Drug-Drug Interactions: How to Manage the Risk-A Stakeholder Approach

Drug-drug interactions (DDIs) are well-recognized, chronic, multidimensional issues that have defied efforts to make substantial reductions in the burden of effects on patients and the health care system. This Commentary offers a stakeholder approach to characterizing the problem and identifying potential ways to address the risks posed by DDIs. Stakeholders may comprise 2 groups: a triad consisting of the patient, the prescriber, and the pharmacist and a pentad of institutional stakeholders consisting of institutions of education and training for prescribers and pharmacists, drug development sector companies, regulatory agencies, payer institutions, and publishing companies of journals on healthcare topics. Suggested strategic opportunities to mitigate the risk of harm from DDIs include the following: (1) identify critical leadership to set the agenda, manage the process, and mark progress; (2) enhance self-advocacy skills, particularly for patients; (3) create more opportunities for patients to learn, understand, and participate in the process; (4) establish and enhance partnerships between and among stakeholders; (5) seek broader use of regulatory machinery; (6) institutionalize principles of conservative prescribing and deprescribing in medical education and professional training; (7) establish, highlight, and promote DDI in HEDIS quality metrics, key performance indicators, and balanced scorecards; (8) encourage publishers to engage the issue more deeply by developing dedicated specialty journals for physicians, pharmacists, and cross-professional audiences and encourage journal editors to dedicate sections in pharmacy and clinical journals; and (9) involve the political process to include markers for DDI mitigation and to set performance goals in US Food and Drug Administration-directed legislation.