A Comparison of Tertiary Drug Resources’ Consistency Regarding Drug-Drug Interactions of Adjunctive Analgesics

Abstract

Background: Health care providers routinely rely on tertiary drug information resources to affirm knowledge or proactively verify the safety and efficacy of medications. Though all patient care areas are affected, the reliability of these resources is perhaps nowhere as poignant as it is in high-acuity settings, including the emergency department and the intensive care unit. As providers seek to identify adjunctive analgesics for acute pain in these areas, they must be able to rely on the integrity to whichever resource their institution has granted access. Objective: To determine the congruency of drug-drug interaction information found on 3 tertiary drug resources. Methods: A drug-drug interaction analysis was conducted on Micromedex, Lexicomp, and Medscape. Adjunctive analgesics included dexmedetomidine and ketamine, which were compared with the intravenous opioid products morphine, fentanyl, and hydromorphone. Results: Significant discrepancies were appreciated with regard to the severity of drug-drug interactions. In addition, the heterogeneity in which reaction severity and likelihood are described by each respective resource makes direct comparisons difficult. Interaction warnings for dexmedetomidine and fentanyl included a “major interaction” from Micromedex, whereas Lexicomp did not identify a risk and Medscape only recommended increased monitoring on the grounds of respiratory and central nervous system depression. Conclusions: Health care providers must remain vigilant when reviewing tertiary drug information resources. Pharmacists possess the training and skills necessary to assist interdisciplinary medical teams in providing optimal patient care through evaluating and applying the information gleaned from these resources.

An Evaluation of Tertiary Drug Resources’ Consistency Regarding Drug-Drug Interactions Between Tricyclic Antidepressants and Herbal Supplements

“…Lexicomp sources its information from approximately 25 different drug information repositories, whereas Micromedex populates its databases from more than 30 sources, including the Physician's Desk Reference. 9,10,12 Medscape extrapolates data directly from MEDLINE. 11,12 From 2004 to 2013, it was estimated from national surveillance data that herbal supplements were involved in 23 000 emergency department visits and 2000 hospitalizations annually.…”

“…9,10,12 Medscape extrapolates data directly from MEDLINE. 11,12 From 2004 to 2013, it was estimated from national surveillance data that herbal supplements were involved in 23 000 emergency department visits and 2000 hospitalizations annually. 13 Herbal supplements have the potential to be effective at treating various ailments, however; a lack of standardization across the industry and the ability to provide herbal supplements to market without Food and Drug Administration (FDA) oversight is problematic.…”

“…Lexicomp sources its information from approximately 25 different drug information repositories, whereas Micromedex populates its databases from more than 30 sources, including the Physician’s Desk Reference. 9,10,12 Medscape extrapolates data directly from MEDLINE. 11,12…”

Comparison of Tertiary Drug Information Resources With the CDC Guideline for Oxycodone Dosing: Are Patients at Risk?

“…Tertiary resources are commonly used by health care providers to locate information on drug dosing, drug interactions, and available commercial products. 6 It has been reported that primary care providers may lack sufficient training in the prescribing of opioids. 7 To assist health care providers in pain management, the Centers for Disease Control and Prevention (CDC) developed and published a guideline for prescribing opioids for pain management.…”

“…Tertiary resources are commonly used by health care providers to locate information on drug dosing, drug interactions, and available commercial products. 6 …”