An international consensus list of potentially clinically significant drug-drug interactions in older people

P Anrys, A-E Petit, S Thevelin, B. Sallevelt, C. Drenth, Roy Soiza, Andrea Correa-Pérez, O. Dalleur, I. De Brauwer, Mirko Petrovic, J.J. Coleman, K. Dalton, Denis O’Mahony, J Löwe, S Thürig, A. Gudmundsson, A Cherubin, Agapios Panos, Dimitris Mavridis, N RodondiA. Spinewine* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)
9 Downloads (Pure)


Objectives: We aimed to establish an explicit list of potentially clinically significant DDIs in people aged ≥65 years.
Design: A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a two-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided.
Setting and Participants: 29 experts, including geriatricians and clinical pharmacists from eight European countries
Measures: For each DDI, in the first two rounds, experts were asked to score the severity of potential harm on a five-point Likert scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round.
Results: Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs.
Conclusion and implications: We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiological and intervention studies
Original languageEnglish
Pages (from-to)2121-2133.e24
Number of pages37
JournalJournal of the American Medical Directors Association
Issue number10
Early online date24 Apr 2021
Publication statusPublished - 31 Oct 2021

Bibliographical note

We gratefully acknowledge the valuable input of the expert panel in the validation of the DDI list (members of the expert panel who are not co-authors of the manuscript were: Benoit Boland, Stephen Byrne, Alessandro Caraffa, Samanta Corradi, Manuel Velez Diaz-Pallares, Anne Fournier, Petur Gunnarsson, Lianne Huibers, Anna Ingibjorg Gunnarsdottir, Joan MacLeod, Paolo Marinelli, Beatriz Montero Errasquin, Olafur Samuelsson, Annemie Somers, Ingeborg Wilting). We thank Perrine Evrard, Catherine Pétein and Simon Lion for their support in developing the final drug-drug interaction tables and the coding with ATC codes. We thank Anne-Laure Sennesael for her support in the literature review on drug-drug interactions with direct oral anticoagulants.


  • Delphi Technique
  • Drug Interaction
  • Aged


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