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Original research article
Fixed-dose combination antihypertensives and risk of medication errors
  1. Frank Moriarty1,
  2. Kathleen Bennett2,
  3. Tom Fahey1
  1. 1 HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Dr Frank Moriarty, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland; frankmoriarty{at}


Objective While fixed-dose combinations (FDC) can improve adherence, they may add complexity to the prescribing/dispensing process, potentially increasing risk of medication errors. This study aimed to determine if prescriptions for antihypertensive FDCs increase the risk of therapeutic duplication and drug–drug interactions (DDI).

Methods This retrospective observational study used administrative pharmacy claims data from the Irish Primary Care Reimbursement Service. Prescriptions dispensed to adults in 2015 were included if they contained an antihypertensive FDC, or the same drugs prescribed separately. The outcomes were therapeutic duplication and potentially serious DDI involving FDC drugs. Relative risk (RR) of these outcomes, adjusted for prescription and patient factors, was determined using generalised linear models with Poisson distributions and propensity score matching.

Results This study included 307 833 FDC prescriptions (67.0%) and 151 632 separate component prescriptions. Half of patients prescribed FDCs were female with a mean age of 67.1 (SD 12.5) years and, compared with separate component prescriptions, FDCs were less often coprescribed with other cardiovascular medications. Therapeutic duplication occurred in 0.8% of prescriptions, most often involving calcium channel blockers, and 10.6% contained a DDI (most often amlodipine and simvastatin). The RR of therapeutic duplication on FDC prescriptions compared with separate component prescriptions was 1.46 (95% CI 1.17 to 1.83) and the adjusted RR was 2.06 (95% CI 1.64 to 2.60). For DDIs, there was no significant difference between FDC and separate component prescriptions after confounder adjustment.

Conclusions This study found FDCs were associated with increased risk of duplication. When considering prescribing FDCs, this safety consideration should be weighed against potential benefits.

  • epidemiology
  • drug interactions
  • quality and outcomes of care
  • hypertension

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Twitter @FrankMoriarty @HRBPrimaryCare

  • Contributors FM conceived and designed the study. KB acquired the data and FM conducted the analysis. FM, KB and TF interpreted the data. FM drafted the manuscript and all authors revised this critically and approved the final version.

  • Funding This research was supported by the Health Research Board (HRB) in Ireland through the HRB Centre for Primary Care Research (grant number HRC/2014/1). KB was supported by the HRB (grant number RL/15/1579).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available from this study.

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