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Drug interactions among commonly used medications. Chart simplifies data from critical literature review
N R Crowther1, A M Holbrook, R Kenwright
1University of Toronto. rcrowthr@fhs.csu.mcmaster.ca
Objective:
To simplify risk assessment, we have developed a way to present critically appraised drug interaction information through a chart.
Data Sources:
Fifty drugs most frequently prescribed by Canadian family physicians and 16 drugs and substances that frequently interact with these drugs were the basis for a literature review. Drug interaction textbooks and MEDLINE (from 1966 to 1994) were searched for documented interactions. Reports of additive effects and animal or in vitro studies were excluded.
Study Selection:
All reports of interactions were evaluated for clinical effect, clinical significance, and quality of evidence.
Synthesis:
Of the 464 drug-drug or drug-substance pairs evaluated, 387 (83.4%) demonstrated an interaction, 59 (12.7%) documented no effect, and 18 (3.9%) pairs had conflicting evidence. Five percent of interactions were of major clinical significance; only 1.3% were of major clinical significance and supported by good-quality evidence. By using symbols, colours, and legends in a "grid-map" format, a large amount of drug interaction information was reduced to a single-page chart suitable for a desk reference or wall mounting.
Conclusions:
Our chart organizes a large amount of drug interaction information in a format that allows for rapid appreciation of outcome, clinical significance, and quality of evidence.