Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Basic Clin Pharmacol Toxicol. 2020 Feb;126(2):126-132. doi: 10.1111/bcpt.13312. Epub 2019 Sep 12.
Drug interaction databases are important tools in today's clinical decision support. However, there is great variation with regard to classification and presentation of interactions among databases. The present study aimed to investigate consensus among databases with regard to combinations of psychotropics. A database integrated in Norwegian computerised clinical decision support systems and three international recommended subscription databases were compared. Combinations of psychotropics (two or more) prescribed to patients 65 years or older on a single day from three nursing homes in Bergen, Norway 16 years apart (2000 and 2016) were studied. The databases were compared in a common analysis with the following questions: interaction (no, not contraindicated or contraindicated), type (pharmacodynamic or pharmacokinetic), the total number of interactions, and the first ranked interaction among several in each patient. Consensus among the four drug interaction databases was associated with pharmacokinetic interactions involving mainly older psychotropics in the common analysis. The qualities that best characterised interactions with consensus was primarily the evidence including a description of manageability. There was a surprising lack of consensus with regard to contraindicated interactions, even when older psychotropics were involved. Lack of consensus decreased with the number of psychotropics in the combinations. This was mainly because the highest ranked interactions in the respective databases involved different drugs. We propose evidence and manageability as core factors when ranking and presenting interactions in clinical decision support.
药物相互作用数据库是当今临床决策支持的重要工具。然而，不同数据库在相互作用的分类和呈现方式上存在很大差异。本研究旨在调查数据库在精神药物组合方面的共识。将挪威计算机化临床决策支持系统中集成的数据库与三个国际推荐的订阅数据库进行了比较。研究了挪威卑尔根的三个养老院中，16 年前（2000 年）和 16 年后（2016 年）同一天接受精神药物（两种或多种）治疗的 65 岁及以上患者的药物组合。这四个药物相互作用数据库在一个共同的分析中进行了比较，以下问题：相互作用（无、不禁忌或禁忌）、类型（药效学或药代动力学）、相互作用的总数以及每个患者中多个相互作用中的第一个排名。在共同分析中，与药代动力学相互作用相关的共识与主要涉及较老精神药物的相互作用相关。具有共识的相互作用的最佳特征是证据，包括可管理性的描述。即使涉及较老的精神药物，禁忌相互作用也缺乏共识，这令人惊讶。随着组合中精神药物数量的增加，共识的减少。这主要是因为各自数据库中排名最高的相互作用涉及不同的药物。我们建议在临床决策支持中对相互作用进行排名和呈现时，将证据和可管理性作为核心因素。
