title: Antidepressants: prevalence of duplicate therapy and avoidable drug interactions in Australian veterans.
abstract: OBJECTIVE
  This study assessed the prevalence of duplicate antidepressant prescribing and avoidable potential antidepressant drug interactions in the Australian war veteran population.
  
  
  METHODS
  The Department of Veterans' Affairs Pharmacy Claims database was interrogated, using specific criteria, to identify antidepressant duplication. In addition, potential drug interactions where safer alternative therapies were available were assessed. These included anticholinergic agents with tricyclic antidepressants and tramadol with antidepressants. Episodic tramadol dispensings with antidepressants were also assessed.
  
  
  RESULTS
  A total of 46,859 veterans had antidepressants regularly dispensed to them in the period 1 April-31 July 2005. Overall, 4037 potential interactions were identified in 3818 veterans (8.1%) to whom were dispensed antidepressants regularly. Antidepressant and tramadol co-prescribing was the most common potential interaction identified among 3.6% of veterans. Two or more interactions were identified in 212 veterans (0.5%). Analysis of episodic tramadol dispensings with antidepressants suggested a much higher prevalence of 7.7%.
  
  
  CONCLUSIONS
  The increasing use of antidepressants and the high level of potentially avoidable interactions detected in the present study, highlight the necessity of ongoing vigilance concerning the use of potentially inappropriate drug combinations, particularly in the elderly.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia. libby.roughead@unisa.edu.au
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
authors.forename: Brian
authors.initials: B
authors.lastname: McDermott
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Gilbert
mesh_terms: D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D014147:Tramadol / Q000627:therapeutic use; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D018680:Cholinergic Antagonists; D014147:Tramadol