Clinical relevance of drug-drug interactions - A structured assessment procedure
Clinical relevance of drug-drug interactions - A structured assessment procedure
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DOI：
10.2165/00002018-200528120-00007
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发表时间：
2005-01-01
期刊：
影响因子：
4.2
通讯作者：
Brouwers, JRBJ
中科院分区：
文献类型：
--
作者：
van Roon, EN;Flikweert, S;Brouwers, JRBJ
简介：计算机化药物相互作用监测系统（CIS）可能有助于检测临床上显着的药物相互作用。 CIS C 的经验表明，它们经常产生临床意义存疑的警报，无法提供相互作用不良反应风险因素的相关信息，也无法检测所有重要的药物相互作用。这些问题凸显了在选择 CIS 中包含的药物相互作用时透明度和选择性的重要性。在荷兰，药物治疗和药物信息工作组负责维护荷兰皇家药学促进协会 (KNMP) 的 CIS。 方法：工作组制定了基于证据的程序，用于结构化评估药物-药物相互作用，并相应修订了 CIS 中的所有药物相互作用。 结果：对于每种药物相互作用，评估了四个核心参数：（i）相互作用的证据； (ii) 相互作用引起的潜在不良反应的临床相关性； (iii) 确定相互作用特别重要的患者、药物或疾病特征的风险因素； (iv) 不良反应的发生率。在此评估的基础上，选择了纳入 CIS 的药物间相互作用。在对 KNMP-CIS 中的药物组合进行修订后，工作组判断 22% 的组合不存在相互作用，另外 12% 的组合存在相互作用但不需要采取行动。在此评估的基础上，对生成相互作用警报的药物组合子集以及 CIS 用户的药物相互作用警报管理信息进行了调整。当 CIS 生成警报时，系统的用户将获得关于四个核心参数、相互作用机制以及个体患者相互作用管理的关键信息的综合信息。讨论：这种结构化程序提供了对药物相互作用的临床相关性进行透明且可重复的评估的可能性。结论：基于此评估选择性地生成相互作用警报的 CIS 可能有助于实现良好临床实践的目标，并可能提供进一步提高药物安全性的方法。
Introduction: Computerised drug interaction surveillance systems (CIS) may be helpful in detecting clinically significant drug interactions. Experience with CIS C, reveals that they often yield alerts with questionable clinical significance, fail to provide relevant information on risk factors for the adverse reaction of the interaction and fail to detect all significant drug interactions. These problems highlight the importance of transparency and selectivity in choosing the drug interactions to be included in CIS. In The Netherlands, the Working Group on Pharmacotherapy and Drug Information is responsible for maintenance of the CIS of the Royal Dutch Association for the Advancement of Pharmacy (KNMP).Methods: The Working Group developed an evidence-based procedure for structured assessment of drug-drug interactions and revised all drug interactions in the CIS accordingly.Results: For every drug interaction four core parameters were assessed: (i) evidence on the interaction; (ii) clinical relevance of the potential adverse reaction resulting from the interaction; (iii) risk factors identifying patient, medication or disease characteristics for which the interaction is of special importance; and (iv) the incidence of the adverse reaction. On the basis of this assessment the drug-drug interactions for inclusion in the CIS were selected. After revision of the drug combinations in the KNMP-CIS, the Working Group judged 22% of the combinations to be not interacting and another 12% to be interacting but not requiring action. On the basis of this assessment the subset of drug combinations for which interaction alerts are generated and the information on management of a drug interaction alert for users of the CIS were adapted. When an alert is generated by the CIS, the user of the system is supplied with comprehensive information on the four core parameters, the mechanism of the interaction and critical information for management of the interaction for the individual patient.Discussion: This structured procedure offers the possibility for transparent and reproducible assessment of the clinical relevance of drug interactions.Conclusion: A CIS selectively generating interaction alerts based on this assessment may help in realising the goal of good clinical practice and may offer a methodology to further increase drug safety.