Prescription Patterns of Inducers and Inhibitors of Cytochrome P450 and Their Potential Drug Interactions in the Real World: A Cross-Sectional Study

Abstract

Introduction: Both the induction and inhibition of cytochrome P450 are associated with multiple pharmacological interactions, which can lead to loss of efficacy or increase the risk of adverse drug reactions. Objective: The aim was to determine the prescription patterns of cytochrome P450-inducing and -inhibiting drugs and their contraindicated and major pharmacological interactions in a group of patients from Colombia. Methods: This cross-sectional observational study included patients who received drugs that induce or inhibit metabolism and examined their contraindicated and major pharmacological interactions. The patients were identified from a population-based database of drug dispensing. Patients were included between December 1 and December 31, 2021. Inhibitors and inducers of cytochrome P450 were classified based on FDA (Food and Drug Administration) guidelines. Drug interactions were identified using the Micromedex® database. Descriptive, bivariate and multivariable analysis was performed. Results: A total of 63,433 patients were analyzed. Antiseizure medications (35.9%) and antifungals (27.6%) were the most used inducers and inhibitors. A total of 30.1% of patients had potential contraindicated or greater interactions. The following factors were associated with a higher probability of presenting a potential pharmacological interaction: being male (OR 1.14; 95% CI 1.10–1.19), aged 18–39 years (OR 1.77; 95% CI 1.67–1.89) or 40–64 years (OR 1.64; 95% CI 1.56–1.72), having neurological diseases (OR 1.28; 95% CI 1.21–1.35), having psychiatric diseases (OR 3.84; 95% CI 3.58–4.13), having rheumatologic diseases (OR 1.32; 95% CI 1.23–1.41), receiving comedications with statins (OR 1.14; 95% CI 1.08–1.19), receiving comedications with analgesics (OR 1.33; 95% CI 1.27–1.38), receiving comedications with antiparasitics (OR 2.88; 95% CI 2.66–3.11) and an increase in the number of medications (OR 1.24; 95% CI 1.23–1.25). Conclusion: Among the users of cytochrome P450 inhibitors and inducers, potential contraindications and greater interactions are very common, especially in men under 65 years of age with comorbidities and polypharmacy.