Drug–drug interactions (DDIs) can either enhance or diminish the positive or negative effects of the associated drugs. Multiple drug combinations create difficulties in identifying clinically relevant drug interactions; this is why electronic drug interaction checkers frequently report DDI results inconsistently. Our paper aims to analyze drug interactions in cardiovascular diseases by selecting drugs from pharmacotherapeutic subcategories of interest according to Level 2 of the Anatomical Therapeutic Chemical (ATC) classification system. We checked DDIs between 9316 pairs of cardiovascular drugs and 25,893 pairs of cardiovascular and other drugs. We then evaluated the overall agreement on DDI severity results between two electronic drug interaction checkers. Thus, we obtained a fair agreement for the DDIs between drugs in the cardiovascular category, as well as for the DDIs between drugs in the cardiovascular and other (i.e., non-cardiovascular) categories, as reflected by the Fleiss’ kappa coefficients of $\kappa =0.3363$ and $\kappa =0.3572$, respectively. The categorical analysis of agreement between ATC-defined subcategories reveals Fleiss’ kappa coefficients that indicate levels of agreement varying from poor agreement ($\kappa <0$) to perfect agreement ($\kappa =1$). The main drawback of the overall agreement assessment is that it includes DDIs between drugs in the same subcategory, a situation of therapeutic duplication seldom encountered in clinical practice. Our main conclusion is that the categorical analysis of the agreement on DDI is more insightful than the overall approach, as it allows a more thorough investigation of the disparities between DDI databases and better exposes the factors that influence the different responses of electronic drug interaction checkers. Using categorical analysis avoids potential inaccuracies caused by particularizing the results of an overall statistical analysis in a heterogeneous dataset.

Background: Drug-drug interactions (DDIs) are a growing safety concern in dental care, particularly among patients with comorbidities and polypharmacy. However, real-world data (RWD) on the prevalence and severity of DDIs in dental settings remain scarce. Objectives: This study aimed to assess the frequency, severity, and clinical relevance of DDIs in dental patients and to identify age- and comorbidity-related risk patterns. Methods: This retrospective study analyzed a cohort of 105 dental patients, considering demographics, preexisting diseases, dental procedures, and prescribed medications. We examined drug-drug interactions (DDIs) employing the DrugBank Drug Interaction Checker, which yields DDI severity into major, moderate, or minor. Results: 45.7% of patients had preexisting diseases, with cardiovascular diseases most prevalent (19.0%). Higher prevalent dental diagnoses and procedures included apical lesions (47.6%) and tooth extractions (53.3%), suggesting frequent pharmacotherapy exposure. We identified 542 DDIs out of 1332 drug pairs and found 2.3% major, 25.0% moderate, and 13.4% minor, with 59.3% showing no interactions. Key high-risk DDIs included epinephrine with beta-blockers. Fifteen patients aged 31–60 years experienced the most major DDIs of 61.3%, patients ≥ 61 years faced 38.7%, and the 0–30 group had none, highlighting age-specific risks. The higher DDIs burden in the 31–60 age group may reflect better knowledge of the drugs they used and accurate reporting of them. Conclusions: Our retrospective study addresses the paucity of dental DDIs real-world data (RWD) studies, pleading for improved drug reconciliation, systematic screening, and age- and comorbidity-tailored strategies to enhance patient safety.

Background: Chronic obstructive pulmonary disease (COPD) is commonly managed alongside multimorbidity, polypharmacy, recurrent treatment escalation, and older age, all of which increase vulnerability to drug–drug interactions (DDIs). We aimed to synthesize the main DDI domains relevant to COPD pharmacotherapy and to distinguish harmful DDIs from beneficial combination therapy and formal compatibility findings. Methods: We performed a narrative review using structured literature searches and citation tracking to evaluate COPD-related studies. We prioritized direct COPD-specific DDI evidence, while also including mechanistic, class-specific, and contextual studies when direct evidence was lacking. Retained evidence included observational cohorts, prescribing studies, pharmacokinetic trials, case reports, and systematic reviews. Results: The reviewed literature indicates that DDI vulnerability in COPD is driven less by isolated drug pairs than by overall regimen complexity, multimorbidity, aging, fragmented prescribing, and high-intensity treatment periods such as exacerbations, hospitalization, and discharge. Key DDI domains included cardiopulmonary co-treatment, QT-related vulnerability, and potential or clinically relevant interactions amplified during exacerbations. Inhaled therapies are not universally interaction-free, particularly with strong metabolic inhibitors. Psychotropics, frailty, dementia, and palliative care further increase clinical complexity. However, beneficial bronchodilator combinations and formal compatibility studies demonstrate that not all multidrug COPD regimens are harmful. Conclusions: In COPD, DDI assessment should focus on the full treatment regimen and not be limited to a set of iconic drug pairs. Clinicians must focus on exacerbation-related prescribing, QT-active drugs, theophylline exposure, psychotropic co-medication, and vulnerable subgroups such as older, frail, and palliative patients. Pharmacist-supported drug review, drug reconciliation, and selective deprescribing are key strategies for reducing clinically relevant DDI burden in COPD.

In the context of an aging population and the increasing number of patients receiving multiple medications, modern dental practice faces the growing challenge of drug–drug interactions (DDIs)

Background: Respiratory disorders are frequently managed in community pharmacies and may involve complex multidrug regimens, particularly in asthma and chronic obstructive pulmonary disease (COPD). We aimed to characterize respiratory pharmacotherapy and moderate or major potential drug–drug interaction (DDI) risk using one index respiratory prescription per patient. Methods: We performed a retrospective observational secondary analysis of anonymized electronic prescription data from two Romanian community pharmacies (November 2022–October 2023). From a combined source dataset comprising prescriptions with at least two active substances, we selected records containing at least one eligible respiratory diagnosis. Demographics, diagnostic groups, active substances, therapeutic classes, medication burden, and potential DDIs were evaluated. Multivariable logistic regression identified factors independently associated with at least one moderate or major potential DDI. Results: The final cohort included 643 patients. Median age was 52 years [interquartile range 23.5–66.0], and 50.7% were female. Asthma was the most frequent diagnostic group (41.1%), followed by acute upper respiratory tract infections (19.8%) and COPD (15.4%). The most frequent therapeutic classes were inhaled and intranasal corticosteroids (54.0%), long-acting beta-2 agonists (46.7%), and anti-infectives (35.0%). At least one moderate or major potential DDI was identified in 28.0% of index prescriptions. In the fully adjusted multivariable model, each additional active substance was associated with higher potential DDI odds (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.96–3.00), while cardiovascular or metabolic co-medication showed the strongest positive class-level association (OR 14.16, 95% CI 5.25–38.21). Conclusions: Respiratory prescriptions showed distinct diagnostic and therapeutic profiles. The highest prevalence of moderate or major potential DDIs among the major diagnostic groups was observed in COPD. Potential DDI risk was strongly associated with medication burden and cardiovascular/metabolic co-medication, supporting targeted community pharmacy medication review that considers both respiratory therapy and the broader pharmacotherapeutic regimen.