Sensitivity and specificity of open access systems to detect potential drug-drug interactions
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2021.176483Keywords:
Drug interaction, Noncommunicable diseases, Clinical decision support systems, Access to information, Patient safetyAbstract
This study aims to evaluate the sensitivity and specificity of open-access screening systems in detecting potential drug-drug interactions (PDDIs) compared to the DRUG-REAX® system and analyze the potential clinical impact of PDDIs of “Contraindicated” and “Major” severities not detected. A cross-sectional study was conducted in an outpatient clinic specialized in caring for patients with noncommunicable diseases (NCDs) of a university hospital. PDDIs were identified and classified in the DRUG-REAX® System and eight open-access screening systems. The "Contraindicated" and "Major" severity PDDIs were analyzed according to clinical impact. Descriptive statistics were used and the sensitivity and specificity of the screening systems were calculated to identify the PDDIs. Results: The open-access systems Drugs.com, UCLA School of Health and CVC Caremark showed sensitivity and specificity > 70%. All open access systems did not detect the pairs ciprofibrate + statins and metformin + sitagliptin, whose clinical impacts included the risk of myopathy/ rhabdomyolysis and hypoglycemia, respectively. About a third (37.5%) of open-access systems did not detect PDDI acetylsalicylic acid + hydrochlorothiazide, which is capable of causing nephrotoxicity. Conclusion: Most pairs of PDDIs are part of the therapeutic role of patients with NCDs and whose clinical impacts are time-dependent. The combination of clinical judgment, periodic review of the therapeutic plan and the attributes of precision (sensitivity and specificity) are essential to ensure patient safety, especially in the outpatient setting.
Downloads
References
Uijtendaal E, Van Harssel LLM, Hugenholtz GWK, Kuck EM, Zwart-Van Rijkom JEF, Cremer OL, et al. Analysis of potential drug-drug interactions in medical intensive care unit patients. Pharmacotherapy. 2014;34(3):213–9.
Hennessy S, Leonard C, Gagne JJ, Flory JH, Han X, Brensinger CM, et al. Pharmacoepidemiologic Methods for Studying the Health Effects of Drug-Drug Interactions. Clinical Pharmacology and Therapeutics. 2016;99(1):92–100.
Rekić D, Reynolds KS, Zhao P, Zhang L, Yoshida K, Sachar M, et al. Clinical Drug–Drug Interaction Evaluations to Inform Drug Use and Enable Drug Access. Journal of Pharmaceutical Sciences. 2017;106(9):2214–8.
Guthrie B, Makubate B, Hernandez-Santiago V, Dreishculte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Medicine. 2015;13:74.
Askari M, Eslami S, Louws M, Wierenga PC, Dongelmans DA, Kuiper RA, et al. Frequency and nature of drug-drug interactions in the intensive care unit. Pharmacoepidemiology and Drug Safety. 2013;22(4):430–7.
Trevisan DD, Silva JB, Póvoa VC, Araujo CP, Oliveira HC, Araújo EP, et al. Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil. International Journal of Diabetes in Developing Countries. 2016;36(3):283–9.
Roblek T, Vaupotic T, Mrhar A, Lainscak M. Drug-drug interaction software in clinical practice: A systematic review. European Journal of Clinical Pharmacology. 2015;71(2):131–42.
Ramos G V, Guaraldo L, Japiassú AM, Bozza FA. Comparison of two databases to detect potential drug-drug interactions between prescriptions of HIV/AIDS patients in critical care. Journal of Clinical Pharmacy and Therapeutics. 2015;40(1):63–7.
Muhič N, Mrhar A, Brvar M. Comparative analysis of three drug–drug interaction screening systems against probable clinically relevant drug–drug interactions: a prospective cohort study. European Journal of Clinical Pharmacology. 2017;73:875–882.
Kheshti R, Aalipour M, Namazi S. A comparison of five common drug–drug interaction software programs regarding accuracy and comprehensiveness. Journal of Research in Pharmacy Practice. 2016;5(4):257–63.
Leão DFL, Moura CS, Medeiros DS. Evaluation of potential drug interactions in primary health care prescriptions in Vitória da Conquista, Bahia (Brazil). Ciencia e Saude Coletiva. 2014;19(1):311–8.
Bossaer JB, Thomas CM. Drug interaction database sensitivity with oral antineoplastics: An exploratory analysis. Journal of Oncology Practice. 2017;13(3):e217–22.
Nanji KC, Seger DL, Slight SP, Amato MG, Beeler PE, Her QL, et al. Medication-related clinical decision support alert overrides in inpatients. Journal of the American Medical Informatics Association : JAMIA. 2018;25(5):476–81.
Wong A, Wright A, Seger DL, Amato MG, Fiskio JM, Bates D. Comparison of overridden medication-related clinical decision support in the intensive care unit between a commercial system and a legacy system. Applied Clinical Informatics. 2017;8(3):866–79.
Smithburger PL, Kane-Gill SL, Seybert AL. Drug-drug interactions in cardiac and cardiothoracic intensive care units: An analysis of patients in an academic medical centre in the US. Drug Safety. 2010;33(10):879–88.
Clauson KA, Marsh WA, Polen HH, Seamon MJ, Ortiz BI. Clinical decision support tools: Analysis of online drug information databases. BMC Medical Informatics and Decision Making. 2007;7:7.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. International Journal of Surgery. 2014;12(12):1495–9.
Vonbach P, Dubied A, Krähenbühl S, Beer JH. Evaluation of frequently used drug interaction screening programs. Pharmacy World and Science. 2008;30(4):367–74.
Wang LM, Wong M, Lightwood JM, Cheng CM. Black box warning contraindicated comedications: Concordance among three major drug interaction screening programs. Annals of Pharmacotherapy. 2010;44(1):28–34.
Espinosa MAFP, Carrasco MSD, Soler JLF, Merino GR, Nieto MAR, Miró AE. Pharmacoepidemiological study of drug–drug interactions in onco-hematological pediatric patients. International Journal of Clinical Pharmacy. 2014;36(6):1160–9.
Hazlet TK, Lee TA, Hansten PD, Horn JR. Performance of community pharmacy drug interaction software. Journal of the American Pharmaceutical Association (Washington,DC : 1996). 2001;41(2):200–4.
American Diabetes Association. Comprehensive medical evaluation and assessment of comorbidities: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl. 1):S37–47.
Ito H, Ishida H, Takeuchi Y, Antoku S, Abe M, Mifune M, et al. Long-term effect of metformin on blood glucose control in non-obese patients with type 2 diabetes mellitus. Nutrition and Metabolism. 2010;7(83).
UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;34(352):854–65.
Xie M, Shan Z, Zhang Y, Chen S, Yang W, Bao W, et al. Aspirin for primary prevention of cardiovascular events: Meta-analysis of randomized controlled trials and subgroup analysis by sex and diabetes status. PLoS ONE. 2014;9:e90286.
Bertoluci MC, Moreira RO, Faludi A, Izar MC, Schaan BD, Valerio CM, et al. Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: A position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM). Diabetology and Metabolic Syndrome. 2017;9(53):1–36.
Micromedex® Healthcare Series. Greenwood Village (US): Thomson Reuters (Healthcare) [Internet]. [cited 2019 Nov 5]. Available from: https://www-micromedexsolutions-com.ez32.periodicos.capes.gov.br
Cho I, Slight SP, Nanji KC, Seger DL, Maniam N, Dykes PC, et al. Understanding physicians’ behavior toward alerts about nephrotoxic medications in outpatients: A cross-sectional analysis. BMC Nephrology. 2014;15:200.
Oshikoya KA, Oreagba IA, Ogunleye OO, Lawal S, Senbanjo IO. Clinically significant interactions between antiretroviral and co-prescribed drugs for HIV-infected children: profiling and comparison of two drug databases. Therapeutics and Clinical Risk Management. 2013;9:215–21.
Catisti DG, Cruciol-Souza JM. Comparação de fontes bibliográficas para o diagnóstico farmacoterapêutico de interações medicamentosas. Latin American Journal of Pharmacy. 2009;28(5):682–7.
Smith WD, Karpinski JP, Timpe EM, Hatton RC. Evaluation of seven i.v. drug compatibility references by using requests from a drug information center. American Journal of Health-System Pharmacy. 2009;66(15):1369–75.
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Sandro Ritz Alves Bezerra , Danilo Donizetti Trevisan, Maria Helena Melo Lima, Silvia Regina Secoli
This work is licensed under a Creative Commons Attribution 4.0 International License.
