Children Taking Multiple Drugs May Be at Risk for Drug-Drug Interactions

Node Smith, ND

A recent research study from the University of Illinois at Chicago estimates that 20 percent of children regularly use a prescription medication, and that one in 12 of those children are at risk of a harmful drug-drug interaction (DDI).¹ Adolescent girls are at the highest risk of these adverse events.

Researchers retrospectively looked at medication use patterns of more than 23,000 children & teens in the U.S.

Researchers retrospectively looked at medication use patterns of more than 23,000 children and teens living in the U.S. based on data from the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2014.

Almost 20 percent of children had used at least one prescription medication

It was noted that almost 20 percent of children had used at least one prescription medication, and nearly 14 percent used routine medications for chronic problems. 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.

Medication use increased with age

Medication use seemed to increase with age, from 14 percent in children younger than 5 years to 22 percent in adolescents between the ages of 13 and 19 years.

Most common prescription drugs used were respiratory medications

The most common prescription drugs used were respiratory medications – bronchodilators and leukotriene inhibitors used in for asthma – and psychotherapeutic drugs – CNS stimulants and antidepressants. Psych meds such as these commonly contain black box warnings for adverse effects like suicidal thoughts, serotonin syndrome and even sudden death.

Risky business: polypharmacy

Lead author Dima M. Qato, assistant professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy, says the findings not only provide valuable insight on how many young people in the U.S. regularly use prescription medication, but more importantly show that polypharmacy — the use of multiple medications simultaneously — is also common and comes with a potential risk.

7.5 percent of children were seen to use multiple medications simultaneously

Approximately 7.5 percent of children were seen to use multiple medications simultaneously, and one in 12 of them were at risk for a major DDI based on the medications being taken. Among adolescent girls, this number increased to one in five being at risk for a DDI.

Majority of potential risks involved antidepressants

The majority of these potential risks involved antidepressants. The most common potential DDI was an increase QT interval, which is an abnormal cardiac rhythm that can actually cause sudden death in otherwise healthy children. Increases in QT interval is often asymptomatic.

Difference in gender

The difference in gender was largely due to a higher concurrent use of antidepressants with acute medications, such as NSAIDS, anti-emetics, and macrolide antibiotics.

Study noted it was very common for medications used to be associated with an increase risk in suicide

Additionally, the study noted that it was very common for medications used to be associated with an increase risk in suicide, and they are often used in combination. An example of this was that more than half of teen girls taking antidepressants also were using at least two other psychotropic medications or birth control.

Why this is worrisome

This is worrisome considering that the leading cause of death in older children is suicide. And suicidality was noted in the article to not be a potential DDI that is considered in current drug interaction software. This means that healthcare practitioners may not be aware of the potential suicide risks in using these medications.

Source:

Dima M. Qato, G. Caleb Alexander, Jenny S. Guadamuz, Stacy Tessler Lindau. Prescription Medication Use Among Children and Adolescents in the United States. Pediatrics, 2018; e20181042 DOI: 10.1542/peds.2018-1042

Photo by Janko Ferlič on Unsplash

Node Smith, ND, is a naturopathic physician in Portland, OR and associate editor for NDNR. He has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp-out where naturopathic medicine and medical philosophy are experienced in nature. Four years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.