Drug interaction
In pharmacology, drug interactions are "the action of a drug that may affect the activity, metabolism, or toxicity of another drug."[1]
Mechanisms
Protein binding
These interactions are usually transient and mild until a new steady state is achieved.[2][3] These are mainly for drugs without much first-pass liver metabolism. The principle plasma proteins for drug binding are:[4]
- albumin
- α1-acid glycoprotein
- lipoproteins
Some drug interactions with warfarin are due to changes in protein binding.[4]
Cytochrome P450
Patients have abnormal metabolism by cytochrome P-450 due to either inheriting abnormal alleles or due to drug interactions. Tables are available to check for drug interactions due to cytochrome P-450 interactions.[5].
Prevention
Resources about drug interactions
In detecting drug-drug interactions, the accuracy of software used by hospital pharmacies range from:[6][7][8]
In detecting drug-drug interactions, the accuracy of PDA-based software range from:[9]
- Sensitivity 84% to 100%
- Specificity 68% to 95%
List of resources
The concordance between alerts generated by major resources is low.[10]
- First Databank's Evaluations of Drug Interactions
- Facts & Comparisons®
- MicroMedex's DRUG-REAX
- http://www.gsm.com
- http://www.epocrates.com
- Centers for Education & Research on Therapeutics (CERTs). These are sponsored in the United States by the Agency for Healthcare Research and Quality.
- http://drug-interactions.com - Cytochrome P-450
- http://www.arizonacert.org - QT interval prolongation
- http://www.hit-cert.org/ - role of information technology
Medical order entry system
Perhaps due to imperfect specificity of drug interaction resources, health care providers overide 49% to 96% of alerts.[11]
Efforts are being made to improve drug safety alerts by structuring[12] and tiering[13] information.
References
- ↑ Anonymous (2024), Drug interaction (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ DeVane CL (2002). "Clinical significance of drug binding, protein binding, and binding displacement drug interactions". Psychopharmacology bulletin. 36 (3): 5–21. PMID 12473961. [e]
- ↑ Benet LZ, Hoener BA (2002). "Changes in plasma protein binding have little clinical relevance". Clin. Pharmacol. Ther. 71 (3): 115–21. DOI:10.1067/mcp.2002.121829. PMID 11907485. Research Blogging. OVID full text summary table at OVID
- ↑ 4.0 4.1 Sands CD, Chan ES, Welty TE (2002). "Revisiting the significance of warfarin protein-binding displacement interactions". The Annals of pharmacotherapy 36 (10): 1642–4. PMID 12369572. [e]
- ↑ Drug-Interactions.com. Retrieved on 2007-09-18.
- ↑ 6.0 6.1 6.2 Abarca J, Colon LR, Wang VS, Malone DC, Murphy JE, Armstrong EP (June 2006). "Evaluation of the performance of drug-drug interaction screening software in community and hospital pharmacies". J Manag Care Pharm 12 (5): 383–9. PMID 16792445. [e]
- ↑ 7.0 7.1 7.2 Hazlet TK, Lee TA, Hansten PD, Horn JR (2001). "Performance of community pharmacy drug interaction software". J Am Pharm Assoc (Wash) 41 (2): 200–4. PMID 11297332. [e]
- ↑ Fernando B, Savelyich BS, Avery AJ, et al. (May 2004). "Prescribing safety features of general practice computer systems: evaluation using simulated test cases". BMJ 328 (7449): 1171–2. DOI:10.1136/bmj.328.7449.1171. PMID 15142922. PMC 411094. Research Blogging.
- ↑ Robinson RL, Burk MS (March 2004). "Identification of drug-drug interactions with personal digital assistant-based software". Am. J. Med. 116 (5): 357–8. DOI:10.1016/j.amjmed.2003.09.025. PMID 14984827. Research Blogging.
- ↑ Abarca J, Malone DC, Armstrong EP, et al. (2004). "Concordance of severity ratings provided in four drug interaction compendia". J Am Pharm Assoc (2003) 44 (2): 136–41. PMID 15098847. [e]
- ↑ van der Sijs H, Aarts J, Vulto A, Berg M (2006). "Overriding of drug safety alerts in computerized physician order entry". J Am Med Inform Assoc 13 (2): 138–47. DOI:10.1197/jamia.M1809. PMID 16357358. PMC 1447540. Research Blogging.
- ↑ van Roon EN, Flikweert S, le Comte M, et al. (2005). "Clinical relevance of drug-drug interactions : a structured assessment procedure". Drug Saf 28 (12): 1131–9. PMID 16329715. [e]
- ↑ Paterno MD, Maviglia SM, Gorman PN, et al. (2009). "Tiering drug-drug interaction alerts by severity increases compliance rates". J Am Med Inform Assoc 16 (1): 40–6. DOI:10.1197/jamia.M2808. PMID 18952941. PMC 2605599. Research Blogging.