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Journal de Pharmacie Clinique

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Heterogeneous information on drug interactions: review by a drug database editor for health practitioners Volume 23, issue 1, janvier-février-mars 2004

Authors
Centre national hospitalier d‘information sur le médicament, CNHIM‐Hôpital de Bicêtre, Le Kremlin Bicêtre

The screening of prescriptions with a computerized drug interaction (DI) system improves the ability to detect DI. In this field the quality of the information sources is essential. In France two DI sources could be considered as official and validated: the DI rubric in the Summary Product Characteristics (SPC) and the minutes of a specific workgroup (GTIAM) from the French drug agency. This workgroup concludes on clinical significant DIs between active substances, or classes, according to 4 severity levels: contra‐indication, unrecommended combination, precaution, warning. Our aim was to evaluate the discordances in the information contained in these two different sources and to report one. Design: prospective study concerning new drugs commercialised from February to May 2002. A discordance was defined by the absence of the interaction in one of the source (SPC or GTIAM) or by the presence of the interaction in the two sources but with severity levels and\or actions to be taken different. Main outcome measures: 1) Number of discordances and concordances concerning DIs data and DI severity level between the 2 DI official sources (GTIAM minutes\SPCs); 2) Case report about 5HT1 receptors selective agonists used in migraine therapy. Results: 1) On 166 new drugs, 28 had discordant interaction data and 138 had concordant ones; 2) In the 5HT1 selective agonists group, the ergot alkaloids DIs were concordant. The DIs concerning the monoamine oxidase inhibitors, the methylergometrine and the selective 5HT1 re‐uptake inhibitors were discordant. The DIs between eletripan and cytochrome P3A4 inhibitors, eletriptan, naratriptan and cytochrome P450 inhibitors and, between naratriptan and oral contraceptive were discordant. Conclusions: the discordances between DIs data and severity levels in the 2 French official sources are a difficulty first for their integration in DIs softwares, second for health practitioners in their benefit\risk therapeutic evaluation. It is today impossible to us to recommend a source with regard to the other one and the choice remains responsibility of each one.