Almost 20% of children and adolescents used prescription medications in 2013 to 2014, and 8.2% of concurrent users of prescription medications in 2009 to 2014 was at risk for a potentially major drug-drug interaction (DDI), according to a study published in the September issue of Pediatrics.

Information on the use of prescription medications among children and adolescents in the United States is lacking. We estimate the prevalence of prescription medication use, concurrent use, and potential major drug-drug interactions (DDIs) in this population.

Dima M. Qato, Pharm.D., M.P.H., Ph.D., from the University of Illinois at Chicago, and colleagues conducted descriptive analyses using nationally representative data for people aged ≤19 years from the National Health and Nutrition Examination Survey to estimate the prevalence of prescription medication use, concurrent use, and potential major DDIs. Concurrent use was defined as the use of two or more prescription medications.

The researchers found that 19.8% of children and adolescents used at least one prescription medication from 2013 to 2014 and 7.1% used acute medications (used for no more than 30 days).

Concurrent medication use was 7.5% overall and was highest among 6- to 12-year-old boys (12 percent) and 13- to 19-year-old boys and girls (10% for both). Pooled data from 2009 to 2014 showed that 8.2% of concurrent prescription medication users were at risk for a potentially major DDI.

Antidepressants were involved in the majority of interacting regimens, and they occurred more often among adolescent girls than boys (18.1 versus 6.6%); this was mainly driven by increased rates of acute medication use.

Potential Major DDIs

Among concurrent users of ≥2 prescription medications during 2013–2014 (N = 301), a total of 156 unique prescription medications were used. Using Micromedex, a total of 826 potential DDIs (contraindicated [n = 29] or potentially major [n = 797]) for these 156 medications were identified. In the pooled 2003–2014 sample, 101 unique combinations of these potential DDIs were used by 158 people.

In the pooled 2009–2014 sample, 63 unique DDI combinations were used by 78 people, making the overall rate 0.7% (CI, 0.5%–1.0%). They found only 1 individual using a contraindicated DDI (aripiprazole–metoclopramide).

"Efforts to prevent adverse drug events in children and adolescents should consider the role of interacting drug combinations, especially among adolescent girls," the authors write. One author disclosed financial ties to pharmacy benefits and health care consultancy companies.

Using nationally representative data, we found that many children and adolescents use and concurrently use prescription medications in the United States. Among concurrent users of prescription medications, nearly 1 in 12 was at risk for a major DDI.

Largely because of their higher rate of acute medication use, adolescent girls were at a higher risk of using interacting drug regimens than other subgroups. Treatment and prevention efforts to reduce the burden of adverse drug events in younger populations should be used to consider the role of interacting drug combinations, especially among these individuals.