Drug interaction

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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]

  1. albumin
  2. α1-acid glycoprotein
  3. 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].

Gastrointestinal absorption

Medicines may change the biological availability of other medications via changes in absorption. An example is the interaction between proton pump inhibitors and aspirin.[6]

Renal clearance

Drugs may compete for renal excretion.[7]

Prevention

Resources about drug interactions

In detecting drug-drug interactions, the accuracy of software used by hospital pharmacies range from:[8][9]

In detecting drug-drug interactions, the accuracy of PDA-based software range from:[10]

Lower sensitivities have been reported using a different test collection of interactions.[11]

List of resources

The concordance between alerts generated by major resources is low.[12]

Medical order entry system

For more information, see: Medical order entry system.

Perhaps due to imperfect specificity and information of drug interaction resources, health care providers do not always find alerts to be useful[13] overide 49% to 96% of alerts.[14]

Efforts are being made to improve drug safety alerts by structuring[15] and tiering[16] information.

References

  1. ↑ Anonymous (2024), Drug interaction (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ DeVane CL (2002). "Clinical significance of drug binding, protein binding, and binding displacement drug interactions". Psychopharmacology bulletin. 36 (3): 5–21. PMID 12473961. [e]
  3. ↑ 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. ↑ 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]
  5. ↑ Drug-Interactions.com. Retrieved on 2007-09-18.
  6. ↑ Charlot M, Grove EL, Hansen PR, Olesen JB, Ahlehoff O, Selmer C et al. (2011). "Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study.". BMJ 342: d2690. DOI:10.1136/bmj.d2690. PMID 21562004. PMC PMC3092520. Research Blogging.
  7. ↑ Somogyi A, Stockley C, Keal J, Rolan P, Bochner F (1987). "Reduction of metformin renal tubular secretion by cimetidine in man.". Br J Clin Pharmacol 23 (5): 545-51. PMID 3593625. PMC PMC1386190. [e]
  8. ↑ 8.0 8.1 8.2 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]
  9. ↑ 9.0 9.1 9.2 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]
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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]
  13. ↑ Ko Y, Abarca J, Malone DC, et al. (2007). "Practitioners' views on computerized drug-drug interaction alerts in the VA system". J Am Med Inform Assoc 14 (1): 56–64. DOI:10.1197/jamia.M2224. PMID 17068346. PMC 2215077. Research Blogging.
  14. ↑ 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.
  15. ↑ 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]
  16. ↑ 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.
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