications; 55% taking 10 or more medications; and 31.5% taking from 5 to 9 and 20.1% taking 10 or more medications (Erickson et al., [<reflink idref="bib15" id="ref34">15</reflink>]; Haider, [<reflink idref="bib20" id="ref35">20</reflink>]; O'Dwyer et al., [<reflink idref="bib37" id="ref36">37</reflink>]).</p> <p>In this sample, over 80% had at least one DI present in their current medication regimen. This is consistent with other studies that have found DIs to be common in patients' medication regimens, ranging from 16 to 91%, depending on the population studied and the unit of measurement (person or prescriptions) in the general population (Aparasu et al., [<reflink idref="bib1" id="ref37">1</reflink>]; Bozana et al., [<reflink idref="bib8" id="ref38">8</reflink>]; Costa, [<reflink idref="bib10" id="ref39">10</reflink>]; Holm et al., [<reflink idref="bib23" id="ref40">23</reflink>]; Obreli et al., [<reflink idref="bib36" id="ref41">36</reflink>]). The results of the present study on adults with IDD fell at the higher end of prevalence of DIs. Over 26% had 13 or more DIs (C-, D-, and/or X-level interactions). Although not assessed in the current study, polypharmacy and DIs are two important factors associated with adverse medication events (Marengoni et al., [<reflink idref="bib34" id="ref42">34</reflink>]; Nobili et al., [<reflink idref="bib35" id="ref43">35</reflink>]). A study of U.S. hospitalizations found that adults with IDD had a greater proportion of hospitalizations related to adverse medication events compared to the general population (Erickson et al., [<reflink idref="bib16" id="ref44">16</reflink>]). DIs are one risk factor for hospitalizations due to adverse medication events (Flaherty et al., [<reflink idref="bib18" id="ref45">18</reflink>]; Lombrdi et al., [<reflink idref="bib30" id="ref46">30</reflink>]).</p> <p>The large number of C- and D-level DIs, which indicate that the two interacting medications should only be used when the benefit outweighs the risk and only with careful monitoring for intended and unintended drug effects, highlights the importance for health care professionals to have heightened awareness of the potential for adverse medication events due to DIs occurring in patients with IDD.</p> <p>The total number of medications taken per participant was significantly associated with the total number of DIs. This is consistent with the literature, where studies have documented that the number of medications in a person's medication regimen tends to be associated with a higher number of DIs, as well as poor health outcomes (Guthrie et al., [<reflink idref="bib19" id="ref47">19</reflink>]; Johnell & Klarinc, [<reflink idref="bib25" id="ref48">25</reflink>]; McMahon et al., [<reflink idref="bib33" id="ref49">33</reflink>]).</p> <p>Race was significantly associated with the number of DIs when analyzing all race categories in bivariate analyses. A limitation of using individual race categories for this study, however, is that there were too few participants in several race categories. When all minority categories were combined and compared with the white category, the difference between the numbers of DIs was not significant. In the general population, the association of race and prevalence of drug interactions is complex. Whereas minorities tend to use fewer medications (Schmittdiel et al., [<reflink idref="bib42" id="ref50">42</reflink>]), an interaction between race, income, and polypharmacy has been demonstrated. In an analysis of data from a survey of older adults, race interacted with low income on the likelihood for polypharmacy. This suggests that low income may be more strongly associated with polypharmacy, a strong predictor of DIs, in minority adults than in white older adults. (Assari & Bazargan, [<reflink idref="bib3" id="ref51">3</reflink>]).</p> <p>There were no significant differences based on age, gender, or level of cognitive impairment. In a recent study of persons with IDD, McMahon et al., [<reflink idref="bib33" id="ref52">33</reflink>], found that age and severity of ID also were not significantly associated with the number of DIs. Unlike the present study, they did find that gender was significant, with females having a greater exposure to DIs than males. Other research in the general, elderly population has found female gender to be associated with greater number of DIs, associated with greater medication use by women (Venturini et al., [<reflink idref="bib47" id="ref53">47</reflink>]).</p> <hd id="AN0159162291-6">Medications</hd> <p>Potassium supplements interacting with medications that have anticholinergic activity were the most common Level X DIs, with 48 occurrences. The problem associated with this interaction is that many medications, especially those with anticholinergic activity, slow down gastric motility and transit time through the intestine, which increases the contact time for a potassium tablet to irritate the lining of the intestine and may then lead to ulceration and possibly perforation. A limitation of the present study is that the formulation of potassium (i.e., tablet or liquid) taken by each participant could not be determined. The likelihood of damage to the lining of the gastrointestinal tract is more with potassium tablets than liquids. Nonetheless, this report demonstrates the potential for this type of interaction being present in the medication regimens of adults with IDD.</p> <p>Psychotropic medications were the largest category of medications involved in potential DIs. Adult patients with IDD develop chronic illnesses at a similar rate to the general population, meaning many will be taking medications for management of chronic disease (Erickson et al., [<reflink idref="bib15" id="ref54">15</reflink>]). This fact, coupled with the fact that many people with IDD are prescribed psychotropic medication, leads to an increased risk of potential DIs (McMahon et al., [<reflink idref="bib32" id="ref55">32</reflink>]).</p> <p>Seizure medications were also commonly found in potential drug interactions. Note that seizure medications are used not only as treatment for seizure disorders, but also as a treatment for mood stabilization and challenging behaviors (Aman et al., [<reflink idref="bib2" id="ref56">2</reflink>]; Deb et al., [<reflink idref="bib11" id="ref57">11</reflink>]). DIs with seizure medications that potentially lead to central nervous system depression found in this study included other medications for the treatment of mental illness or behavioral challenges, to alleviate pain, as a sleep aide, to treat allergic rhinitis, and other seizure medications. Some seizure medications may also potentially cause drug interactions by their action on liver enzymes, either enhancing (inducing) or reducing (inhibiting) their activity to metabolize other medications (Perucca et al., [<reflink idref="bib40" id="ref58">40</reflink>]; Tanaka et al., [<reflink idref="bib44" id="ref59">44</reflink>]; Tannenbaum & Sheehan, [<reflink idref="bib45" id="ref60">45</reflink>]). In one study of patients seen by a seizure disorder clinic, potential or actual DIs with seizure medication was found in 30% of patients (Bosak et al., [<reflink idref="bib7" id="ref61">7</reflink>]). It is important to note that in the D-Level DIs, most of these interactions included concurrent administration of two or more seizure medications, antipsychotics, benzodiazepines, and statin medications, used to lower cholesterol.</p> <p>A group of medications known to bind other drugs in the gastrointestinal tract were also implicated in the analysis of potential DIs. Medications included ferrous sulfate, magnesium salts, calcium supplements, and fiber-based laxatives which may bind to other medications when present at the same time in the gastrointestinal tract, altering absorption and intended pharmacological effect. In practice, these medications should be timed and spaced far enough apart to reduce the potential for interaction.</p> <p>Nonsteroidal anti-inflammatory agents (NSAIDs), used for the treatment of pain and inflammation, were somewhat common DIs. NSAIDs reduce or inhibit platelet activity which may increase a patient's risk of bleeding. When NSAIDs are given along with other medications that interfere with blood coagulation or platelet activity, there is an increased risk of bleeding. This potential DI was present primarily when an NSAID was prescribed at the same time as a selective serotonin receptor inhibitor (SSRI). This finding was similar to other population-based research (Jazbar et al., [<reflink idref="bib24" id="ref62">24</reflink>]).</p> <p>A relatively uncommon DI that is clinically significant is the potential for two drugs to cause QT prolongation, which may lead to an arrhythmia and, in rare situations, sudden death. The drugs found in the present study primarily included second generation antipsychotics prescribed concurrently or with a first generation antipsychotic, chlorpromazine.</p> <hd id="AN0159162291-7">Limitations</hd> <p>Only one drug-interaction software program was used to determine the drug interactions for this study. Others exist, and may have been useful to cross-check interactions that may be categorized differently or may not have been included in the reference used for this study. The investigators only had access to the one software program used for this study.</p> <p>It is important to note that DIs listed in this analysis are potential interactions. Data on whether the participant experienced or exhibited signs or symptoms that may have resulted from an actual interaction was not available. As well, clinical signs and symptoms of the effects of potential DIs were not assessed, only whether the drugs involved in the interaction were co-listed on the participant's medication record at the time of the survey. Comorbidities were not listed in this dataset, limiting assessment of the relationship between the number and types of drug interactions associated with number or types of illnesses participants may have had.</p> <p>Another limitation of the present study is that directions for use such as frequency per day or specific instructions such as "take on an empty stomach", as well as dosage forms of some of the medications were not known. This is important for potassium, for example. If medications with significant anticholinergic activity are administered along with potassium tablets, there is a chance of ulceration and perforation of the intestinal tract. This is much less likely to occur when potassium supplements are administered as a liquid. Finally, this research was cross-sectional and as such we can only describe the association between personal and contextual factors with the total number of DIs.</p> <hd id="AN0159162291-8">Moving Forward</hd> <p>Regular review by a clinical pharmacist of medications prescribed for people with IDD may lead to a reduction in polypharmacy, decrease in potential DIs, and improved overall quality of prescribing. Studies of pharmacists' consultations for older patients' medication regimens demonstrated improved appropriateness of prescribing and reduced complexity of medication regimens (Elliott et al., [<reflink idref="bib13" id="ref63">13</reflink>]; Jokanovic et al., [<reflink idref="bib26" id="ref64">26</reflink>]). As for patients with IDD, there is limited research into ways to improve prescribing for this population. A narrative review of pharmacists' interventions found only eight papers associated with research to assess activities to improve prescribing and use of medications by people with IDD (O'Dwyer et al., [<reflink idref="bib38" id="ref65">38</reflink>]). The authors concluded that more work is needed to demonstrate the value of interventions to ensure safe use of medications by people with IDD. A recent study piloting a comprehensive medication review process in group homes found numerous potential and actual medication-related problems, some of which were DIs (Erickson, [<reflink idref="bib14" id="ref66">14</reflink>]). Further work using pharmacists in reviewing the medication regimens and medication use process of people with IDD living in the community is warranted.</p> <hd id="AN0159162291-9">Conclusion</hd> <p>Many people with IDD take multiple medications and as a result are exposed to potential drug interactions. Health care professionals must have clear goals and endpoints in mind when prescribing medications for this vulnerable population. People with IDD often have multiple healthcare providers prescribing medication, which may lead to polypharmacy, a leading factor associated with potential drug interactions. Health care professionals can play an important role in clarifying the need for medications that are known to have potential drug interaction when prescribed for people with IDD. The current findings bring awareness to the importance of monitoring polypharmacy for individuals with IDD. Future research is needed to explore how the broad range of professionals who support people with IDD in daily living can play a role in reducing polypharmacy and potential adverse medication events.</p> <p>Table 1 Description of Sample and Univariate Analyses</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Demographics</p></th><th align="left"><p>Frequency (Percent) or Mean <underline>(</underline>standard deviation) </p></th><th align="left"><p>Mean (standard deviation) Potential Drug Interactions (C, D, X), </p><p>p value</p></th></tr></thead><tbody><tr><td align="left"><p>Age (years)</p><p> 18 to 29</p><p> 30 to 39</p><p> 40 to 49</p><p> 50 to 59</p><p> 60 and above</p></td><td align="left"><p>48.1 <underline>(</underline>12.3)</p><p>Range 20-77</p><p>53 (8.9)</p><p>101 (16.9)</p><p>141 (23.6)</p><p>190 (31.8)</p><p>113 (18.9)</p></td><td align="left"><p>7.6 (10.5)</p><p>7.3 (9.0)</p><p>8.0 (10.1)</p><p>9.7 (9.5)</p><p>10.2 (9.4)</p><p>p=0.08</p></td></tr><tr><td align="left"><p>Gender</p><p> Male</p><p> Female</p></td><td align="left"><p>344 (57.5)</p><p>254 (42.5)</p></td><td align="left"><p>8.7 (9.3)</p><p>9.0 (10.2)</p><p>p=0.76</p></td></tr><tr><td align="left"><p>Race</p><p> American Indian, Alaska Native</p><p> Asian</p><p> Black </p><p> White</p><p> Hispanic/Latino</p><p> Dichotomized Race Variable</p><p> White</p><p> Minority</p></td><td align="left"><p>50 (8.4)</p><p>3 (0.5)</p><p>74 (12.4)</p><p>455 (76.1)</p><p>11 (1.8)</p><p>455 (76.1)</p><p>143 (23.9)</p></td><td align="left"><p>9.7 (11.3)</p><p>20.3 (7.5)</p><p>7.9 (9.7)</p><p>9.1 (9.5)</p><p>3.4 (1.5)</p><p>p=0.02</p><p>9.1 (9.5)</p><p>8.1 (10.1)</p><p>p=0.32</p></td></tr><tr><td align="left"><p>Level of intellectual disability </p><p> Mild</p><p> Moderate</p><p> Severe</p><p> Profound </p></td><td align="left"><p>216 (36.1)</p><p>150 (25.1)</p><p>104 (17.4)</p><p>128 (21.4)</p></td><td align="left"><p>9.2 (9.9)</p><p>8.3 (9.2)</p><p>9.2 (10.0)</p><p>8.5 (9.5)</p><p>p=0.80</p></td></tr><tr><td align="left"><p>Number of medications per patient</p><p>Number of medications per patient, categorical</p><p> None</p><p> 1 to 5</p><p> 6 to 11</p><p> 12 or more</p></td><td align="left"><p>8.6 (4.8) </p><p>Range 0-17</p><p>30 (5.0)</p><p>151 (25.3)</p><p>239 (40.0)</p><p>178 (29.8)</p></td><td align="left"><p>0</p><p>1.6 (2.4)</p><p>7.6 (6.5)</p><p>18.1 (10.3)</p><p>p<0.001</p></td></tr><tr><td align="left"><p>Dependent Variables</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Number of potential drug interactions (C, D, X Level) per patient</p></td><td align="left"><p>8.8 (9.7) </p><p>Range 0-56</p></td><td align="left" /></tr><tr><td align="left"><p>Number of patients per category of number of potential drug interactions (C, D, X Level)</p><p> None</p><p> 1 to 4</p><p> 5 to 12</p><p> 13 or more </p></td><td align="left"><p>115 (19.2)</p><p>155 (25.9)</p><p>169 (28.3)</p><p>159 (26.6)</p></td><td align="left" /></tr></tbody></table> </ephtml> </p> <p>N=598</p> <p>Table 2 Summary Description of Drug Interactions (n=598 Subjects)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Drug Interaction Severity Rating<sup>22</sup></p></th><th align="left"><p>Number of Drug Interaction Pairs</p><p>Mean (standard deviation)</p><p>Range</p></th></tr></thead><tbody><tr><td align="left"><p>C-level<sup>a</sup></p></td><td align="left"><p>4633</p><p>7.75 (8.8)</p><p>0-53</p></td></tr><tr><td align="left"><p>D-level<sup>b</sup></p></td><td align="left"><p>542</p><p>0.91 (1.4)</p><p>0-8</p></td></tr><tr><td align="left"><p>X-level<sup>c</sup></p></td><td align="left"><p>105</p><p>0.18 (0.58)</p><p>0-5</p></td></tr></tbody></table> </ephtml> </p> <p>N=598 <sups>a</sups>Data demonstrate that the specified agents may interact with each other in a clinically significant manner. The benefits of concomitant use of these two medications usually outweigh the risks. An appropriate monitoring plan should be implemented to identify potential negative effects. Dosage adjustments of one or both agents may be needed in a minority of patients <sups>b</sups>Data demonstrate that the two medications may interact with each other in a clinically significant manner. A patient-specific assessment must be conducted to determine whether the benefits of concomitant therapy outweigh the risks. Specific actions must be taken in order to realize the benefits and/or minimize the toxicity resulting from concomitant use of the agents. These actions may include aggressive monitoring, empiric dosage changes, choosing alternative agents <sups>c</sups>Data demonstrate that the specified agents may interact with each other in a clinically significant manner. The risks associated with concomitant use of these agents usually outweigh the benefits. Such combinations should generally be avoided.</p> <hd id="AN0159162291-10">Authors' Contributions</hd> <p>Each author of this manuscript was involved with idea generation, data analysis and interpretation, writing of the manuscript, and approved the final version of the manuscript. Data acquisition was made possible by Jennifer Jones.</p> <hd id="AN0159162291-11">Funding</hd> <p>No funding was used to conduct this study.</p> <hd id="AN0159162291-12">Data Availability</hd> <p>Not applicable.</p> <hd id="AN0159162291-13">Code Availability</hd> <p>Not applicable.</p> <hd id="AN0159162291-14">Declarations</hd> <p></p> <hd id="AN0159162291-15">Ethics Approval</hd> <p>Data collection procedures were approved by the human subjects review board (IRB) at Oklahoma State University and a data use agreement was used between Oklahoma State University and University of Michigan for secondary data analysis in the current study.</p> <hd id="AN0159162291-16">Consent to Participate</hd> <p>This study used existing dataset that was deidentified. It did not require informed consent from persons in the dataset.</p> <hd id="AN0159162291-17">Consent for Publication</hd> <p>Not applicable.</p> <hd id="AN0159162291-18">Conflict of Interest</hd> <p>The authors have no conflicts of interest to report.</p> <hd id="AN0159162291-19">Appendix</hd> <p>Table 3 X-Level Drug Interactions*</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Drug 1</p></th><th align="left"><p>Drug 2</p></th><th align="left"><p>Number of occurrences</p></th><th align="left"><p>Description of Interaction</p></th></tr></thead><tbody><tr><td align="left" colspan="3"><p><italic>Enhanced CNS depressant effects</italic></p></td><td align="left"><p>This interaction is more prominent if both agents are administered by injection. If both agents are given orally, the effects would be less</p><p>Severity Major, Reliability rating good.</p></td></tr><tr><td align="left"><p>lorazepam</p></td><td align="left"><p>olanzapine</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>clonazepam</p></td><td align="left"><p>olanzapine</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>alprazolam</p></td><td align="left"><p>olanzapine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>alphagan</p></td><td align="left"><p>azelastine</p></td><td align="left"><p>1</p></td><td align="left"><p>CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Severity Major Reliability Rating Fair </p></td></tr><tr><td align="left"><p>loratidine</p></td><td align="left"><p>azelastine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>risperidone</p></td><td align="left"><p>azelastine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left" colspan="2"><p>Total</p></td><td align="left"><p>10</p></td><td align="left" /></tr><tr><td align="left" colspan="3"><p><italic>Enhanced anticholinergic effects</italic></p></td><td align="left" /></tr><tr><td align="left"><p>quetiapine</p></td><td align="left"><p>tiotropium</p></td><td align="left"><p>1</p></td><td align="left"><p>Anticholinergic enhanced effect. Severity major, reliability fair</p></td></tr><tr><td align="left"><p>umeclidinium</p></td><td align="left"><p>loratadine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>clozapine</p></td><td align="left"><p>glycopyrrolate</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>cetirizine</p></td><td align="left"><p>ipratropium</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>cetirizine</p></td><td align="left"><p>tiotropium</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>ipatropium</p></td><td align="left"><p>tiotropium</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>diphenhyramine</p></td><td align="left"><p>umeclidinium</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>risperidone</p></td><td align="left"><p>umeclidinium</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>cyclobenzaprine</p></td><td align="left"><p>ipratropium</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>clomipramine</p></td><td align="left"><p>ipratropium</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>ipatropium</p></td><td align="left"><p>loratadine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>Total</p></td><td align="left" /><td align="left"><p>11</p></td><td align="left" /></tr><tr><td align="left" colspan="4"><p><italic>Increased Vitamin D absorption</italic></p></td></tr><tr><td align="left"><p>multivitamin with D</p></td><td align="left"><p>Vitamin D3</p></td><td align="left"><p>3</p></td><td align="left"><p>Potential for vitamin D toxicity </p></td></tr><tr><td align="left"><p>retinoic acid derivative</p></td><td align="left"><p>Vitamin D3</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left" colspan="2"><p>Total</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p><italic>QTc Prolongation</italic></p></td><td align="left" /><td align="left" /><td align="left"><p>Possible cardiac arrhythmia</p></td></tr><tr><td align="left"><p>quetiapine</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>escitalopram</p></td><td align="left"><p>1</p></td><td align="left"><p>In addition to potential cardiac arrhythmia, citalopram may enhance antiplatelet effect of escitalopram. </p><p>Escitalopram may enhance serotonergic effect of citalopram resulting in serotonin syndrome.</p><p>Severity Major, Reliability rating good.</p></td></tr><tr><td align="left" colspan="2"><p>Total</p></td><td align="left"><p>6</p></td><td align="left" /></tr><tr><td align="left"><p><italic>Potential Potassium induced GI ulceration</italic></p></td><td align="left" /><td align="left" /><td align="left"><p>Anticholinergic effect slowing gastric motility increasing risk of ulceration of the lining of the stomach or intestines. </p></td></tr><tr><td align="left"><p>fexofenadine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>loratadine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>7</p></td><td align="left" /></tr><tr><td align="left"><p>cetirizine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>6</p></td><td align="left" /></tr><tr><td align="left"><p>oxybutynin</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>scopolamine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>promethazine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>benztropine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>quetiapine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>9</p></td><td align="left" /></tr><tr><td align="left"><p>risperidone</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>5</p></td><td align="left" /></tr><tr><td align="left"><p>diphenhyramine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>thioridazine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>haloperidol</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>molindone</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>hydroxyzine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>chlorpromazine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>clozapine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>glycopyrrolate</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>olanzapine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>cyclobenzaprine</p></td><td align="left"><p>potassium chloride</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>Total Potassium chloride interactions</p></td><td align="left" /><td align="left"><p>48</p></td><td align="left" /></tr><tr><td align="left"><p><italic>Liver and muscle toxicity</italic></p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>gemfibrozil</p></td><td align="left"><p>simvastatin</p></td><td align="left"><p>1</p></td><td align="left"><p>Gemfibrozil may enhance the myopathic (rhabdomyolysis) effect of Simvastatin. Gemfibrozil may increase the serum concentration of Simvastatin. Concentrations of the active simvastatin acid metabolite may also be increased by gemfibrozil. Severity Major Reliability Rating Excellent </p></td></tr><tr><td align="left"><p>gemfibrozil</p></td><td align="left"><p>pravastatin</p></td><td align="left"><p>1</p></td><td align="left"><p>Gemfibrozil may enhance the myopathic (rhabdomyolysis) effect of Simvastatin. Gemfibrozil may increase the serum concentration of Simvastatin. Concentrations of the active simvastatin acid metabolite may also be increased by gemfibrozil. Severity Major Reliability Rating Excellent </p></td></tr><tr><td align="left"><p>atorvastatin</p></td><td align="left"><p>cyclosporin</p></td><td align="left"><p>1</p></td><td align="left"><p>Atorvastatin labeling states that concurrent use of cyclosporine and atorvastatin should be avoided due to an increased risk for atorvastatin-related toxicities such as myopathy and rhabdomyolysis. Consider changing to a statin that is less sensitive to this interaction (eg, pravastatin or fluvastatin) or to an alternative type of LDL-lowering medication. An American Heart Association scientific statement suggests these agents could be combined if the atorvastatin dose is limited to no more than 10 mg daily. </p></td></tr><tr><td align="left" colspan="2"><p>total</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p><italic>Increased aluminum absorption</italic></p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>sucralfate</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>2</p></td><td align="left"><p>Multivitamins/Minerals (with ADEK, Folate, Iron) may increase the serum concentration of Sucralfate. Specifically, the absorption of aluminum from sucralfate may be increased, leading to an increase in the serum aluminum concentration. Severity Major Reliability Rating Fair </p></td></tr><tr><td align="left"><p>sucralfate</p></td><td align="left"><p>Vitamin D3</p></td><td align="left" colspan="2"><p>2</p></td></tr><tr><td align="left"><p>Total</p></td><td align="left" /><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left" colspan="4"><p><italic>Cytochrome interactions</italic></p></td></tr><tr><td align="left"><p>fluvoxamine</p></td><td align="left"><p>melatonin</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP1A2 Inhibitors (Strong) may increase the serum concentration of Melatonin. Severity Moderate Reliability Rating Good </p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>lurasidone</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 Inducers (Strong) may decrease the serum concentration of Lurasidone. Severity Major Reliability Rating Fair:</p></td></tr><tr><td align="left"><p>cariprazine</p></td><td align="left"><p>primidone</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 Inducers (Strong) may decrease the serum concentration of Cariprazine. Severity Major Reliability Rating Fair:</p></td></tr><tr><td align="left"><p>lurasidone</p></td><td align="left"><p>primidone</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 Inducers (Strong) may decrease the serum concentration of Lurasidone. Severity Major Reliability Rating Fair: </p></td></tr><tr><td align="left" colspan="2"><p>Total</p></td><td align="left"><p>5</p></td><td align="left" /></tr><tr><td align="left"><p><italic>Miscellaneous Interactions</italic></p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>docusate</p></td><td align="left"><p>mineral oil</p></td><td align="left"><p>2</p></td><td align="left"><p>Docusate may increase the absorption of Mineral Oil. Severity Major Reliability Rating Poor</p></td></tr><tr><td align="left"><p>metoclopramide</p></td><td align="left"><p>olanzapine</p></td><td align="left"><p>2</p></td><td align="left"><p>Metoclopramide may enhance the adverse/toxic effect of Antipsychotic Agents. Severity Major Reliability Rating Fair</p></td></tr><tr><td align="left"><p>celecoxib</p></td><td align="left"><p>ibuprofen</p></td><td align="left"><p>1</p></td><td align="left"><p>Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Severity Major Reliability Rating Fair: </p></td></tr><tr><td align="left"><p>prazosine</p></td><td align="left"><p>tamsulosin</p></td><td align="left"><p>1</p></td><td align="left"><p>Alpha1-Blockers may enhance the antihypertensive effect of other Alpha1-Blockers. Severity Major Reliability Rating Fair </p></td></tr><tr><td align="left"><p>desmopressin</p></td><td align="left"><p>fluticasone</p></td><td align="left"><p>4</p></td><td align="left"><p>Corticosteroids (Nasal) may enhance the hyponatremia effect of Desmopressin. Severity Major Reliability Rating Fair:</p></td></tr><tr><td align="left"><p>budesonide</p></td><td align="left"><p>desmopressin</p></td><td align="left"><p>1</p></td><td align="left"><p>Corticosteroids (Orally Inhaled) may enhance the hyponatremia effect of Desmopressin. Severity Major Reliability Rating Fair: </p></td></tr></tbody></table> </ephtml> </p> <p>*Data demonstrate that the specified agents may interact with each other in a clinically significant manner. Such combinations should generally be avoided</p> <p>Table 4 D-Level Drug Interactions</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Drug 1</p></th><th align="left"><p>Drug 2</p></th><th align="left"><p>Number of Occurrences</p></th><th align="left"><p>Description of Interaction</p></th></tr></thead><tbody><tr><td align="left" colspan="3" /><td align="left"><p>Enhanced Central Nervous System Depression</p></td></tr><tr><td align="left"><p>alprazolam</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>alprazolam</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amitriptyline</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amitriptyline</p></td><td align="left"><p>morphine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amitriptyline</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>fluoxetine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>baclofen</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>baclofen</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>baclofen</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>baclofen</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>brexpiprazole</p></td><td align="left"><p>oxycodone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>brivaracetam</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>cetirizine</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>cetirizine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>clomipramine</p></td><td align="left"><p>fluoxetine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>clonidine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>clozapine</p></td><td align="left"><p>diazepam</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>clozapine</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>cyclobenzaprine</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>diazepam</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>diphenhydramine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>divalproex</p></td><td align="left"><p>lorazepam</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>eszopiclone</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>felbamate</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>fexofenadine</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>fexofenadine</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>flurazepam</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>gabapentin</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>gabapentin</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>gabapentin</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>haloperidol</p></td><td align="left"><p>oxycodone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>promethazine</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>topiramate</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>hydroxyzine</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>hydroxyzine</p></td><td align="left"><p>phenobarbital</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>lamotrigine</p></td><td align="left"><p>oxycodone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>lamotrigine</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>lamotrigine</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>levetiracetam</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>levetiracetam</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>levetiracetam</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>atropine/</p><p>diphenoxylate</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>loratadine</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>loratadine</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>loratadine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>loratadine</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>lorazepam</p></td><td align="left"><p>oxycodone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>lorazepam</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>lorazepam</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>lorazepam</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>mirtazapine</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>mirtazapine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>mirtazapine</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>morphine</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>morphine</p></td><td align="left"><p>promethazine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>naltrexone</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>olanzapine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>oxycodone</p></td><td align="left"><p>quetiapine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>peramanel</p></td><td align="left"><p>quetiapine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>peramanel</p></td><td align="left"><p>scopolamine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>phenobarbital</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>promethazine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>quetiapine</p></td><td align="left"><p>hydrocodone acetaminophen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>quetiapine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>mirtazapine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>risperidone</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>risperidone</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>temazepam</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>tizanidine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>topiramate</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>tramadol</p></td><td align="left"><p>trazodone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>tramadol</p></td><td align="left"><p>valproic acid</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>trazodone</p></td><td align="left"><p>perampanel</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>valproic acid</p></td><td align="left"><p>felbamate</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>ziprasidone</p></td><td align="left"><p>zolpidem</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>Total of CNS depression</p></td><td align="left" /><td align="left"><p>107</p></td><td align="left" /></tr><tr><td align="left"><p>cetirizine</p></td><td align="left"><p>clozapine</p></td><td align="left"><p>3</p></td><td align="left"><p>Increased anticholinergic activity</p></td></tr><tr><td align="left"><p>chlorpromazine</p></td><td align="left"><p>clozapine</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>clozapine</p></td><td align="left"><p>glycopyrrolate</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>clozapine</p></td><td align="left"><p>loxapine</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>pramipexole</p></td><td align="left"><p>risperidone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>ibuprofen</p></td><td align="left"><p>1</p></td><td align="left"><p>Increase risk of bleeding</p></td></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>meloxicam</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>diclofenac</p></td><td align="left"><p>fluoxetine</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>ibuprofen</p></td><td align="left"><p>sertraline</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>diclofenac</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>ibuprofen</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>meloxicam</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>nabumetone</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>meloxicam</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>apixaban</p></td><td align="left"><p>diclofenac</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>meloxicam</p></td><td align="left"><p>sertraline</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>rivaroxaban</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>sulfamethoxazole trimethoprim</p></td><td align="left"><p>warfarin</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>celecoxib</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>diclofenac</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>ibuprofen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>meloxicam</p></td><td align="left"><p>8</p></td><td align="left" /></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>naproxen</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>escitalopram</p></td><td align="left"><p>ibuprofen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>escitalopram</p></td><td align="left"><p>meloxicam</p></td><td align="left"><p>5</p></td><td align="left" /></tr><tr><td align="left"><p>escitalopram</p></td><td align="left"><p>naproxen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>fluoxetine</p></td><td align="left"><p>meloxicam</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>fluoxetine</p></td><td align="left"><p>naproxen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>naproxen</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>naproxen</p></td><td align="left"><p>sertraline</p></td><td align="left"><p>3</p></td><td align="left" /></tr><tr><td align="left"><p>diclofenac</p></td><td align="left"><p>meloxicam</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>diclofenac</p></td><td align="left"><p>naproxen</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amantadine</p></td><td align="left"><p>aripiprazole</p></td><td align="left"><p>1</p></td><td align="left"><p>antipsychotic may diminish effect of amantadine (dopamine agonist)</p></td></tr><tr><td align="left"><p>amantadine</p></td><td align="left"><p>brexpiprazole</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amantadine</p></td><td align="left"><p>haloperidol</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amantadine</p></td><td align="left"><p>quetiapine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amantadine</p></td><td align="left"><p>risperidone</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>amantadine</p></td><td align="left"><p>trifluoperazine</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>amantadine</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>alendronate</p></td><td align="left"><p>calcium carbonate</p></td><td align="left"><p>12</p></td><td align="left"><p>binding of alendronate and decreased absorption</p></td></tr><tr><td align="left"><p>alendronate</p></td><td align="left"><p>ferrous sulfate</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>alendronate</p></td><td align="left"><p>fiber laxative</p></td><td align="left"><p>6</p></td><td align="left" /></tr><tr><td align="left"><p>alendronate</p></td><td align="left"><p>magnesium oxide</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>alendronate</p></td><td align="left"><p>milk of magnesia</p></td><td align="left"><p>2</p></td><td align="left" /></tr><tr><td align="left"><p>alendronate</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>8</p></td><td align="left" /></tr><tr><td align="left"><p>calcium antacid</p></td><td align="left"><p>ibandronate</p></td><td align="left"><p>1</p></td><td align="left"><p>Binding of ibandronate and decreased absorption</p></td></tr><tr><td align="left"><p>doxycycline</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>1</p></td><td align="left"><p>binding doxycycline</p></td></tr><tr><td align="left"><p>calcium antacid or supplement</p></td><td align="left"><p>levothyroxine</p></td><td align="left"><p>23</p></td><td align="left"><p>binding of levothyroxine and decreased absorption</p></td></tr><tr><td align="left"><p>ferrous sulfate</p></td><td align="left"><p>levothyroxine</p></td><td align="left"><p>9</p></td><td align="left" /></tr><tr><td align="left"><p>fiber laxative</p></td><td align="left"><p>levothyroxine</p></td><td align="left"><p>5</p></td><td align="left" /></tr><tr><td align="left"><p>levothyroxine</p></td><td align="left"><p>magnesium oxide</p></td><td align="left"><p>4</p></td><td align="left" /></tr><tr><td align="left"><p>levothyroxine</p></td><td align="left"><p>milk of magnesia</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>levothyroxine</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>6</p></td><td align="left" /></tr><tr><td align="left"><p>bismuth subsalicylate</p></td><td align="left"><p>minocycline</p></td><td align="left"><p>1</p></td><td align="left"><p>binding to minocycline and decreased absorption</p></td></tr><tr><td align="left"><p>ferrous sulfate</p></td><td align="left"><p>minocycline</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>milk of magnesia</p></td><td align="left"><p>minocycline</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>minocycline</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>1</p></td><td align="left" /></tr><tr><td align="left"><p>calcium antacid</p></td><td align="left"><p>thyroid</p></td><td align="left"><p>1</p></td><td align="left"><p>binding to thyroid and decreased absorption</p></td></tr><tr><td align="left"><p>sucralfate</p></td><td align="left"><p>furosemide</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease absorption of furosemide, decrease effect</p></td></tr><tr><td align="left"><p>cephalexin</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease cephalexin effect</p></td></tr><tr><td align="left"><p>calcium antacid</p></td><td align="left"><p>ferrous sulfate</p></td><td align="left"><p>9</p></td><td align="left"><p>decrease iron absorption</p></td></tr><tr><td align="left"><p>minocycline</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease minocycline absorption</p></td></tr><tr><td align="left"><p>mineral oil</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>3</p></td><td align="left"><p>decrease multivitamin absorption</p></td></tr><tr><td align="left"><p>colesevelam</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease multivitamin absorption</p></td></tr><tr><td align="left"><p>mineral oil</p></td><td align="left"><p>vitamin D</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease vitamin D absorption</p></td></tr><tr><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>Cytochrome P450 Enzyme Interaction in the Liver – Enhancing effect of drug</p></td></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>3</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>carvedilol</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>chlorpromazine</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>fluoxetine</p></td><td align="left"><p>perphenazine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>fluoxetine</p></td><td align="left"><p>propranolol</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>fluoxetine</p></td><td align="left"><p>risperidone</p></td><td align="left"><p>4</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>haloperidol</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>metoclopramide</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>paroxetine</p></td><td align="left"><p>perphenazine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>paroxetine</p></td><td align="left"><p>propranolol</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>paroxetine</p></td><td align="left"><p>risperidone</p></td><td align="left"><p>9</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>paroxetine</p></td><td align="left"><p>tolterodine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP2D6 inhibitor</p></td></tr><tr><td align="left"><p>alprazolam</p></td><td align="left"><p>carbamazepine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>alprazolam</p></td><td align="left"><p>primidone</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>carbamazepine</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>primidone</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>armodafinil</p></td><td align="left"><p>phenytoin</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>atorvastatin</p></td><td align="left"><p>carbamazepine</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>atorvastatin</p></td><td align="left"><p>phenobarbital</p></td><td align="left"><p>3</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>buspirone</p></td><td align="left"><p>carbamazepine</p></td><td align="left"><p>3</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>buspirone</p></td><td align="left"><p>primidone</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>clonazepam</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>diazepam</p></td><td align="left"><p>3</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>doxazosin</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>escilalopram</p></td><td align="left"><p>4</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>isosorbide dinitrate</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>rabeprazole</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>risperidone</p></td><td align="left"><p>3</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>simvastatin</p></td><td align="left"><p>3</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>tamsulosin</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>tolterodine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>trazodone</p></td><td align="left"><p>4</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>phenobarbital</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>phenytoin</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>escitalopram</p></td><td align="left"><p>phenytoin</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>phenobarbital</p></td><td align="left"><p>quetiapine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>phenobarbital</p></td><td align="left"><p>simvastatin</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>phenobarbital</p></td><td align="left"><p>trazodone</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>phenytoin</p></td><td align="left"><p>conjugated estrogen</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>phenytoin</p></td><td align="left"><p>tamsulosin</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>primidone</p></td><td align="left"><p>quetiapine</p></td><td align="left"><p>1</p></td><td align="left"><p>CYP3A4 inducer</p></td></tr><tr><td align="left"><p>phenytoin</p></td><td align="left"><p>risperidone</p></td><td align="left"><p>2</p></td><td align="left"><p>CYP3A4 inducer, reduce risperidone effect</p></td></tr><tr><td align="left"><p>aripiprazole</p></td><td align="left"><p>fluoxetine</p></td><td align="left"><p>4</p></td><td align="left"><p>CYP3A4 inhibitor</p></td></tr><tr><td align="left"><p>rotigotine</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease anti Parkinson's effect</p></td></tr><tr><td align="left"><p>carbidopa levodopa</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease effect of carbidopa levodopa</p></td></tr><tr><td align="left"><p>phenytoin</p></td><td align="left"><p>pravastatin</p></td><td align="left"><p>2</p></td><td align="left"><p>decrease pravastatin effect</p></td></tr><tr><td align="left"><p>phenytoin</p></td><td align="left"><p>simvastatin</p></td><td align="left"><p>1</p></td><td align="left"><p>decrease pravastatin effect</p></td></tr><tr><td align="left"><p>guanfacine</p></td><td align="left"><p>mirtazapine</p></td><td align="left"><p>2</p></td><td align="left"><p>decreased antihypertensive effect</p></td></tr><tr><td align="left"><p>guanfacine</p></td><td align="left"><p>pindolol</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased antihypertensive effect</p></td></tr><tr><td align="left"><p>bisacodyl</p></td><td align="left"><p>calcium carbonate</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased bisacodyl effect, stomach upset</p></td></tr><tr><td align="left"><p>bisacodyl</p></td><td align="left"><p>milk of magnesia</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased bisacodyl effect, stomach upset</p></td></tr><tr><td align="left"><p>lamotrigine</p></td><td align="left"><p>phenytoin</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased concentration of lamotrigine</p></td></tr><tr><td align="left"><p>celecoxib</p></td><td align="left"><p>furosemide</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased diuretic effect of furosemide</p></td></tr><tr><td align="left"><p>diclofenac</p></td><td align="left"><p>furosemide</p></td><td align="left"><p>2</p></td><td align="left"><p>decreased diuretic effect of furosemide</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>felbamate</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased effect of both drugs</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>theophylline</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased effect of both drugs</p></td></tr><tr><td align="left"><p>cyclosporine</p></td><td align="left"><p>carbamazepine</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased effect of cyclosporin</p></td></tr><tr><td align="left"><p>colesevelam</p></td><td align="left"><p>ezetimibe</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased effect of ezetimibe</p></td></tr><tr><td align="left"><p>furosemide</p></td><td align="left"><p>ibuprofen</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased effect of furosemide</p></td></tr><tr><td align="left"><p>furosemide</p></td><td align="left"><p>naproxen</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased effect of furosemide</p></td></tr><tr><td align="left"><p>mesalamine</p></td><td align="left"><p>pantoprazole</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased effect of mesalamine, absorption</p></td></tr><tr><td align="left"><p>fexofenadine</p></td><td align="left"><p>magnesium carbonate</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased fexofenadine absorption</p></td></tr><tr><td align="left"><p>gabapentin</p></td><td align="left"><p>magnesium oxide</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased absorption gabapentin </p></td></tr><tr><td align="left"><p>ferrous sulfate</p></td><td align="left"><p>magnesium oxide</p></td><td align="left"><p>1</p></td><td align="left"><p>decreased iron absorption</p></td></tr><tr><td align="left"><p>ferrous sulfate</p></td><td align="left"><p>milk of magnesia</p></td><td align="left"><p>2</p></td><td align="left"><p>decreased iron absorption</p></td></tr><tr><td align="left"><p>clomipramine</p></td><td align="left"><p>clonidine</p></td><td align="left"><p>1</p></td><td align="left"><p>diminished effect of clonidine</p></td></tr><tr><td align="left"><p>amitriptyline</p></td><td align="left"><p>tizanidine</p></td><td align="left"><p>1</p></td><td align="left"><p>diminished tizanidine effect</p></td></tr><tr><td align="left"><p>clopidogrel</p></td><td align="left"><p>omeprazole</p></td><td align="left"><p>2</p></td><td align="left"><p>diminished antiplatelet effect of clopidogrel</p></td></tr><tr><td align="left"><p>clonidine</p></td><td align="left"><p>mirtazapine</p></td><td align="left"><p>1</p></td><td align="left"><p>diminished clonidine effects</p></td></tr><tr><td align="left"><p>brivaracetam</p></td><td align="left"><p>levetiracetam</p></td><td align="left"><p>1</p></td><td align="left"><p>diminished effect of brivaraetam</p></td></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>topiramate</p></td><td align="left"><p>11</p></td><td align="left"><p>enhance adverse effect of both drugs</p></td></tr><tr><td align="left"><p>lamotrigine</p></td><td align="left"><p>carbamazepine</p></td><td align="left"><p>1</p></td><td align="left"><p>enhance adverse effects of lamotrigine</p></td></tr><tr><td align="left"><p>carvedilol</p></td><td align="left"><p>tizanidine</p></td><td align="left"><p>1</p></td><td align="left"><p>enhance AV blocking effect of beta blocker</p></td></tr><tr><td align="left"><p>glimepiride</p></td><td align="left"><p>sitagliptin</p></td><td align="left"><p>1</p></td><td align="left"><p>enhance hypoglycemic effect of glimepriride</p></td></tr><tr><td align="left"><p>glipizide</p></td><td align="left"><p>linagliptin</p></td><td align="left"><p>1</p></td><td align="left"><p>enhance hypoglycemic effect of glipizide</p></td></tr><tr><td align="left"><p>glipizide</p></td><td align="left"><p>pioglitazone</p></td><td align="left"><p>2</p></td><td align="left"><p>enhance hypoglycemic effect of glipizide</p></td></tr><tr><td align="left"><p>glipizide</p></td><td align="left"><p>sitagliptin</p></td><td align="left"><p>1</p></td><td align="left"><p>enhance hypoglycemic effect of glipizide</p></td></tr><tr><td align="left"><p>allopurinol</p></td><td align="left"><p>lisinopril</p></td><td align="left"><p>2</p></td><td align="left"><p>enhance toxicity of allopurinol</p></td></tr><tr><td align="left"><p>niacin</p></td><td align="left"><p>simvastatin</p></td><td align="left"><p>2</p></td><td align="left"><p>enhance toxicity of simvastatin</p></td></tr><tr><td align="left"><p>carvedilol</p></td><td align="left"><p>clonidine</p></td><td align="left"><p>1</p></td><td align="left"><p>enhanced AV blocking of beta blocker</p></td></tr><tr><td align="left"><p>clonidine</p></td><td align="left"><p>metoprolol</p></td><td align="left"><p>3</p></td><td align="left"><p>enhanced AV blocking of beta blocker</p></td></tr><tr><td align="left"><p>clonidine</p></td><td align="left"><p>pindolol</p></td><td align="left"><p>3</p></td><td align="left"><p>enhanced AV blocking of beta blocker</p></td></tr><tr><td align="left"><p>diltiazem</p></td><td align="left"><p>simvastatin</p></td><td align="left"><p>1</p></td><td align="left"><p>enhanced effect of both drugs</p></td></tr><tr><td align="left"><p>clobazam</p></td><td align="left"><p>clozapine</p></td><td align="left"><p>2</p></td><td align="left"><p>enhanced effect of clozapine</p></td></tr><tr><td align="left"><p>lamotrigine</p></td><td align="left"><p>valproic acid</p></td><td align="left"><p>4</p></td><td align="left"><p>enhanced effect of lamotrigine</p></td></tr><tr><td align="left"><p>lamotrigine</p></td><td align="left"><p>primidone</p></td><td align="left"><p>1</p></td><td align="left"><p>enhanced effect of primidone</p></td></tr><tr><td align="left"><p>insulin</p></td><td align="left"><p>liraglutide</p></td><td align="left"><p>1</p></td><td align="left"><p>enhanced hypoglycemic effect of insulin</p></td></tr><tr><td align="left"><p>insulin</p></td><td align="left"><p>pioglitazone</p></td><td align="left"><p>1</p></td><td align="left"><p>enhanced hypoglycemic effect of insulin</p></td></tr><tr><td align="left"><p>insulin</p></td><td align="left"><p>saxagliptin</p></td><td align="left"><p>1</p></td><td align="left"><p>enhanced hypoglycemic effect of insulin</p></td></tr><tr><td align="left"><p>insulin</p></td><td align="left"><p>sitagliptin</p></td><td align="left"><p>2</p></td><td align="left"><p>enhanced hypoglycemic effect of insulin</p></td></tr><tr><td align="left"><p>hydrochlorothiazide</p></td><td align="left"><p>topiramate</p></td><td align="left"><p>1</p></td><td align="left"><p>enhanced topiramate effect</p></td></tr><tr><td align="left"><p>acetaminophen</p></td><td align="left"><p>probenecid</p></td><td align="left"><p>1</p></td><td align="left"><p>increase acetaminophen levels and increase toxic metabolite</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>quetiapine</p></td><td align="left"><p>2</p></td><td align="left"><p>increase adverse effect carbamazepine, decrease quetiapine effect</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>lamotrigine</p></td><td align="left"><p>1</p></td><td align="left"><p>increase adverse effect lamotrigine</p></td></tr><tr><td align="left"><p>atorvastatin</p></td><td align="left"><p>diltiazem</p></td><td align="left"><p>1</p></td><td align="left"><p>increase concentration of both drugs</p></td></tr><tr><td align="left"><p>amlodipine</p></td><td align="left"><p>simvastatin</p></td><td align="left"><p>2</p></td><td align="left"><p>increase concentration of statin</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>verapamil</p></td><td align="left"><p>1</p></td><td align="left"><p>increase effect of carbamazepine, decrease effect of verapamil</p></td></tr><tr><td align="left"><p>lorazepam</p></td><td align="left"><p>valproic acid</p></td><td align="left"><p>1</p></td><td align="left"><p>increase effect of lorazepam</p></td></tr><tr><td align="left"><p>valproic acid</p></td><td align="left"><p>lamotrigine</p></td><td align="left"><p>1</p></td><td align="left"><p>increase lamotrigine levels and adverse effects</p></td></tr><tr><td align="left"><p>phenytoin</p></td><td align="left"><p>verapamil</p></td><td align="left"><p>1</p></td><td align="left"><p>increase levels of phenytoin, decrease levels of verapamil</p></td></tr><tr><td align="left"><p>lisinopril</p></td><td align="left"><p>lithium</p></td><td align="left"><p>1</p></td><td align="left"><p>increase lithium concentration and toxicity</p></td></tr><tr><td align="left"><p>lithium</p></td><td align="left"><p>losartan</p></td><td align="left"><p>1</p></td><td align="left"><p>increase lithium concentration and toxicity</p></td></tr><tr><td align="left"><p>amlodipine</p></td><td align="left"><p>carbamazepine</p></td><td align="left"><p>2</p></td><td align="left"><p>increase metabolism of calcium channel blocker</p></td></tr><tr><td align="left"><p>aspirin</p></td><td align="left"><p>methotrexate</p></td><td align="left"><p>1</p></td><td align="left"><p>increase methotrexate concentration and toxicity</p></td></tr><tr><td align="left"><p>citalopram</p></td><td align="left"><p>omeprazole</p></td><td align="left"><p>17</p></td><td align="left"><p>increased citalopram effect</p></td></tr><tr><td align="left"><p>simvastatin</p></td><td align="left"><p>verapamil</p></td><td align="left"><p>2</p></td><td align="left"><p>increased concentration simvastatin, toxicity</p></td></tr><tr><td align="left"><p>escitalopram</p></td><td align="left"><p>omeprazole</p></td><td align="left"><p>24</p></td><td align="left"><p>increased effect of escitalopram</p></td></tr><tr><td align="left"><p>divalproex</p></td><td align="left"><p>lamotrigine</p></td><td align="left"><p>5</p></td><td align="left"><p>increased effect of lamotrigine</p></td></tr><tr><td align="left"><p>divalproex</p></td><td align="left"><p>lorazepam</p></td><td align="left"><p>3</p></td><td align="left"><p>increased effect of lorazepam</p></td></tr><tr><td align="left"><p>cyclosporine</p></td><td align="left"><p>pravastatin</p></td><td align="left"><p>1</p></td><td align="left"><p>increased effect of pravastatin, possible toxicity</p></td></tr><tr><td align="left"><p>calcium antacid</p></td><td align="left"><p>multivitamin</p></td><td align="left"><p>6</p></td><td align="left"><p>may increase calcium levels</p></td></tr><tr><td align="left"><p>calcium antacid</p></td><td align="left"><p>prednisone</p></td><td align="left"><p>1</p></td><td align="left"><p>may increase calcium levels</p></td></tr><tr><td align="left"><p>potassium chloride</p></td><td align="left"><p>spironolactone</p></td><td align="left"><p>1</p></td><td align="left"><p>potassium elevation</p></td></tr><tr><td align="left"><p>chlorpromazine</p></td><td align="left"><p>clozapine</p></td><td align="left"><p>2</p></td><td align="left"><p>QT prolongation</p></td></tr><tr><td align="left"><p>chlorpromazine</p></td><td align="left"><p>olanzapine</p></td><td align="left"><p>1</p></td><td align="left"><p>QT prolongation</p></td></tr><tr><td align="left"><p>chlorpromazine</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>1</p></td><td align="left"><p>QT prolongation</p></td></tr><tr><td align="left"><p>escitalopram</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>1</p></td><td align="left"><p>QT prolongation</p></td></tr><tr><td align="left"><p>olanzapine</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>1</p></td><td align="left"><p>QT prolongation</p></td></tr><tr><td align="left"><p>risperidone</p></td><td align="left"><p>ziprasidone</p></td><td align="left"><p>2</p></td><td align="left"><p>QT prolongation</p></td></tr><tr><td align="left"><p>carbamazepine</p></td><td align="left"><p>warfarin</p></td><td align="left"><p>1</p></td><td align="left"><p>reduce effect of warfarin</p></td></tr><tr><td align="left"><p>estrogen</p></td><td align="left"><p>warfarin</p></td><td align="left"><p>1</p></td><td align="left"><p>reduce effect of warfarin</p></td></tr><tr><td align="left"><p>amitriptyline</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left"><p>Enhance serotonergic activity</p></td></tr><tr><td align="left"><p>amitriptyline</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>1</p></td><td align="left"><p>Enhance serotonergic activity</p></td></tr><tr><td align="left"><p>metoclopramide</p></td><td align="left"><p>paroxetine</p></td><td align="left"><p>1</p></td><td align="left"><p>Enhance serotonergic activity</p></td></tr><tr><td align="left"><p>mirtazapine</p></td><td align="left"><p>tramadol</p></td><td align="left"><p>2</p></td><td align="left"><p>Enhance serotonergic activity</p></td></tr></tbody></table> </ephtml> </p> <hd 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Gallus; Amy Esler and James Houseworth</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib12" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib17" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib15" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib27" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib16" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib22" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib39" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib10" firstref="ref13"></nolink> <nolink nlid="nl9" bibid="bib23" firstref="ref14"></nolink> <nolink nlid="nl10" bibid="bib36" firstref="ref15"></nolink> <nolink nlid="nl11" bibid="bib29" firstref="ref22"></nolink> <nolink nlid="nl12" bibid="bib31" firstref="ref23"></nolink> <nolink nlid="nl13" bibid="bib46" firstref="ref25"></nolink> <nolink nlid="nl14" bibid="bib43" firstref="ref26"></nolink> <nolink nlid="nl15" bibid="bib20" firstref="ref27"></nolink> <nolink nlid="nl16" bibid="bib41" firstref="ref28"></nolink> <nolink nlid="nl17" bibid="bib33" firstref="ref30"></nolink> <nolink nlid="nl18" bibid="bib28" firstref="ref31"></nolink> <nolink nlid="nl19" bibid="bib21" firstref="ref33"></nolink> <nolink nlid="nl20" bibid="bib37" firstref="ref36"></nolink> <nolink nlid="nl21" bibid="bib34" firstref="ref42"></nolink> <nolink nlid="nl22" bibid="bib35" firstref="ref43"></nolink> <nolink nlid="nl23" bibid="bib18" firstref="ref45"></nolink> <nolink nlid="nl24" bibid="bib30" firstref="ref46"></nolink> <nolink nlid="nl25" bibid="bib19" firstref="ref47"></nolink> <nolink nlid="nl26" bibid="bib25" firstref="ref48"></nolink> <nolink nlid="nl27" bibid="bib42" firstref="ref50"></nolink> <nolink nlid="nl28" bibid="bib47" firstref="ref53"></nolink> <nolink nlid="nl29" bibid="bib32" firstref="ref55"></nolink> <nolink nlid="nl30" bibid="bib11" firstref="ref57"></nolink> <nolink nlid="nl31" bibid="bib40" firstref="ref58"></nolink> <nolink nlid="nl32" bibid="bib44" firstref="ref59"></nolink> <nolink nlid="nl33" bibid="bib45" firstref="ref60"></nolink> <nolink nlid="nl34" bibid="bib24" firstref="ref62"></nolink> <nolink nlid="nl35" bibid="bib13" firstref="ref63"></nolink> <nolink nlid="nl36" bibid="bib26" firstref="ref64"></nolink> <nolink nlid="nl37" bibid="bib38" firstref="ref65"></nolink> <nolink nlid="nl38" bibid="bib14" firstref="ref66"></nolink>
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  Data: Potential Drug Interactions in Medication Regimens of Adults Who Have Intellectual and Developmental Disabilities
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  Data: <searchLink fieldCode="AR" term="%22Steven+R%2E+Erickson%22">Steven R. Erickson</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-1855-3645">0000-0002-1855-3645</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jennifer+L%2E+Jones%22">Jennifer L. Jones</searchLink><br /><searchLink fieldCode="AR" term="%22Kami+L%2E+Gallus%22">Kami L. Gallus</searchLink><br /><searchLink fieldCode="AR" term="%22Amy+Esler%22">Amy Esler</searchLink><br /><searchLink fieldCode="AR" term="%22James+Houseworth%22">James Houseworth</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Developmental+and+Physical+Disabilities%22"><i>Journal of Developmental and Physical Disabilities</i></searchLink>. 2022 34(5):795-828.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 34
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Drug+Use%22">Drug Use</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Disabilities%22">Developmental Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Interaction%22">Interaction</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Oklahoma%22">Oklahoma</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10882-021-09824-7
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1056-263X<br />1573-3580
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Polypharmacy is a risk factor for drug interactions (DI). Adults with intellectual and developmental disabilities (IDD) are at increased risk for polypharmacy and as such increased risk for potential DIs. The objectives of this study were to determine the number of potential DIs present in medication regimens of adults with IDD as well as factors associated with the number of potential DIs. Community-based cross sectional study. Retrospective analysis of data obtained from the cross-sectional National Core Indicators survey in the state of Oklahoma in the United States. 598 respondents were included. The number of medications prescribed, the number of potential DIs, and the association between participant factors with the total number of potential DIs present. 598 adults with IDD were studied. In this sample, over 80% had at least one DI present in their current medication regimen. There were 8.9 ± 9.7 potential DIs in the medication regimens, with 29.8% of participants having 12 or more. Greater number of medications was significantly associated with a greater number of potential drug interactions. People with IDD who take medications are exposed to potential drug interactions. Health care professionals must have clear goals and endpoints in mind when prescribing medications for this vulnerable population. Potential drug interactions are common in the medication regimens of adults with intellectual or developmental disabilities. Polypharmacy is associated with a greater number of potential drug interactions. Health care professionals must have clear goals and endpoints in mind when prescribing medications for adults with IDD to minimize the occurrence of drug interactions.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1431394
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1431394
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  BibEntity:
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      – Type: doi
        Value: 10.1007/s10882-021-09824-7
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 34
        StartPage: 795
    Subjects:
      – SubjectFull: Drug Use
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Developmental Disabilities
        Type: general
      – SubjectFull: At Risk Persons
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      – SubjectFull: Correlation
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      – SubjectFull: Interaction
        Type: general
      – SubjectFull: Oklahoma
        Type: general
    Titles:
      – TitleFull: Potential Drug Interactions in Medication Regimens of Adults Who Have Intellectual and Developmental Disabilities
        Type: main
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            NameFull: Steven R. Erickson
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            NameFull: Jennifer L. Jones
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            NameFull: Kami L. Gallus
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            NameFull: Amy Esler
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            – D: 01
              M: 10
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 1056-263X
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              Value: 5
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            – TitleFull: Journal of Developmental and Physical Disabilities
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