International Journal of Clinical Pharmacy

, Volume 34, Issue 6, pp 807–817 | Cite as

Prevalence of drug interactions in hospital healthcare

  • María Espinosa-Bosch
  • Bernardo Santos-RamosEmail author
  • María Victoria Gil-Navarro
  • María Dolores Santos-Rubio
  • Roberto Marín-Gil
  • Paloma Villacorta-Linaza
Review Article


Aim of the review To study the prevalence of drug interactions in hospital healthcare by reviewing literature. Method A review was carried out of studies written in Spanish and English on the prevalence of drug interactions in hospital care published in Pubmed between January 1990 and September 2008. The search strategy combined free text and MeSH terms, using the following keywords: “Drug interaction”, “prevalence” and “hospital”. For each article, we classified independent variables (pathology, age of population, whether patients were hospitalized or not, geographical location, etc.) and dependent variables (number of interactions per 100 patients studied, prevalence of patients with interactions, most common drug interactions, and others). Results The search generated 436 articles. Finally, 47 articles were selected for the study, 3 provided results about drug interactions with real clinical consequences, 42 about potential interactions, and 2 described both. The prevalence of patients with interactions was between 15 and 45 % and the number of interactions per 100 patients was between 37 and 106, depending on the group of studies analyzed. There was a considerable increase in these rates in patients with heart diseases and elderly persons. Conclusion There is a large number of studies on the prevalence of drug interactions in hospitals but they report widely varying results. The prevalence is higher in patients with heart diseases and elderly people.


Drug interactions Hospital Prevalence 



This study was supported by the Health Department of the Andalusian Government in Spain (Proyectos de Investigación en Salud de la Consejería de Salud de la Junta de Andalucía).

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet. 2007;370:185–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Zopf Y, Rabe C, Neubert A, Hahn A, Dormann D. Risk factors associated with adverse drug reactions following hospital admission: a prospective analysis of 907 patients in two German university hospitals. Drug Saf. 2008;31:789–98.PubMedCrossRefGoogle Scholar
  3. 3.
    Joshua L, Devi P, Guido S. Adverse drug reactions in medical intensive care unit of a tertiary care hospital. Pharmacoepidemiol Drug Saf. 2009;18:639–45.PubMedCrossRefGoogle Scholar
  4. 4.
    Rodríguez-Terol A, Caraballo MO, Palma D, Santos-Ramos D, Molina T, Desongles T, Aguilar A. Calidad estructural de las bases de datos de interacciones. Farm Hosp. 2009;33:134–96.PubMedCrossRefGoogle Scholar
  5. 5.
    Stanton LA, Peterson GM, Rumble RH, Cooper GM, Polack AE. Drug related admissions to an Australian hospital. J Clin Pharm Ther. 1994;19:341–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Raschetti R, Morgutti M, Menniti-Ippolito F, Belisari A, Rossignoli A, Longhini P, et al. Suspected adverse drug events requiring emergency department visits or hospital admissions. Eur J Clin Pharmacol. 1999;54:959–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Peyriere H, Cassan S, Floutard E, Riviere S, Blayac JP, Hillaire-Buys D, et al. Adverse drug events associated with hospital admission. Ann Pharmacother. 2003;37:5–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Egger T, Dormann H, Ahne G, Runge U, Neubert A, Criegee-Rieck M, et al. Identification of adverse drug reactions in geriatric inpatients using a computerized drug database. Drugs Aging. 2003;20:769–76.PubMedCrossRefGoogle Scholar
  9. 9.
    Depont F, Vargas F, Dutronc H, Giauque E, Ragnaud JM, Galperine T, et al. Drug-drug interactions with systemic antifungals in clinical practice. Pharmacoepidemiol Drug Saf. 2007;16:1227–33.PubMedCrossRefGoogle Scholar
  10. 10.
    Herr RD, Caravati EM, Tyler LS, Iorg E, Linscott MS. Prospective evaluation of adverse drug interactions in the emergency department. Ann Emerg Med. 1992;21:1331–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Crespo CA, Guerrero E, Sanmartín P. Interacciones entre medicamentos: detección precoz mediante un sistema computerizado. Farm Hosp. 1992;16:38–44.Google Scholar
  12. 12.
    Braverman SE, Howard RS, Bryant PR, Belandres PV. Potential drug interactions in a physical medicine and rehabilitation clinic. Am J Phys Med Rehabil. 1996;75:44–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Sierra P, Castillo J, Gomez M, Sorribes V, Monterde J, Castano J. Interacciones potenciales y reales en pacientes críticos. Rev Esp Anestesiol Reanim. 1997;44:383–7.PubMedGoogle Scholar
  14. 14.
    Kohler GI, Bode-Boger SM, Busse R, Hoopmann M, Welte T, Boger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther. 2000;38:504–13.PubMedGoogle Scholar
  15. 15.
    Langdorf MI, Fox JC, Marwah RS, Montague BJ, Hart MM. Physician versus computer knowledge of potential drug interactions in the emergency department. Acad Emerg Med. 2000;7:1321–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38:666–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Mur Lalaguna MA, Cobos Campos R, Hurtado Gomez MF, Marwah RS. Estudio de las interacciones entre fármacos antirretrovirales y tratamiento concominante. Farm Hosp. 2003;27:84–92.PubMedGoogle Scholar
  18. 18.
    Miyasaka LS, Atallah AN. Risk of drug interaction: combination of antidepressants and other drugs. Rev Saude Publica. 2003;37:212–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Egger SS, Drewe J, Schlienger RG. Potential drug–drug interactions in the medication of medical patients at hospital discharge. Eur J Clin Pharmacol. 2003;58:773–8.PubMedGoogle Scholar
  20. 20.
    Wilcock A, Thomas J, Frisby J, Webster M, Keeley V, Finn G, et al. Potential for drug interactions involving cytochrome P450 in patients attending palliative day care centres: a multicentre audit. Br J Clin Pharmacol. 2005;60:326–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Saltvedt I, Spigset O, Ruths S, Fayers P, Kaasa S, Sletvold O. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomized study. Eur J Clin Pharmacol. 2005;61:921–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Yusuff KB, Balogun O. Physicians’ prescribing of anti-hypertensive combinations in a tertiary care setting in southwestern Nigeria. J Pharm Pharm Sci. 2005;8:235–42.PubMedGoogle Scholar
  23. 23.
    Riechelmann RP, Moreira F, Smaletz O, Saad ED. Potential for drug interactions in hospitalized cancer patients. Cancer Chemother Pharmacol. 2005;56:286–90.PubMedCrossRefGoogle Scholar
  24. 24.
    Glintborg B, Andersen SE, Dalhoff K. Drug-drug interactions among recently hospitalized patients–frequent but mostly clinically insignificant. Eur J Clin Pharmacol. 2005;61:675–81.PubMedCrossRefGoogle Scholar
  25. 25.
    López Vázquez P, Rodríguez Moreno C, Durán Parrondo C, Tato Herrero F, Rodríguez López I, Lado Lado FL. Interacciones entre medicamentos prescritos al alta en un Servicio de Medicina Interna. An Med Intern. 2005;22:69–75.Google Scholar
  26. 26.
    Straubhaar B, Krahenbuhl S, Schlienger RG. The prevalence of potential drug–drug interactions in patients with heart failure at hospital discharge. Drug Saf. 2006;29:79–90.PubMedCrossRefGoogle Scholar
  27. 27.
    Hassan FA, Taylor D, Leow F, Doolan G, Knott J. Potential interactions between drugs taken by emergency department patients of an Australian hospital. J Pharm Pract Res. 2006;4:266–70.Google Scholar
  28. 28.
    Hastings SN, Sloane RJ, Goldberg KC, Oddone EZ, Schmader KE. The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic. J Am Geriatr Soc. 2007;55:1339–48.PubMedCrossRefGoogle Scholar
  29. 29.
    Miller CD, El-Kholi R, Faragon JJ, Lodise TP. Prevalence and risk factors for clinically significant drug interactions with antiretroviral therapy. Pharmacotherapy. 2007;27:1379–86.PubMedCrossRefGoogle Scholar
  30. 30.
    Riechelmann RP, Tannock IF, Wang L, Saad ED, Taback NA, Krzyzanowska MK. Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst. 2007;99:592–600.PubMedCrossRefGoogle Scholar
  31. 31.
    Peral AJ, Lertxundi EU, Martinez Bengoechea MJ, Mora AO, Franco LE, Gabilondo Z. Evaluación prospectiva de interacciones entre medicamentos en pacientes ingresados mediante una aplicación informática. Farm Hosp. 2007;31:93–100.CrossRefGoogle Scholar
  32. 32.
    Radosevic N, Gantumur M, Vlahovic-Palcevski V. Potentially inappropriate prescribing to hospitalised patients. Pharmacoepidemiol Drug Saf. 2008;17:733–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Blix HS, Viktil KK, Moger TA, Reikvam A. Identification of drug interactions in hospitals–computerized screening vs. bedside recording. J Clin Pharm Ther. 2008;33:131–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Riechelmann RP, Zimmermann C, Chin SN, Wang L, O’Carroll A, Zarinehbaf S, et al. Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manage. 2008;35:535–43.PubMedCrossRefGoogle Scholar
  35. 35.
    Martín I, Feal B, Piñeiro MJ, Cuña B. Detección de interacciones medicamento–medicamento en un sistema de dispensación dosis-día. Farm Hosp. 1992;16:198–202.Google Scholar
  36. 36.
    Gonzalez R, Gomez M, Monterde J. Detección “en proceso” de interacciones farmacológicas. Farm Clin. 1993;10:488–92.Google Scholar
  37. 37.
    Wiltink EH. Medication control in hospitals: a practical approach to the problem of drug–drug interactions. Pharm World Sci. 1998;20:173–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Gaddis GM, Holt TR, Woods M. Drug interactions in at-risk emergency department patients. Acad Emerg Med. 2002;9:1162–7.PubMedCrossRefGoogle Scholar
  39. 39.
    García Batllé C, Pla Poblador R. Revisión de interacciones farmacológicas en un Hospital General. Farm Hosp. 2002;26:110–8.Google Scholar
  40. 40.
    Gaeta TJ, Fiorini M, Ender K, Bove J, Diaz J. Potential drug–drug interactions in elderly patients presenting with syncope. J Emerg Med. 2002;22:159–62.PubMedCrossRefGoogle Scholar
  41. 41.
    Ledwidge M, Travers B, Ryder M, Ryan E, McDonald K. Specialist care of heart failure improves appropriate pharmacotherapy at the expense of greater polypharmacy and drug-interactions. Eur J Heart Fail. 2004;6:235–43.PubMedCrossRefGoogle Scholar
  42. 42.
    Yu DT, Peterson JF, Seger DL, Gerth WC, Bates DW. Frequency of potential azole drug–drug interactions and consequences of potential fluconazole drug interactions. Pharmacoepidemiol Drug Saf. 2005;14:755–67.PubMedCrossRefGoogle Scholar
  43. 43.
    Vonbach P, Dubied A, Beer JH, Krahenbuhl S. Recognition and management of potential drug–drug interactions in patients on internal medicine wards. Eur J Clin Pharmacol. 2007;63:1075–83.PubMedCrossRefGoogle Scholar
  44. 44.
    Martinbiancho J, Zuckermann J, Dos Santos L, Silva MM. Profile of drug interactions in hospitalized children. Pharm Pract. 2007;5:157–61.Google Scholar
  45. 45.
    Mok S, Minson Q. Drug-related problems in hospitalized patients with HIV infection. Am J Health Syst Pharm. 2008;65:55–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Beers MH, Storrie M, Lee G. Potential adverse drug interactions in the emergency room. An issue in the quality of care. Ann Intern Med. 1990;112:61–4.PubMedGoogle Scholar
  47. 47.
    Gronroos PE, Irjala KM, Huupponen RK, Scheinin H, Forsstrom J, Forsstrom JJ. A medication database—a tool for detecting drug interactions in hospital. Eur J Clin Pharmacol. 1997;53:13–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Heininger-Rothbucher D, Bischinger S, Ulmer H, Pechlaner C, Speer G, Wiedermann CJ. Incidence and risk of potential adverse drug interactions in the emergency room. Resuscitation. 2001;49:283–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Davies SJ, Eayrs S, Pratt P, Lennard MS. Potential for drug interactions involving cytochromes P450 2D6 and 3A4 on general adult psychiatric and functional elderly psychiatric wards. Br J Clin Pharmacol. 2004;57:464–72.PubMedCrossRefGoogle Scholar
  50. 50.
    Samoy LJ, Zed PJ, Wilbur K, Balen RM, bu-Laban RB, Roberts M. Drugrelated hospitalizations in a tertiary care internal medicine service of a Canadian hospital: a prospective study. Pharmacotherapy. 2006;26:1578–86.PubMedCrossRefGoogle Scholar
  51. 51.
    Cruciol-Souza JM, Thomson JC. Prevalence of potential drug–drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9:427–33.PubMedGoogle Scholar
  52. 52.
    Jankel CA, Speedie SM. Detecting drug interactions: a review of the literature. DICP. 1990;24:982–9.PubMedGoogle Scholar
  53. 53.
    Lalloo UG. Efavirenz and nevirapine interactions with rifampicin: resolving the dilemmas? Clin Infect Dis. 2009;48:1760–2.PubMedCrossRefGoogle Scholar
  54. 54.
    Soriano V, Geretti AM, Perno CF, Fätkenheuer G, Pillay D, Reynes J, et al. Optimal use of maraviroc in clinical practice. AIDS. 2008;22:2231–40.PubMedCrossRefGoogle Scholar
  55. 55.
    Hellinger FJ, Encinosa WE. Inappropriate drug combinations among privately insured patients with HIV disease. Med Care. 2005;43(9 Suppl):III53–62.PubMedGoogle Scholar
  56. 56.
    Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalizations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16:641–51.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • María Espinosa-Bosch
    • 1
  • Bernardo Santos-Ramos
    • 1
    Email author
  • María Victoria Gil-Navarro
    • 1
  • María Dolores Santos-Rubio
    • 1
  • Roberto Marín-Gil
    • 1
  • Paloma Villacorta-Linaza
    • 1
  1. 1.Servicio de FarmaciaHospital Universitario Virgen del RocíoSevilleSpain

Personalised recommendations