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Prevalence of adverse drug combinations in a large post-mortem toxicology database

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Abstract

The prevalence of important adverse drug combinations was studied among the 37,367 cases included in the Finnish post-mortem toxicology database during 2000–2006. The new SFINX interaction database (Swedish, Finnish, INteraction X-referencing) was utilised to identify adverse drug combinations. Consequently, the 24 drugs chosen for the study generated 96 two-compound combinations possessing potentially severe interactions. The total number of hits for the combinations found in the post-mortem database was 267, which accounts for approximately 0.71% of all cases. The potential role of adverse drug interaction (ADI) in these cases was evaluated from the background information and death certificate. The possible ADI cases comprised 23% of all hits and 0.17% of all cases analysed. In cases with a pharmacodynamic mechanism, the most prominent combinations were medicines causing serotonin syndrome or a β1-blocker with verapamil or diltiazem. In cases with a pharmacokinetic mechanism, half of the cases involved digoxin in combination with verapamil. In one third of the possible ADI cases, a forensic pathologist had noted the studied compounds as an underlying or contributing cause of death, although the agents’ specific role in ADIs was rarely recognised.

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Authors and Affiliations

  1. Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014, Helsinki, Finland

    Terhi Launiainen, Erkki Vuori & Ilkka Ojanperä

Authors
  1. Terhi Launiainen
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  2. Erkki Vuori
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  3. Ilkka Ojanperä
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Correspondence to Terhi Launiainen.

Electronic supplementary material

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Table S1

Number of findings of drug combinations with potential for severe pharmacodynamic interaction in the post-mortem database (DOC 102 kb)

Table S2

Number of findings of drug combinations with potential for severe pharmacokinetic interaction in the post-mortem database (DOC 53.0 kb)

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Launiainen, T., Vuori, E. & Ojanperä, I. Prevalence of adverse drug combinations in a large post-mortem toxicology database. Int J Legal Med 123, 109–115 (2009). https://doi.org/10.1007/s00414-008-0261-3

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