Evaluation of frequently used drug interaction screening programs
- 552 Downloads
Objective Drug-drug interaction (DDI) screening programs are an important tool to check prescriptions of multiple drugs. The objective of the current study was to critically appraise several DDI screening programs. Methods A DDI screening program had to fulfil minimal requirements (information on effect, severity rating, clinical management, mechanism and literature) to be included into the final evaluation. The 100 most frequently used drugs in the State Hospital of Baden, Switzerland, were used to test the comprehensiveness of the programs. Qualitative criteria were used for the assessment of the DDI monographs. In a precision analysis, 30 drugs with and 30 drugs without DDIs of clinical importance were tested. In addition, 16 medical patient profiles were checked for DDIs, using Stockley’s Drug Interactions as a reference. Main outcome measure Suitability of DDI screening program (quality of monographs, comprehensiveness of drug list, statistical evaluation). Results Out of nine programs included, the following four fulfilled the above mentioned criteria: Drug Interaction Facts, Drug-Reax, Lexi-Interact and Pharmavista. Drug Interaction Facts contained the smallest number of drugs and was therefore the least qualified program. Lexi-Interact condenses many DDIs into one group, resulting in less specific information. Pharmavista and Drug-Reax offer excellent DDI monographs. In the precision analysis, Lexi-Interact showed the best sensitivity (1.00), followed by Drug-Reax and Pharmavista (0.83 each) and Drug Interaction Facts (0.63). The analysis of patient profiles revealed that out of 157 DDIs found by all programs, only 18 (11%) were detected by all of them. No program found more than 50% of the total number of DDIs. A further evaluation using Stockley’s Drug interactions as the gold standard revealed that Pharmavista achieved a sensitivity of 0.86 (vs Drug Interaction Facts, Lexi-Interact and Drug-Reax with a sensitivity of 0.71 each) and a positive predictive value of 0.67. Conclusion None of the four DDI screening programs tested is ideal, every program has its strengths and weaknesses, which are important to know. Pharmavista offers the highest sensitivity of the programs evaluated with a specificity and positive predictive value in an acceptable range.
KeywordsDrug-drug interactions Drug interaction screening programs Sensitivity analysis Positive predictive value Software Switzerland
We thank Sanofi Aventis, Meyrin, Switzerland, for financial support of this study. The study was also supported by a grant of the Swiss National Science Foundation to S.K. (3100-59812-03/1).
Conflicts of interest
The authors declare no conflicts of interest directly relevant to the content of this manuscript.
- 7.Hazlet TK, Lee TA, Hansten PD, et al. Performance of community pharmacy drug interaction software. J Am Pharm Assoc (Wash) 2001;41(2):200–4 Mar–Apr.Google Scholar
- 9.Perrin Y, Buclin T, Biollaz J. Drug interaction computer programs: which choice? [in French]. Schweiz Rundsch Med Prax 2004;93(23):991–6 Jun 2.Google Scholar
- 10.WHO collaborating centre for drug statistics methodology, Norwegian Institute of Public Health, Oslo. WHO ATC/DDD applications (online). Available from URL: http://www.whocc.no/atcddd/. Accessed 2004 May–July.
- 11.Sweetman SC. Martindale—The complete drug reference. 33rd ed. London: The Pharmaceutical Press; 2002.Google Scholar
- 12.Hulley SB, Cummings SR, Browner WS, et al. Designing clinical research: an epidemiologic approach. 2nd ed. Baltimore: Williams & Wilkins; 2001.Google Scholar
- 13.Stockley IH (editor). Stockley’s drug interactions. 6th ed. London, Chicago: The Pharmaceutical Press; 2002.Google Scholar
- 14.Hansten PD, Horn JR, Hazlet TK. ORCA: Operational classification of drug interactions. J Am Pharm Assoc (Wash) 2001;41(2):161–5 Mar–Apr.Google Scholar
- 15.Center for drug evaluation and research, U.S. food and drug administration. Electronic orange book [online]. Available from URL: http://www.fda.gov/cder/ob/default.htm. Accessed 2005 Aug 12.
- 16.Payne TH, Nichol WP, Hoey P, et al. Characteristics and override rates of order checks in a practitioner order entry system. Proc AMIA Symp 2002:602–6.Google Scholar
- 19.Abarca J, Malone DC, Armstrong EP, et al. Concordance of severity ratings provided in four drug interaction compendia. J Am Pharm Assoc (Wash DC) 2004;44(2):136–41 Mar–Apr.Google Scholar