Category: Professional Posters
Purpose: Our objective is to assess drug-drug interaction identification and suggested clinical management of online, open-access resources in comparison to each other and to subscription-based databases. Clinicians and patients alike utilize drug interaction databases to manage drug therapy. Open-access resources offer a readily accessible method for checking drug interactions and provide details of a specific interaction’s clinical consequences regardless of the user’s ability to pay for or affiliation with a clinic, hospital, or healthcare system. While these resources provide timely information, it is unclear whether the information provide is comparative to subscription-based services or whether any provide inappropriate or outdated information.
Methods: Open-access drug-drug interaction resources were defined as websites with or without mobile applications that offered free interaction analysis of a medication list. Inclusion criteria included English language, incorporation of FDA-approved medications, and the ability to check 3 or more medications for interaction at one time. Exclusion criteria included any resource that required pay for service, subscription, or personal information (such as registration of name and email to provide results), the ability to compare no more than 2 medications at one time, clear promotion of a particular product or service, or redirection to a subscription-based database. Websites and subsequent tools with emphasis on natural products or a specific disease/condition (such as hiv-druginteractions.org) were also excluded. Each resources was assessed as follows: 1) Data source; 2) Last update and update policy if available; 3) Identification, clinical management suggestion, and references for three unique drug interactions of varying severity. The drug interactions were: amoxicillin and norgestimate and ethinyl estradiol; sertraline, venlafaxine, and trazodone; and simvastatin and fluconazole.
Results: Six open-access, online drug-drug interaction checkers met the study criteria for inclusion (American Association of Retired Persons [AARP], Drugs.com, Medscape, RxIsk, RxList, and WebMD). Data source was identified in 3 of 6 of resources. Last update and references were available in 1 of 6 resources. As a whole, the six resources identified the 3 posed interactions 83% of the time (15 of 18). Drugs.com was the only interaction checker that identified its source, last update, and successfully identified all three interactions supported by relevant clinical management suggestions and references. Three tools were housed under WebMD Health Services (WebMD, Medscape, RxList). Despite having similar ownership, each of these interaction checkers gave varied results with one (RxList) being unable to identify any of the three interactions posed. The data source for each of these 3 interaction checkers were not clearly defined but did include a disclaimer pertaining to third parties. Several tools gave results intermixed with drug-food, drug-herb, and drug-lifestyle interactions which may decrease the likelihood that the drug-drug interaction is readily identified and subsequently addressed by the user.
Conclusion: Patients and off-site clinicians choosing to utilize open-access resources for drug interaction screens should be cognizant of the tool’s source, update frequency, and ability to analyze multiple FDA-approved medications to meet their needs.Several tools described the same interaction as either mild, moderate, or severe (with one tool listing the same interaction as all three) which could lead to confusion over appropriate clinical management. As all tools were likely licensed by third-parties that also own or oversee a commercial drug database, it is likely that these open-access tools would suffer without a thriving subscription-based environment.