Newswise — According to a new study from the University of Illinois at Chicago, University of Chicago Medicine and Johns Hopkins Bloomberg School of Public Health, about one in five children regularly uses prescription medications, and nearly one in 12 of those children is at risk for experiencing a harmful drug- drug interaction. The findings from the study were published Monday in the journal Pediatrics.
"The findings from this study not only provide valuable insight on how many young people in the U.S. use prescription medications, but more importantly that some, particularly adolescent girls, use multiple medications that put them at-risk for potentially serious drug-drug interactions,” said Dima Qato, PharmD, Ph.D., MPH, lead author and UIC associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy.
Although adverse drug events are a leading cause of injuries and death among both children and adolescents in the U.S., information on how younger populations use the prescription medications that potentially could lead to these adverse events is lacking.
To fill this gap, the researchers retrospectively analyzed medication use patterns of more than 23,000 children and adolescents living in the U.S. based on data collected as part of the National Health and Nutrition Examination Survey from 2003 to 2014. Included in the study was a nationally representative sample of children and adolescents ages 0 to 19 who responded or whose parents responded to a questionnaire on prescription medications.
The researchers found that nearly 20 percent of children had used at least one prescription medication. Nearly 14 percent used chronic medications and 7 percent used acute medications. Chronic medication use was defined as taking at least one prescription medication for more than 30 days and acute medication as taking at least one for medication for less than 30 days.
Analysis also showed that medication use increased with age, from 14 percent in children younger than 5 years to 22 percent in adolescents 13 to 19 years.
The most common medications were respiratory agents and psychotherapeutic agents. Respiratory agents, used primarily in the management of asthma, included bronchodilators and leukotriene modifiers. Psychotherapeutic agents included CNS stimulants and antidepressants, which are associated with rare but serious adverse effects like thoughts of suicide, serotonin syndrome and even sudden death.
According to the study, approximately 7.5 percent of children used multiple medications simultaneously, and among them, one in 12 was at risk for a major drug-drug interaction. Among those using multiple medications, adolescent girls were at highest risk, with nearly one in five using potentially interacting drug regimens.
The vast majority of these potential interactions involved antidepressants with the most common potential adverse interaction effect being QT prolongation -- an abnormal heart rhythm that can cause sudden death in otherwise healthy kids. The researchers report that this risk is "especially noteworthy" given that condition is often asymptomatic and sudden death is an under-reported problem in children.
Other findings from the study showed that prescription medications associated with an increased risk of suicide are among the most commonly used, often in combination. For example, more than half of adolescent girls taking antidepressants concurrently use at least two other psychotropic medications or oral contraceptives.
“We choose to use medicines like anti-depressants and contraceptives because serious untreated depression, debilitating menstrual periods or not using contraception also present real risk to young women’s health and well-being,” said study co-author Stacy Tessler Lindau, MD, MA, professor of Obstetrics and Gynecology at UChicago Medicine.
“Our findings are a call to action to OB/GYNs and others responsible for medical care of adolescent women to know and counsel patients and parents about the potential for drug-drug interactions and serious adverse side effects when using these medications.”
In contrast to QT prolongation and serotonin syndrome, suicidality is not captured as a potential DDI in existing drug interaction software.
"Therefore, health care professionals, including psychiatrists, may not be aware of the suicidal risks associated with the concurrent use of prescriptions in the treatment of depressive symptoms in younger patients," the researchers write.
Although this study did not evaluate the incidence of adverse drug events specifically in association with the concurrent use of prescription medications, Qato and her colleagues say that they hope the findings will be used to inform preventive efforts and promote awareness of the potential for drug-drug interactions and increased risks associated with the concurrent use of prescription medications, particularly suicidality and QT prolongation.
"Such efforts may include the incorporation of a list of commonly used medications and interacting combinations associated with increases in QT prolongation and suicidal risks in treatment guidelines and screening tools for depression," the authors write.
Co-authors on the study are G. Caleb Alexander of the Johns Hopkins Bloomberg School of Public Health and Jenny Guadamuz of UIC.
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