RESEARCHIdentification of Serious Drug–Drug Interactions: Results of the Partnership to Prevent Drug–Drug Interactions
Section snippets
Objectives
The purpose of this study was to develop a list of the clinically important DDIs that are likely to be encountered in community and ambulatory pharmacy settings and detected by a computerized pharmacy system.
Methods
A three-stage process was undertaken to identify DDIs of the highest clinical importance. Clinically important interactions were defined as those interactions most likely to cause harm if not detected. This process began with the selection of candidate interactions from a review of drug interaction compendia followed by a systematic literature review and the development of an evidence report for each candidate DDI. These evidence reports were then evaluated and rated by an expert panel using a
Results
Table 1 lists the number of severe or major interactions identified in each compendium. The listed interactions were then aggregated at the medication class level when appropriate. Sixty-two DDIs were found in at least 3 out of the 4 compendia. As detailed below, 18 DDIs were excluded from further consideration for one of the five reasons for exclusion presented in the Methods.
Eight DDIs were excluded because at least one of the medications was no longer available in the United States (the
Discussion
We used a systematic evaluation of the literature and an expert-panel process to identify clinically important DDIs. Our panel evaluated 54 DDIs and assigned a mean score for clinical importance of 7.5 on a 1 to 10 scale. After excluding products that were not on the U.S. market, products not likely to be used in an outpatient setting, and combinations that can be used for therapeutic benefit, a total of 25 clinically important DDIs were identified.
Hundreds of drug interactions are listed in
Limitations
The reader should keep several limitations in mind when interpreting our findings, most notably the use of an expert panel to rate the DDIs. Expert panels make subjective judgments based on the best evidence available, but these conclusions may be imperfect. The results are likely to differ depending upon the membership of the panel. By using a modified Delphi approach, we were able to minimize the potential for coalescence around one or two members' opinions and to ensure that all members were
Conclusion
Using an expert panel and a standard evaluation tool, we identified 25 drug interactions deemed to be clinically important and likely to occur in the community and ambulatory pharmacy settings. These interactions represent a subset of all interactions that have been noted by drug interaction compendia as being of high severity or major importance. We encourage pharmacists to take steps to prevent patients from receiving these interacting medications and computer software vendors to focus
References (35)
- et al.
Drug-related morbidity and mortality: updating the cost-of-illness model
J Am Pharm Assoc.
(2001) - et al.
Increase in US medication-error deaths between 1983 and 1993
Lancet.
(1998) - et al.
Performance of community pharmacy drug interaction software
J Am Pharm Assoc.
(2001) - et al.
Concordance of major drug interaction classifications among drug interaction compendia
J Am Pharm Assoc.
(2004) - et al.
Screening of drug candidates for their drug-drug interaction potential
Curr Opin Chem Biol.
(2001) - et al.
Disagreement among drug compendia on inclusion and ratings of drug-drug interactions
Curr Ther Res.
(2000) To err is human
(1999)- et al.
Drug-related morbidity and mortality. A cost- of-illness model
Arch Intern Med
(1995) IMS health reports 14.9 percent growth in US prescription sales to $145 billion in 2000 [news release]
(2001)- et al.
The economic consequences of a drug-drug interaction
J Clin Psychopharmacol.
(2001)
The role of pharmacy computer systems in preventing medication errors
J Am Pharm Assoc.
Evaluation of online prospective DUR programs in community pharmacy practice
J Manag Care Pharm.
Collecting and analyzing expert group judgment data
The Hearst Corporation
Drug interaction facts
Drug interactions: analysis and management
DRUG-REAX system
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Disclosure: Dr. Hansten is an editor of and declares financial interests in the textbook, Hansten and Horn's Drug Interaction Analysis and Management. Dr. Lipton has financial interests in AdvancePCS, and as noted above, Ms. Van Bergen is a former employee and Dr. Duncan-Edgar is a current employee of that firm. The other authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.
Funding: Supported by the Centers for Disease Control and Prevention, Contract 2001-N-08014.
Acknowledgment: The authors would like to thank John Palmer, MD, for participating on the expert panel used in this study.
Presented previously at the Academy of Managed Care Pharmacy Annual Meeting, Minneapolis, Minn., April 10, 2003, and the American Academy of Family Physicians National Ambulatory Primary Care Research & Education Conference on Patient Safety, Chicago, Ill., September 18, 2003.