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. 2015 Mar 11:350:h949.
doi: 10.1136/bmj.h949.

Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines

Siobhan Dumbreck  1 , Angela Flynn  1 , Moray Nairn  2 , Martin Wilson  3 , Shaun Treweek  4 , Stewart W Mercer  5 , Phil Alderson  6 , Alex Thompson  7 , Katherine Payne  7 , Bruce Guthrie  8
Affiliations

Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines

Siobhan Dumbreck et al. BMJ. .

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.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that the work reported is part of the Better Guidelines for Better Care study funded by the National Institute for Health Research Health Services and Delivery Programme (NIHR HS&DR 11/2003/27); PA is a full time employee of NICE working on the development of clinical guidelines, but the views in the paper are personal and do not represent the views of NICE; and MN is a full time employee of Scottish Intercollegiate Guideline Network (SIGN) working on the development of clinical guidelines, but the views in the paper are personal and do not represent the views of SIGN.

Figures

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Fig 1 Proportion of people with three index conditions who have each of other conditions. Morbidity data were not available for osteoarthritis or neuropathic pain; “painful condition” data shown are defined by receipt of four or more prescriptions for non-over the counter analgesics in previous 12 months
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Fig 2 Potentially serious drug-drug interactions between drugs recommended by clinical guidelines for three index conditions and drugs recommended by each of other 11 other guidelines
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Fig 3 Types of potentially serious harm from drug-drug interactions between drugs recommended by clinical guidelines for three index conditions and drugs recommended by each of other 11 other guidelines
See this image and copyright information in PMC

Comment in

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