May 2, 2010

May 2, 2010
Drug Interactions Common

Welcome to another day in my life. Today is Sunday and I hope you are having a safe and great weekend. It is another beautiful day here in south Florida and having a great time spending it relaxing and enjoying time with the dogs.

Since I got their baths out of the way yesterday, today was just for fun with them. It is so funny to watch them as they run around like wound up little kids after getting their baths. Of course, I have to keep them from rolling around in the grass. I guess they do not like smelling like humans and want to smell like a dog again.

A few month ago I had a reaction to a new medication when taken in combination with my HIV medications. After speaking to some experts, I have found out this happens all too often.

Not only are significant drug drug interactions common among people living with HIV taking antiretroviral therapy, but they are frequently overlooked by health care providers.

“Unrecognized drug drug interactions are one of the most common reasons for medication error with HIV drugs among the most therapeutically risky,” writes John Evans-Jones of the Royal Liverpool and Broadgreen University Hospitals NHS Trust and his colleagues. Failing to recognize these interactions, the authors point out, can result in blood concentrations of some drugs to fall below the levels needed to remain therapeutically active or to become elevated to the point where serious side effects are a risk.

Although previous studies have suggested that the risk of clinically significant drug interactions (CSDIs) is common, no study has assessed the extent to which these interactions are recognized and managed by health care providers.

Evans-Jones’s group asked HIV treating physicians at the Royal Liverpool University Hospital to complete structured questionnaires. For each patient a total of 159 were included in the study the health care providers were told to record all prescription and over the counter medications being taken by the patient, along with any known recreational/illicit drugs. From there, the participating physicians were asked to identify potential CSDIs in the list of medications being used by each patient and to note any dosing changes to compensate for the interactions.

A total of 86 CSDIs were documented, occurring in 43 (27 percent) of the patients enrolled. Not surprisingly, patients using a protease inhibitor a class of ARVs known for their many drug drug interactions faced the greatest risk of a CSDI.

Among the drugs most frequently involved in drug interactions including ARVs, antidepressants, antibiotics, statins (for cholesterol management) and recreational/illicit drugs.

Only 31 (36 percent) of the 86 CSDIs were correctly identified by physicians. There was a broad range of CSDIs observed, including interactions between antiretrovirals and with other classes of drugs, notably antidepressants, antibiotics, cholesterol lowering statins, and recreational/illicit drugs.

“Poor physician recognition of CSDIs is not confined to HIV treatment and is also seen with other commonly prescribed medications,” Evans-Jones and his fellow authors write. “Nevertheless, the consequences of failure to recognize or to manage HIV CSDIs may be considerable, because over one quarter of CSDIs in our study had the potential to lower antiretroviral concentrations. Moreover, patients with CSDIs may present with ill‐defined symptoms or unexplained laboratory abnormalities.”

To better manage CSDIs considered by the researchers to be “to a large extent unavoidable” Evans-Jones and his colleagues argue that better medication recording is essential. “Computerized systems can support electronic prescribing; however, a systematic review of such systems showed that 55 to 91.2 percent of drug interaction alerts are ignored by physicians, probably because of ‘alert fatigue.’ Until such systems can be made more usable, we recommend that physicians are vigilant to the risks of CSDIs, use available drug information resources, and that the pharmacy department aid in identification of CSDIs and regularly audit prescribing practice.”

So just remember whenever you are given a new medication (and even over the counter medications) to always check with your doctor and a pharmacist about the possible problems.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab