Drug-disease and drug-drug interactions

systematic examination of recommendations in 12 UK national clinical guidelines

Siobhan Dumbreck, Angela Flynn, Moray Nairn, Martin Wilson, Shaun Treweek, Stewart W Mercer, Phil Alderson, Alex Thompson, Katherine Payne, Bruce Guthrie

Research output: Contribution to journalArticle

100 Citations (Scopus)
7 Downloads (Pure)

Abstract

OBJECTIVE: To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines.

DESIGN: Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions.

SETTING: NICE clinical guidelines for type 2 diabetes, heart failure, and depression

MAIN OUTCOME MEASURES: Potentially serious drug-disease and drug-drug interactions.

RESULTS: Following recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84%) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions.

CONCLUSIONS: Drug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection.

Original languageEnglish
Article numberh949
JournalBMJ (Clinical research ed.)
Volume350
Early online date11 Mar 2015
DOIs
Publication statusPublished - 2015

Fingerprint

Drug Interactions
Guidelines
Pharmaceutical Preparations
Type 2 Diabetes Mellitus
National Institutes of Health (U.S.)
Heart Failure
Chronic Renal Insufficiency
Delivery of Health Care
Comorbidity
Health Services Needs and Demand

Cite this

Drug-disease and drug-drug interactions : systematic examination of recommendations in 12 UK national clinical guidelines. / Dumbreck, Siobhan; Flynn, Angela; Nairn, Moray; Wilson, Martin; Treweek, Shaun; Mercer, Stewart W; Alderson, Phil; Thompson, Alex; Payne, Katherine; Guthrie, Bruce.

In: BMJ (Clinical research ed.), Vol. 350, h949, 2015.

Research output: Contribution to journalArticle

Dumbreck, S, Flynn, A, Nairn, M, Wilson, M, Treweek, S, Mercer, SW, Alderson, P, Thompson, A, Payne, K & Guthrie, B 2015, 'Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines', BMJ (Clinical research ed.), vol. 350, h949. https://doi.org/10.1136/bmj.h949
Dumbreck, Siobhan ; Flynn, Angela ; Nairn, Moray ; Wilson, Martin ; Treweek, Shaun ; Mercer, Stewart W ; Alderson, Phil ; Thompson, Alex ; Payne, Katherine ; Guthrie, Bruce. / Drug-disease and drug-drug interactions : systematic examination of recommendations in 12 UK national clinical guidelines. In: BMJ (Clinical research ed.). 2015 ; Vol. 350.
@article{41d6af9aab854507aa1cbf715ac2d6a5,
title = "Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines",
abstract = "OBJECTIVE: To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines.DESIGN: Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions.SETTING: NICE clinical guidelines for type 2 diabetes, heart failure, and depressionMAIN OUTCOME MEASURES: Potentially serious drug-disease and drug-drug interactions.RESULTS: Following recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84{\%}) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions.CONCLUSIONS: Drug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection.",
author = "Siobhan Dumbreck and Angela Flynn and Moray Nairn and Martin Wilson and Shaun Treweek and Mercer, {Stewart W} and Phil Alderson and Alex Thompson and Katherine Payne and Bruce Guthrie",
year = "2015",
doi = "10.1136/bmj.h949",
language = "English",
volume = "350",
journal = "BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Drug-disease and drug-drug interactions

T2 - systematic examination of recommendations in 12 UK national clinical guidelines

AU - Dumbreck, Siobhan

AU - Flynn, Angela

AU - Nairn, Moray

AU - Wilson, Martin

AU - Treweek, Shaun

AU - Mercer, Stewart W

AU - Alderson, Phil

AU - Thompson, Alex

AU - Payne, Katherine

AU - Guthrie, Bruce

PY - 2015

Y1 - 2015

N2 - OBJECTIVE: To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines.DESIGN: Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions.SETTING: NICE clinical guidelines for type 2 diabetes, heart failure, and depressionMAIN OUTCOME MEASURES: Potentially serious drug-disease and drug-drug interactions.RESULTS: Following recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84%) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions.CONCLUSIONS: Drug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection.

AB - OBJECTIVE: To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines.DESIGN: Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions.SETTING: NICE clinical guidelines for type 2 diabetes, heart failure, and depressionMAIN OUTCOME MEASURES: Potentially serious drug-disease and drug-drug interactions.RESULTS: Following recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84%) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions.CONCLUSIONS: Drug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection.

U2 - 10.1136/bmj.h949

DO - 10.1136/bmj.h949

M3 - Article

VL - 350

JO - BMJ

JF - BMJ

SN - 0959-8146

M1 - h949

ER -