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Drug interactions program for medical doctors, pharmacists and other health care proffesionals

Drug interactions program for medical doctors, pharmacists and other health care proffesionals. PharmDr. Josef Suchopar MUDr. Michal Prokes INFOPHARM a.s., Prague Czech Republic. Metaanalysis of 39 prospective clinical trials has proved:

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Drug interactions program for medical doctors, pharmacists and other health care proffesionals

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  1. Drug interactions program for medical doctors, pharmacists and other health care proffesionals PharmDr. Josef Suchopar MUDr. Michal Prokes INFOPHARM a.s., Prague Czech Republic

  2. Metaanalysis of 39 prospective clinical trials has proved: Adverse Drug Reactions are 4th most frequent cause of death Lazarou et al: JAMA 1998 Analysis of USA National Drug Register has proved: The cause of 2/3 of ADRs are drug interactions Phillips et al: JAMA 2001 Drug interactions: Are they really important?

  3. Different kinds of drug interactions PHARMACOKINETIC Drug interactions: PHARMACODYNAMIC • Interaction drug - drug • Interaction drug - alcohol • Interaction drug - foods (and soft drinks) • Interaction drug – food supplements All these kinds are divided into: Drug interactions: • clinically relevant • not clinically relevant

  4. Pharmacokinetic drug interactions Drug absorption Transport of the drug inside the body Drug displacement (protein-binding) Drug metabolism (biotransformation) CYP3A4, CYP2D6, CYP2C9… Drug excretion

  5. Example: Changes of biological availability of midazolam caused by coincident medication Inhibitors of CYP3A4 increase bioavailability of midazolam, inducers of CYP3A4 lessen it.

  6. Pharmacodynamic drug interaction • Opposing or antagonistic interaction: • Anticoagulants + vitamin K: Anticoagulant effect opposed • Serotonin syndrome • QT prolongation – can lead to life threatening cardiac arrhytmia torsade de pointes • Disturbances in fluid and electrolyte balance • Kalium loosing diuretics + digoxin: Increased toxicity of digoxin

  7. Probability of drug interaction Probability of drug interaction rises with the number of drugs patient uses

  8. Why doctors cannot keep drug interactions on mind? Too many informations: • 2 700 drug interaction in CR, where coincident therapy is forbidden by manufacturer • 3 100 drug clinical relevant interactions in CR, where coincident therapy may cause serious damage to patient

  9. Solution is to combine these activities: • Education of doctors and pharmacits • Cooperation of doctors and pharmacists to identify high-risk patiens • Feedback to doctors from databases of health insurance funds • Computer program: • alerts doctors when potencial drug-drug interaction occurs • offers the most detailed evidence-based information in the actual time the prescription is written

  10. Questions asked by doctors and pharmacists • Two drugs interact: Is this knowledge theoretical (speculative) or is it proved in humans (not only in mice or in vitro)? How strong is the proof? • Clinical relevance: If the interaction occured in humans, how serious is it? • Has it been described many times or only once? • Are all patients affected or only a few? • Is it best to avoid these two drugs altogether or can the interaction be accommodated in some way (and how)? Dosing of drugs, lab tests, watching for specific signs and symptoms… Stockley´s Drug Interactions, Sixth edition

  11. INFOPHARM program offers (I) • Stratification of the clinical importance of drug interaction (values from 0 to 5, where values 3,4 and 5 are clinically relevant) • Validation of quality of documentation of drug interaction: • poor evidence • no EBM proof avilable, only manufacturer´s statement • case-report • good (more than 3 case-reports or a small study) • excelent (study) • Aggregate evaluation of clinical importance and quality of documentation (values from 0 to 5)

  12. INFOPHARM program offers (II) • Information, what happens to patient when the two drugs are applied • Mechanism of drug interaction (if known) • What measures are to be applied to lessen the risk: Decrease dosing, lab tests provided, watching for specific signs and symptoms, or not to apply the two drugs together at all • Comments: Abstracts from medical papers containing all the neccessary information for doctor to know how to deal with the situation • References: Each user can find the primary source of information

  13. The way the information is provided Stratification of quality of documentacion and clinical relevance What happens to patient? Mechanism of interaction What measures are to be made?

  14. Abstracts from medical papers are detailed Sources – to identify the medical papers

  15. Three ways to use INFOPHARM drug interaction program • Isolated use of the program • Drug interaction program is used like a module for other program, such as: • patient notes including medication on PC • pharmacy programs for warehousing activities • Health insurance funds database use the program to provide drug prescription analysis and rational drug prescription support to the doctors

  16. Isolated use of drug interactions program INFOPHARM

  17. Notes (eg. diagnosis, adress of the patient… Name and number of insurance card of the patient Here user writes the name of the medicinal product

  18. Write first 4 letters and list of drugs pops up. Scrool down to find the right drug and then ENTER

  19. List of drugs is being made Number: Clincal relevance of drug interaction Where drug interaction is identified, line is automatically drawn Red line: drug interaction Black line: contraindication!

  20. Program identifies: • Potential drug interactions – red connection-line • Contraindicated drug interactions – black connection-line • No drug interaction – green connection-line (evidence from human studies) • 2 or more drugs with the same active ingredient – blue connection-line • 2 or more drugs with similar active ingredient, when co-prescription is usually erroneous – violet connection-line • 2 or more drugs with marked hepatotoxicity, myelotoxicity or nephrotoxicity, when co-prescription is to be avoided – yellow connection-line

  21. Stratification of the risk of drug interactions in ČR and in other countries In drug-interaction program filters should be implied

  22. Documented evidence in ČR and in other countries

  23. When only clinically relevant interaction are to be identified, press filter button Buttons for saving the patient medical record and opening another one

  24. Now filter is set only for clinical relevant interactions - level 4 and 5 To get detailed information on the drug interaction press this button

  25. Examplex of health insurance database report on drug interactions using INFOPHARM program

  26. Drug interactions prescribed to patients which are client of particular general practicioner Upper index: Dr. prescribed both drugs Lower index: Both drug prescribed by specialists

  27. The same GP: drug interactions are sorted by individual patients

  28. INFOPHARM a.s. • Adress: Hvozdanska 3 • Post code number: 148 00 • City: Prague 4 • Country: Czech Republic • www.drugagency.cz • tel. +420 226 211 791-3, +420 724 375 439 (Prokes Michal, MD) • fax: +420 226 211 794

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