Identification of serious drug-drug interactions: Results of the partnership to prevent drug-drug interactions

Objective: To develop a list of clinically important drug-drug interactions (DDIs) likely to be encountered in community and ambulatory pharmacy settings and detected by a computerized pharmacy system. Design: Cross-sectional, one-time evaluation. Setting: United States in fall 2001. Participants: An expert panel comprising two physicians, two clinical pharmacists, and an expert on DDIs. Interventions: Systematic review of drug interaction compendia and published literature, ratings (on a 1 to 10 scale) of various clinical aspects of DDIs (e.g., clinical importance, quality and quantity of evidence, causal relationship, risk of morbidity and mortality), and a modified Delphi consensus-building process. Main Outcome Measure: Panelists' opinions about clinical importance of DDIs. Results: The expert panel considered 56 DDIs. Of these, 28 had a mean clinical importance score of 8.0 or more. The ratings for clinical importance ranged from 3.2 to 9.6, with a mean ± SD of 7.5 ± 1.5 across the combinations examined. The mean score for the quality of literature suggesting the interaction exists ranged from 1.0 to 9.6, with a mean ± SD of 5.8 ± 2.5. In terms of substantiation of the interactions evaluated, the mean ± SD rating was 6.3 ± 2.2, with a range from 1.4 to 9.2. Through the modified Delphi process, the panel determined that 25 interactions were clinically important. Conclusion: Using an expert panel and a standard evaluation tool, 25 clinically important drug interactions that are likely to occur in the community and ambulatory pharmacy settings were identified. Pharmacists should take steps to prevent patients from receiving these interacting medications, and computer software vendors should focus interaction alerts on these and similarly important DDIs.