Advertisement

Drug Safety

, Volume 40, Issue 2, pp 101–103 | Cite as

Generating Evidence of Clinical Outcomes of Drug–Drug Interactions

  • Katsiaryna Bykov
  • Joshua J. GagneEmail author
Commentary

As prescription drug use is on the rise, new medications are entering the market each year, and individuals with multiple comorbid conditions are living longer, the potential for drug–drug interactions (DDIs) is increasing. It has been estimated that DDIs are responsible for 1–5% of all hospital admissions [2, 3] and 13% of all adverse drug events in community-dwelling older adults [4]. With tens of thousands of potentially interacting drug pairs on the market [5], identifying and managing potential DDIs has become a daunting task for healthcare professionals and patients. Studies have found that clinicians’ knowledge about DDIs is limited [6, 7] and the reliability of DDI information sources is questionable [8, 9]. Once heralded as a solution to reducing exposure to DDIs [7, 10], information technology (IT)-based clinical decision-support systems generate an excessive number of DDI alerts, the overwhelming majority of which (≥90%) are routinely overridden [11, 12, 13] and not always...

Keywords

Ventricular Arrhythmia Potential DDIs Drug Pair Concomitant Exposure Immortal Time Bias 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the preparation of this commentary.

Conflict of interest

Joshua Gagne is Principal Investigator of an investigator-initiated research grant from Novartis Pharmaceuticals Corporation to the Brigham and Women’s Hospital for unrelated work. He is a consultant to Aetion, Inc. and to Oputm, Inc. for unrelated work. Katsiaryna Bykov is supported by an unrestricted training grant from Takeda, Cambridge, MA, USA, to Harvard T.H. Chan School of Public Health.

References

  1. 1.
    Meid AD, von Medem A, Heider D, et al. Investigating the additive interaction of QT-prolonging drugs in older people using claims data. Drug Saf. doi: 10.1007/s40264-016-0477-y. (Epub 20 Nov 2016).
  2. 2.
    Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug–drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23(5):489–97.CrossRefPubMedGoogle Scholar
  3. 3.
    Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16(6):641–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16.CrossRefPubMedGoogle Scholar
  5. 5.
    Langdorf MI, Fox JC, Marwah RS, Montague BJ, Hart MM. Physician versus computer knowledge of potential drug interactions in the emergency department. Acad Emerg Med. 2000;7(11):1321–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Ko Y, Malone DC, Skrepnek GH, et al. Prescribers’ knowledge of and sources of information for potential drug–drug interactions: a postal survey of US prescribers. Drug Saf. 2008;31(6):525–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Weideman RA, Bernstein IH, McKinney WP. Pharmacist recognition of potential drug interactions. Am J Health Syst Pharm. 1999;56(15):1524–9.PubMedGoogle Scholar
  8. 8.
    Abarca J, Malone DC, Armstrong EP, et al. Concordance of severity ratings provided in four drug interaction compendia. J Am Pharm Assoc. 2004;44(2):136–41.CrossRefGoogle Scholar
  9. 9.
    Olvey EL, Clauschee S, Malone DC. Comparison of critical drug–drug interaction listings: the Department of Veterans Affairs medical system and standard reference compendia. Clin Pharmacol Ther. 2010;87(1):48–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Halkin H, Katzir I, Kurman I, Jan J, Malkin BB. Preventing drug interactions by online prescription screening in community pharmacies and medical practices. Clin Pharmacol Ther. 2001;69(4):260–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Isaac T, Weissman JS, Davis RB, et al. Overrides of medication alerts in ambulatory care. Arch Intern Med. 2009;169(3):305–11.CrossRefPubMedGoogle Scholar
  12. 12.
    van der Sijs H, Mulder A, van Gelder T, Aarts J, Berg M, Vulto A. Drug safety alert generation and overriding in a large Dutch university medical centre. Pharmacoepidemiol Drug Saf. 2009;18(10):941–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Bryant AD, Fletcher GS, Payne TH. Drug interaction alert override rates in the Meaningful Use era: no evidence of progress. Appl Clin Inform. 2014;5(3):802–13.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Miller AM, Boro MS, Korman NE, Davoren JB. Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts. J Am Med Inform Assoc. 2011;18(Suppl 1):i45–50.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Scheife RT, Hines LE, Boyce RD, et al. Consensus recommendations for systematic evaluation of drug–drug interaction evidence for clinical decision support. Drug Saf. 2015;38(2):197–206.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Phansalkar S, Desai A, Choksi A, et al. Criteria for assessing high-priority drug–drug interactions for clinical decision support in electronic health records. BMC Med Inform Decis Mak. 2013;13(1):65.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40(12):1161–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Hines LE, Malone DC, Murphy JE. Recommendations for generating, evaluating, and implementing drug–drug interaction evidence. Pharmacotherapy. 2012;32(4):304–13.CrossRefPubMedGoogle Scholar
  19. 19.
    Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians’ decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003;163(21):2625–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Tilson H, Hines LE, McEvoy G, et al. Recommendations for selecting drug–drug interactions for clinical decision support. Am J Health Syst Pharm. 2016;73(8):576–85.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Schelleman H, Bilker WB, Brensinger CM, Han X, Kimmel SE, Hennessy S. Warfarin with fluoroquinolones, sulfonamides, or azole antifungals: interactions and the risk of hospitalization for gastrointestinal bleeding. Clin Pharmacol Ther. 2008;84(5):581–8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Fischer HD, Juurlink DN, Mamdani MM, Kopp A, Laupacis A. Hemorrhage during warfarin therapy associated with cotrimoxazole and other urinary tract anti-infective agents: a population-based study. Arch Intern Med. 2010;170(7):617–21.CrossRefPubMedGoogle Scholar
  23. 23.
    van der Sijs H, Kowlesar R, Klootwijk AP, Nelwan SP, Vulto AG, van Gelder T. Clinically relevant QTc prolongation due to overridden drug–drug interaction alerts: a retrospective cohort study. Br J Clin Pharmacol. 2009;67(3):347–54.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sumic JC, Baric V, Bilic P, Herceg M, Sisek-Sprem M, Jukic V. QTc and psychopharmacs: are there any differences between monotherapy and polytherapy. Ann Gen Psychiatry. 2007;6:13.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Hennessy S, Leonard CE, Gagne JJ, et al. Pharmacoepidemiologic methods for studying the health effects of drug–drug interactions. Clin Pharmacol Ther. 2016;99(1):92–100.CrossRefPubMedGoogle Scholar
  26. 26.
    Maclure M, Fireman B, Nelson JC, et al. When should case-only designs be used for safety monitoring of medical products? Pharmacoepidemiol Drug Saf. 2012;21(Suppl 1):50–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Donneyong MM, Bykov K, Bosco-Levy P, Dong YH, Levin R, Gagne JJ. Risk of mortality with concomitant use of tamoxifen and selective serotonin reuptake inhibitors: multi-database cohort study. BMJ. 2016;354:i5014.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Bykov K, Schneeweiss S, Donneyong MM, Dong YH, Choudhry NK, Gagne JJ. Impact of an interaction between clopidogrel and selective serotonin reuptake inhibitors. Am J Cardiol. (Epub 16 Nov 2016).Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA

Personalised recommendations