Key result
Among 589 drug interaction queries, advice included vigilance (42%), no problem (29%), avoid (15%), and adjust dose (10%), with 71% of action-requiring queries matching database alerts.
Why the study?
Many people are treated with >=1 drug, requiring consideration of drug interaction risks, but the nature of interaction queries and advice provided had not been described over 10 years.
Observational (n=4,335)
No
Seven in ten replies from a drug information centre recommended explicit drug treatment actions regarding interactions, highlighting that automated decision support systems cannot be solely relied upon.
Many interaction queries warrant explicit actions; leaves open optimal integration of expert centres with automated alerts.
Many people are treated with ≥1 drug, implying that risks of drug interactions need to be considered. The aim of this study was to describe drug interaction queries from healthcare professionals to a drug information centre in Sweden over 10 years focusing on drugs frequently asked about and the advice provided. Advice was recorded in mutually exclusive groups: Avoid, Adjust dose, Separate intake, Vigilance or No problem. For queries with Avoid, Adjust dose or Separate intake advice, alerts were extracted from an interaction database (Janusmed). Of 4335 queries to the centre in 2008-2017, 589 (14%) concerned interactions. Most were posed by physicians (91%) and concerned a specific patient (83%) before treatment initiation (76%). Sertraline, warfarin and methotrexate were the most frequently asked about, whereas queries about cyclophosphamide and rifampicine occurred most often in relation to the number of exposed patients. Advice provided in 557 (95%) replies comprised Avoid: n = 85 (15%), Adjust dose: n = 57 (10%), Separate intake: n = 17 (3%), Vigilance: n = 235 (42%) or No problem: n = 163 (29%). In all, 113 (71%) of 159 queries with Avoid/Adjust dose/Separate intake advice elicited an action alert on Janusmed, whereas 31 (20%) did not result in any alert at all. Summarized, seven in ten replies from the drug information centre recommended an explicit drug treatment action, regarding either specific prescribing aspects, for instance dose adjustments, or active follow-up including monitoring potential adverse reactions and/or laboratory results. Readily accessible decision support regarding drug interactions often provides relevant action alerts, but cannot be solely relied on.
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Tukukino et al. (2019) conducted an observational in Drug interactions (n=4,335). Drug interaction queries was evaluated on Advice provided and correlation with interaction database alerts. Among 589 drug interaction queries, advice included vigilance (42%), no problem (29%), avoid (15%), and adjust dose (10%), with 71% of action-requiring queries matching database alerts.