Pharmacoepidemiology and Prescription

European Journal of Clinical Pharmacology

, Volume 65, Issue 11, pp 1149-1157

Successful strategy to improve the specificity of electronic statin–drug interaction alerts

  • Hanna Marita SeidlingAffiliated withDepartment of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of HeidelbergCooperation Unit Clinical Pharmacy, University of Heidelberg
  • , Caroline Henrike StorchAffiliated withDepartment of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg
  • , Thilo BertscheAffiliated withDepartment of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of HeidelbergCooperation Unit Clinical Pharmacy, University of Heidelberg
  • , Christian SengerAffiliated withDepartment of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg
  • , Jens KaltschmidtAffiliated withDepartment of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg
  • , Ingeborg Walter-SackAffiliated withDepartment of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg
  • , Walter Emil HaefeliAffiliated withDepartment of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of HeidelbergCooperation Unit Clinical Pharmacy, University of Heidelberg Email author 

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Abstract

Purpose

A considerable weakness of current clinical decision support systems managing drug–drug interactions (DDI) is the high incidence of inappropriate alerts. Because DDI-induced, dose-dependent adverse events can be prevented by dosage adjustment, corresponding DDI alerts should only be issued if dosages exceed safe limits. We have designed a logical framework for a DDI alert-system that considers prescribed dosage and retrospectively evaluates the impact on the frequency of statin–drug interaction alerts.

Methods

Upper statin dose limits were extracted from the drug label (SPC) (20 statin-drug combinations) or clinical trials specifying the extent of the pharmacokinetic interaction (43 statin–drug combinations). We retrospectively assessed electronic DDI alerts and compared the number of standard alerts to alerts that took dosage into account.

Results

From among 2457 electronic prescriptions, we identified 73 high-risk statin–drug pairs. Of these, SPC dosage information classified 19 warnings as inappropriate. Data from pharmacokinetic trials took quantitative dosage information more often into consideration and classified 40 warnings as inappropriate. This is a significant reduction in the number of alerts by 55% compared to SPC-based information (26%; p < 0.001).

Conclusion

This retrospective study of pharmacokinetic statin interactions demonstrates that more than half of the DDI alerts that presented in a clinical decision support system were inappropriate if DDI-specific upper dose limits are not considered.

Keywords

Clinical decision support systems Drug–drug interactions HMG-CoA-Reductase inhibitors Over-alerting Upper dose limits