Drug Interaction Database Sensitivity With Oral Antineoplastics: An Exploratory Analysis
John B Bossaer1, Christan M Thomas1
1Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City; and James H. Quillen VA Medical Center, Mountain Home, TN.
Purpose:
Drug interactions are a concern in oncology with the shift toward oral antineoplastics (OAs). Using electronic databases to screen for drug interactions with OAs is a common practice. There is little literature to guide clinicians on the reliability of these systems with OAs. The primary objective of this study was to explore the sensitivity of commonly available drug interaction databases in detecting drug interactions with OAs.
Methods:
A list of 20 drug interactions with OAs was developed by two Board-certified oncology pharmacists. The list included multiple types of drug interactions. The sensitivity in detecting these interactions by MicroMedex, Facts & Comparisons, Lexi-Interact, and Epocrates were evaluated. These databases were chosen based on their local availability and widespread use in practice. Drugs.com was evaluated as a surrogate for a patient-accessible drug interaction database. The Cochran Q test was used to assess the sensitivity distribution across the five groups.
Results:
Lexi-Interact and Drugs.com had a sensitivity of 95% for the 20 tested drug interaction pairs. Epocrates had a sensitivity of 90%, and both Micromedex and Facts & Comparisons had a sensitivity of 70%. There was a statistically significant difference ( P = .016) in the distribution across the databases in detecting clinically significant drug interactions.
Conclusion:
Commonly used databases for identifying drug interactions with oral antineoplastics vary significantly in their sensitivity. Clinicians should not rely on a single database and should consider using multiple resources as well as sound clinical judgment. Further work is needed in this area.
Insights
Lexi-Interact and Drugs.com showed 95% sensitivity in detecting oral antineoplastic drug interactions. Other databases varied, highlighting the need for multiple resources and clinical judgment in oncology practice.
Area of Science:
- Oncology
- Pharmacology
- Clinical Pharmacy
Background:
- The increasing use of oral antineoplastics (OAs) in cancer treatment necessitates careful management of drug interactions.
- Electronic databases are commonly used to screen for these interactions, but their reliability with OAs is not well-established.
Purpose of the Study:
- To evaluate the sensitivity of widely used drug interaction databases in identifying interactions involving oral antineoplastics.
- To compare the performance of different electronic resources in detecting OA drug interactions.
Main Methods:
- A curated list of 20 drug interactions with OAs was developed by oncology pharmacy specialists.
- The sensitivity of MicroMedex, Facts & Comparisons, Lexi-Interact, and Epocrates was assessed.
- Drugs.com was included as a patient-accessible database surrogate.
Main Results:
- Lexi-Interact and Drugs.com demonstrated the highest sensitivity at 95%.
- Epocrates showed 90% sensitivity, while MicroMedex and Facts & Comparisons had 70% sensitivity.
- A statistically significant difference in sensitivity distribution was observed among the databases (P = .016).
Conclusions:
- There is significant variability in the sensitivity of drug interaction databases for oral antineoplastics.
- Oncology clinicians should utilize multiple resources and clinical judgment, rather than relying on a single database.
- Further research is recommended to improve the accuracy of drug interaction detection systems for OAs.
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