Analysis of drug patterns and drug-drug-interactions: associations with physical performance in middle-aged military personnel undergoing rehabilitation- a retrospective cohort study.

Abstract

Background: Comprehensive medication regimens increase the risk of potential drug-drug interactions, adversely affecting health outcomes regardless of age. This risk is particularly pertinent in the context of medical vocational rehabilitation for middle-aged patients, who aim at facilitating rapid reintegration into employment. Identifying and addressing unfavourable drug regimens may substantially contribute to the effectiveness of interdisciplinary therapeutic interventions.

Methods: The retrospective cohort study was conducted among middle-aged soldiers diagnosed with post-traumatic stress disorder and at least one physical impairment and long-term medication intake. Patient records were analysed to investigate the nature of the medication such as the number of drugs and distribution according to the anatomical therapeutic code classification and drug-drug interactions in relation to bicycle ergometry performance.

Results: A substantial majority (73.2%) of all patients enrolled were prescribed an average of 3.0 (± 2.0) long-term medications per person. All patients received treatments containing ATC N drugs, which exert antidepressant properties. On average, each patient encountered the possible risk of 1.7 (± 1.3) drug interactions. Patients administered at least two ATC N drugs exhibited reduced maximum performance compared to controls. Conversely, patients receiving at least two drugs, wherein only one drug classified as ATC N, did not demonstrate significant performance differences from the control group. Notably, treatments incorporating selective monoamine reuptake inhibitors significantly reduced maximum performance relative to controls. The risk for potential drug-drug interactions, particularly those leading to QT interval prolongation, accounted for 47.5% of interactions involving ATC N drugs. Patients exclusively exposed to potential QT-prolonging interactions exhibited significantly reduced maximum performance compared to controls as well as patients who experienced different potential interactions.

Conclusion: Potential drug-drug interactions and disadvantageous drug combinations were prevalent among middle-aged adults with psychiatric disorders and may hinder a positive prognosis for physical fitness. The findings of this study underscore the importance of personalized medication management and continuous monitoring to mitigate negative impacts. Clinicians should diligently review patients' medication records and adjust therapies accordingly to prevent adverse drug reactions. Proactive strategies, such as regular medication reviews and drug-drug interaction screening tools, may be essential for optimizing therapeutic efficacy and maintaining physical performance.