Tukukino Carina, Wallerstedt Susanna M
Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Basic Clin Pharmacol Toxicol. 2020 Jan;126(1):65-74. doi: 10.1111/bcpt.13294. Epub 2019 Aug 12.
Many people are treated with ≥1 drug, implying that risks of drug interactions need to be considered. The aim of this study was to describe drug interaction queries from healthcare professionals to a drug information centre in Sweden over 10 years focusing on drugs frequently asked about and the advice provided. Advice was recorded in mutually exclusive groups: Avoid, Adjust dose, Separate intake, Vigilance or No problem. For queries with Avoid, Adjust dose or Separate intake advice, alerts were extracted from an interaction database (Janusmed). Of 4335 queries to the centre in 2008-2017, 589 (14%) concerned interactions. Most were posed by physicians (91%) and concerned a specific patient (83%) before treatment initiation (76%). Sertraline, warfarin and methotrexate were the most frequently asked about, whereas queries about cyclophosphamide and rifampicine occurred most often in relation to the number of exposed patients. Advice provided in 557 (95%) replies comprised Avoid: n = 85 (15%), Adjust dose: n = 57 (10%), Separate intake: n = 17 (3%), Vigilance: n = 235 (42%) or No problem: n = 163 (29%). In all, 113 (71%) of 159 queries with Avoid/Adjust dose/Separate intake advice elicited an action alert on Janusmed, whereas 31 (20%) did not result in any alert at all. Summarized, seven in ten replies from the drug information centre recommended an explicit drug treatment action, regarding either specific prescribing aspects, for instance dose adjustments, or active follow-up including monitoring potential adverse reactions and/or laboratory results. Readily accessible decision support regarding drug interactions often provides relevant action alerts, but cannot be solely relied on.
许多人接受了≥1种药物治疗，这意味着需要考虑药物相互作用的风险。本研究的目的是描述瑞典一家药物信息中心在10年期间收到的医疗保健专业人员关于药物相互作用的咨询，重点关注常见咨询药物及所提供的建议。建议被记录在相互排斥的类别中：避免、调整剂量、分开服用、警惕或无问题。对于给出避免、调整剂量或分开服用建议的咨询，从一个相互作用数据库（Janusmed）中提取警示信息。在2008 - 2017年向该中心提出的4335次咨询中，589次（14%）涉及相互作用。大多数咨询由医生提出（91%），且涉及特定患者（83%），多在治疗开始前（76%）。舍曲林、华法林和甲氨蝶呤是咨询最多的药物，而关于环磷酰胺和利福平的咨询在暴露患者数量方面出现频率最高。557次（95%）回复中提供的建议包括：避免：n = 85（15%），调整剂量：n = 57（10%），分开服用：n = 17（3%），警惕：n = 235（42%）或无问题：n = 163（29%）。在所有给出避免/调整剂量/分开服用建议的159次咨询中，113次（71%）在Janusmed上引发了行动警示，而31次（20%）根本未产生任何警示。总之，药物信息中心十分之七的回复建议采取明确的药物治疗行动，涉及特定的处方方面，如剂量调整，或积极的随访，包括监测潜在不良反应和/或实验室结果。关于药物相互作用的易于获取的决策支持通常会提供相关的行动警示，但不能完全依赖。
