Management of drug-disease interactions: a best practice from the Netherlands

Abstract

Background Drug-disease interactions are situations where pharmacotherapy may have a negative effect on patients' comorbidities. In these cases, it can be necessary to avoid that drug, adjust its dose or monitor therapy. In the Netherlands, pharmacists have developed a best practice how to systematically evaluate drug-disease interactions based on pharmacological considerations and implement recommendations for specific drug-disease interactions. Aim To describe the development of recommendations for drug-disease interactions and the implementation in prescribing and dispensing practice in the Netherlands. Setting Pharmacies and physicians' practices in primary care and hospitals in the Netherlands. Development A multidisciplinary expert panel assessed if diseases had clinically relevant drug-disease interactions and evaluated drug-disease interactions by literature review and expert opinion, and subsequently developed practice recommendations. Implementation The recommendations were implemented in all clinical decision support systems in primary care and hospitals throughout the Netherlands. Evaluation Recommendations were developed for 57 diseases and conditions. Cardiovascular diseases have the most drug-disease interactions (n = 12, e.g. long QT-syndrome, heart failure), followed by conditions related to the reproductive system (n = 7, e.g. pregnancy). The number of drugs with recommendations differed between 6 for endometriosis and tympanostomy tubes, and up to 1171 in the case of porphyria or even all drugs for pregnancy. Conclusion Practice recommendations for drug-disease interactions were developed, and implemented in prescribing and dispensing practice. These recommendations support both pharmacists and physicians by signalling clinically relevant drug-disease interactions at point of care, thereby improving medication safety. This practice may be adopted and contribute to safer medication use in other countries as well.

Implementation of a myasthenia gravis drug‐disease interaction clinical decision support tool reduces prescribing of high‐risk medications

“…11 Given the relative infrequency of MG in clinical practice, there are likely opportunities to limit excessive alerting for other reasons. 12 Our study has several limitations. The success of CDS alerting systems can be hampered by high alert override and low alert adherence rates.…”

“…Continual evaluation of the performance of drug‐disease alerts and overall alert volume is recommended as a part of drug‐disease CDS improvement programs 11 . Given the relative infrequency of MG in clinical practice, there are likely opportunities to limit excessive alerting for other reasons 12 …”

Relação Entre Benefício E Risco Em Interações Medicamentosas Nas Prescrições Médicas De Um Hospital Universitário No Estado De São Paulo

“…A porcentagem de interações medicamentosas em relação ao total de prescrições geradas durante os nove meses de pesquisa foi crescente (14,45% em janeiro, 33,47% em setembro); fato que comprova os problemas descritos anteriormente (DIESVELD et al, 2021;ERMAKOV;FOMINA;KARTASHOVA, 2021). Todavia, houve êxito de atuação dos farmacêuticos à redução do percentual de ocorrências de interações de nível I, as consideradas mais importantes em termos de gravidade, sendo constatada inicialmente com percentual representado por 26,5% de interações em janeiro de 2009 e finalizando em setembro de 2009 com percentual representado por 18,4%.…”

“…O uso concomitante de diferentes medicamentos em ambiente hospitalar é comum na prática e está intrinsecamente relacionado ao risco de interações medicamentosas, podendo trazer respostas tanto desejadas quanto indesejadas, como alterações nas concentrações plasmáticas com consequentes mudanças na eficácia e na segurança (KOVAČEVIĆ et al, 2020;DIESVELD et al, 2021); especialmente quando associados com situações críticas de saúde (CASTRO et al, 2023). Kovačević et al (2020) definem interação medicamentosa como tipos especiais de respostas farmacológicas, em que os efeitos de um ou mais medicamentos são alterados pela administração simultânea ou anterior de outros, ou através da administração concomitante com alimentos.…”

Inconsistencies of absolute drug–drug contraindication reports: Analysis of Summaries of Product Characteristics of commonly prescribed drugs

“…This study focuses on DDCI, compared to drug‐condition contraindications, which were previously reported to be ambiguously formulated in SmPCs with impractical information 29–31 . Further, drug‐category contraindications, which represent contraindications of a drug and a drug category (a group of drugs belonging to the same drug class, e.g.…”