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Related Experiment Videos

Possible interactions with terfenadine or astemizole

A D Zechnich1, J R Hedges, D Eiselt-Proteau

  • 1Department of Emergency Medicine, Oregon Health Sciences University School of Medicine, Portland 97201-3098.

The Western Journal of Medicine
|April 1, 1994
PubMed
Summary

Concurrent prescribing of terfenadine/astemizole with erythromycin/ketoconazole risks fatal heart arrhythmias. Pharmacist screening can significantly reduce these dangerous drug interactions, improving patient safety.

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Area of Science:

  • Clinical Pharmacology
  • Drug Interactions
  • Cardiovascular Safety

Background:

  • Concurrent use of terfenadine or astemizole with erythromycin or ketoconazole is associated with QT interval prolongation and potentially fatal ventricular arrhythmias.
  • Understanding the frequency and patterns of such concurrent prescribing is crucial for mitigating serious drug interactions.

Purpose of the Study:

  • To examine the frequency and patterns of concurrent prescribing of terfenadine or astemizole with macrolide antibiotics or ketoconazole.
  • To suggest methods for reducing the incidence of these serious drug interactions.

Main Methods:

  • Retrospective review of Oregon Medicaid prescription claims data spanning 22 months (1991-1992).
  • Analysis of concurrent prescribing events involving terfenadine/astemizole and macrolide antibiotics/ketoconazole.

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Main Results:

  • Concurrent use episodes increased more than threefold from 1991 to 1992, with 122 total events identified.
  • Most concurrent use (94%) involved terfenadine; 48% of patients received prescriptions from different physicians.
  • Terfenadine use showed a 29% increase and a seasonal peak, indicating widespread and rising exposure.

Conclusions:

  • Widespread and increasing use of terfenadine elevates the risk of serious drug interactions, often without physician awareness.
  • Prospective pharmacist screening presents an effective strategy to significantly reduce concurrent prescribing incidents.
  • Physicians need heightened awareness of these interactions to prevent co-prescription and manage related cardiac events.