Similarity and Consistency Assessment of Three Major Online Drug-Drug
Interaction Resources
Abstract
AIM: To explore the level of agreement on drug-drug interaction (DDI)
information listed in three major online drug information resources
(DIRs) in terms of: (1) interacting drug pairs; (2) severity rating; (3)
evidence rating and (4) clinical management recommendations. METHODS: We
extracted DDI information from the British National Formulary (BNF),
Thesaurus, and Micromedex. Following drug name normalisation, we
estimated the overlap of the DIRs. We annotated clinical management
recommendations either manually, where possible, or through application
of a machine learning algorithm. RESULTS: The DIRs contained 51,481
(BNF), 38,037 (Thesaurus), and 65,446 (Micromedex) drug pairs involved
in DDIs. The number of common DDIs across the three DIRs was 6,970
(13.54% of BNF, 18.32% of Thesaurus, and 10.65% of Micromedex).
Micromedex and Thesaurus overall showed higher levels of similarity in
their severity ratings, while the BNF agreed more with Micromedex on the
critical severity ratings and with Thesaurus on the least significant
ones. Evidence rating agreement between BNF and Micromedex was generally
poor. Variation in clinical management recommendations was also
identified, with some categories (i.e. Monitor and Adjust dose) showing
higher levels of agreement compared to others (i.e. Use with caution,
Wash-out, Modify administration). CONCLUSIONS: There is considerable
variation in the DDIs included in the examined DIRs, together with
variability in categorisation of severity and clinical advice given.
DDIs labelled as critical are more likely to appear in multiple DIRs.
Such variability in information could have deleterious consequences for
patient safety, and there is a need for harmonisation and
standardisation.