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Recognition and management of potential drug–drug interactions in patients on internal medicine wards

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Introduction

Our aim was to study and possibly improve the clinical management of potential drug–drug interactions (pDDIs) in hospitalized patients by specific interventions.

Methods

During the initial period, inpatients on three medical wards were screened for major and moderate pDDIs using the interaction screening program Pharmavista. During the second period, patients at discharge were screened similarly. After assessment of the detected pDDIs for clinical relevance, written recommendations and/or information about the pDDIs were sent to the treating physicians. Feedback from the physicians and implementation of the recommendations were analyzed.

Results

During the initial period, 502 inpatients were exposed to 567 pDDIs, of which 419 (74%) were judged to be clinically relevant. Three hundred and forty-nine substantiated recommendations and 70 simple information leaflets were handed out to the physicians. Eighty percent (278 of 349) of the recommendations were accepted and implemented. During the second period, 792 patients at hospital discharge were exposed to 392 pDDIs, of which 258 (66%) were judged to be clinically relevant. Two hundred and forty-seven substantiated recommendations and 11 simple information leaflets were sent to the physicians. Seventy-three percent (180 of 247) of the recommendations were accepted. At hospital discharge, 47 of 71 interventions recommending checkable medication changes were implemented. One year after hospital discharge, 11 of 13 checked medication changes were still in place.

Conclusions

Clinically relevant pDDIs are common in patients on medical wards, and their management can be influenced by providing substantiated recommendations to physicians. Most changes in medication following such recommendations are still in place 1 year after discharge.

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Notes

  1. Major interactions: May be life threatening, or permanent damage may be induced. Such drugs should not be administered together.

  2. Moderate interactions: Frequently cause therapeutic difficulties and may even cause harm. Combinations may be administered, however, if patients are monitored carefully.

  3. Minor interactions: Are associated with increased or reduced drug effects, but these alterations, in general, do not cause harm and can be tolerated.

  4. Insignificant interactions: Cause mainly no or only unimportant effects, and no special action is required.

  5. Unidentified source: For such interactions, no medical literature is available. Their clinical relevance is therefore unclear.

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Acknowledgements

We thank Sanofi Aventis, Meyrin/Switzerland, for financial support. The study was also supported by a grant from the Swiss National Science Foundation to SK (310000-112483/1). Furthermore, we thank e-Mediat, Schönbühl/Switzerland, for providing us the drug interaction screening program Pharmavista. The authors declare no conflict of interest directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Hospital Pharmacy, Kantonsspital Baden, Baden, Switzerland

    Priska Vonbach & André Dubied

  2. Department of Medicine, Kantonsspital Baden, Baden, Switzerland

    Jürg H. Beer

  3. Clinical Pharmacology & Toxicology, University Hospital, 4031, Basel, Switzerland

    Stephan Krähenbühl

Authors
  1. Priska Vonbach
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  2. André Dubied
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  3. Jürg H. Beer
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  4. Stephan Krähenbühl
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Correspondence to Stephan Krähenbühl.

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Vonbach, P., Dubied, A., Beer, J.H. et al. Recognition and management of potential drug–drug interactions in patients on internal medicine wards. Eur J Clin Pharmacol 63, 1075–1083 (2007). https://doi.org/10.1007/s00228-007-0359-4

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  • DOI: https://doi.org/10.1007/s00228-007-0359-4

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