부산대학교 도서관

Aim: The aim of this study was to identify skeletal muscle relaxant (SMR) drug–drug–drug interaction (3DI) signals associated with increased rates of unintentional traumatic injury. Methods: We conducted automated high‐throughput pharmacoepidemiologic screening of 2000–2019 healthcare data for members of United States commercial and Medicare Advantage health plans. We performed a self‐controlled case series study for each drug triad consisting of an SMR base‐pair (i.e., concomitant use of an SMR with another medication), and a co‐dispensed medication (i.e., candidate interacting precipitant) taken during ongoing use of the base‐pair. We included patients aged ≥16 years with an injury occurring during base‐pair‐exposed observation time. We used conditional Poisson regression to calculate adjusted rate ratios (RRs) with 95% confidence intervals (CIs) for injury with each SMR base‐pair + candidate interacting precipitant (i.e., triad) versus the SMR‐containing base‐pair alone. Results: Among 58 478 triads, 29 were significantly positively associated with injury; confounder‐adjusted RRs ranged from 1.39 (95% CI = 1.01–1.91) for tizanidine + omeprazole with gabapentin to 2.23 (95% CI = 1.02–4.87) for tizanidine + diclofenac with alprazolam. Most identified 3DI signals are new and have not been formally investigated. Conclusion: We identified 29 SMR 3DI signals associated with increased rates of injury. Future aetiologic studies should confirm or refute these SMR 3DI signals. [ABSTRACT FROM AUTHOR]