Moreau Fanny, Décaudin Bertrand, Tod Michel, Odou Pascal, Simon Nicolas
Institut de Pharmacie, Lille, France
Institut de Pharmacie, Lille, France.
Eur J Hosp Pharm. 2024 Dec 30. doi: 10.1136/ejhpharm-2023-004052.
Several drug-drug interaction (DDI) checkers such as DDI-Predictor have been developed to detect and grade DDIs. DDI-Predictor gives an estimate of the magnitude of an interaction based on the ratio of areas under the curve. The objective of the present study was to analyse the frequencies of DDIs involving well-known strong interactors such as rifampicin and selective serotonin reuptake inhibitors (SSRIs), as reported by a clinical pharmacy team using DDI-Predictor, and the pharmacist intervention acceptance rate.
The pharmacist intervention rate and the physician acceptance rate were calculated for DDIs involving rifampicin or the SSRIs fluoxetine, paroxetine, duloxetine and sertraline. The rates were compared with a bilateral χ test or Fisher's exact test.
Of the 284 DDIs recorded, 38 (13.4%) involved rifampicin and 78 (27.5%) involved SSRIs. The pharmacist intervention rate differed significantly (68.4% for rifampicin vs 48.8% for SSRIs; p=0.045) but the physician acceptance rate did not (84.6% for rifampicin vs 81.6% for SSRIs; p=1). Pharmaceutical interventions for SSRIs were more frequent when the ratio of the area under the drug concentration versus time curve in DDI-Predictor was >2. Pharmacists were more likely to issue a pharmacist intervention for DDIs involving rifampicin because of a high perceived risk of treatment failure and were less likely to issue a pharmacist intervention for DDIs involving an SSRI, except when the suspected interaction was strong.
DDI checkers can help pharmacists to manage DDIs involving strong interactors. DDIs involving strong inhibitors versus a strong inducer differ with regard to their intervention and acceptance rates, notably due to the estimation of the magnitude of the DDI.
已开发出多种药物相互作用（DDI）检查工具，如DDI预测器，用于检测和分级药物相互作用。DDI预测器基于曲线下面积的比值来估计相互作用的强度。本研究的目的是分析临床药学团队使用DDI预测器报告的涉及利福平及选择性5-羟色胺再摄取抑制剂（SSRI）等知名强效相互作用药物的药物相互作用频率，以及药师干预接受率。
计算涉及利福平或SSRI类药物氟西汀、帕罗西汀、度洛西汀和舍曲林的药物相互作用的药师干预率和医生接受率。采用双侧χ检验或Fisher精确检验比较这些比率。
在记录的284例药物相互作用中，38例（13.4%）涉及利福平，78例（27.5%）涉及SSRI。药师干预率有显著差异（利福平为68.4%，SSRI为48.8%；p = 0.045），但医生接受率无显著差异（利福平为84.6%，SSRI为81.6%；p = 1）。当DDI预测器中药物浓度-时间曲线下面积的比值>2时，针对SSRI的药学干预更频繁。由于认为治疗失败风险高，药师更有可能对涉及利福平的药物相互作用进行药师干预，而对涉及SSRI的药物相互作用，除了怀疑相互作用较强时，进行药师干预的可能性较小。
药物相互作用检查工具可帮助药师管理涉及强效相互作用药物的药物相互作用。涉及强效抑制剂与强效诱导剂的药物相互作用在干预率和接受率方面存在差异，特别是由于对药物相互作用强度的估计。
