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Proposal for a New Tool to Evaluate Drug Interaction Cases

Professor of Pharmacy, Department of Pharmacy, School of Pharmacy; Associate Director, Pharmacy Services, University of Washington Medical Center, Seattle, WA

Philip D Hansten, PharmD

Professor Emeritus of Pharmacy, Department of Pharmacy, University of Washington

Lingtak-Neander Chan, PharmD

Associate Professor of Pharmacy, Department of Pharmacy, University of Washington

Reprints: Dr. Horn, Department of Pharmacy, School of Pharmacy, Box 357630, University of Washington, Seattle, WA, 98195, fax 206/543-3835, jrhorn{at}u.washington.edu

The assessment of causation for a potential drug interaction requires thoughtful consideration of the properties of both the object and precipitant drugs, patient-specific factors, and the possible contribution of other drugs that the patient may be taking. The Naranjo nomogram was designed to evaluate single-drug adverse events, not drug–drug interactions. Several of the questions on the Naranjo nomogram do not apply to potential drug–drug interactions, while others do not specify object or precipitant drug. Nevertheless, it has been inappropriately used to evaluate drug–drug interactions. The Drug Interaction Probability Scale (DIPS) was developed to provide a guide to evaluating drug interaction causation in a specific patient. It is intended to be used to assist practitioners in the assessment of drug interaction–induced adverse outcomes. The DIPS uses a series of questions relating to the potential drug interaction to estimate a probability score. An accurate assessment using the DIPS requires knowledge of the pharmacologic properties of both the object and precipitant drugs. Inadequate knowledge of either the drugs involved or the basic mechanisms of interaction will be a limitation for some users. The DIPS can also serve as a guide in the preparation of articles describing case reports of drug interactions, as well as in the evaluation of published case reports.

Key Words: causation, drug interactions, probability

Published Online, March 27, 2007. www.theannals.com, DOI 10.1345/aph.1H423

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