Drug-Drug Interaction Levels

Modified on Fri, 22 Oct 2021 at 12:21 PM

In the notifications and checks section of the settings, you can adjust the drug-drug interaction checks you want to see.

The Drug-Drug Interaction Severity Levels

The Drug-Drug Interaction Severity Levels classify drug interactions based on their degree of patient risk.

Interactions have severity levels of 1, 2, 3, and 9, where 1 represents the highest patient risk potential.

1         Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
2 Severe Interaction: Action is required to reduce risk of severe adverse interaction.
3 Moderate Interaction: Assess risk to patient and take action as needed.
 9         Undetermined Severity:Alternative Therapy Interaction          Assess risk to patient and take action as needed.

Severity Level 1, “Contraindicated Drug Combination”
Drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Severity Level 2, “Severe Interaction”
Interactions that produce serious consequences in most patients. However, monitoring and/or titrating the agent(s) involved in severe interactions can significantly minimize the risk of adverse effects. If a drug product’s label contains the phrase, “concurrent use should be avoided,” the interaction is assigned this severity level. The drug combination may be absolutely contraindicated in some but not all patients, and the corresponding Drug-Drug Interaction Monograph contains information on how to identify these patients. The Drug-Drug Interaction Monograph (DDIM) also includes drugs that patients can take on a staggered schedule, but should never take at the same time. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring.

Severity Level 3, “Moderate Interaction”
Interactions of moderate severity. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring.

Severity Level 4, “Undetermined Severity - Alternative Therapy Interaction”
Interactions that involve alternative therapy agents. These interactions may exist between drugs and alternative therapy agents, or between multiple alternative therapy agents.
Alternative drug therapy refers to therapies not subject to the documentation of safety and efficacy through the United States’ Food and Drug Administration (FDA), such as a New Drug Application (NDA), an Abbreviated New Drug Application (ANDA), and so on. Alternative therapies include, but are not limited to, phytopharmaceuticals (herbal agents), Homeopathics, Nutriceuticals, and Anthroposophics.
Undetermined Severity indicates that an interaction is possible, but its potential severity is unknown. Actions required for undetermined severity interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and additional patient monitoring.

 In the current DDIM version, Severity Levels 1 and 2 represent the most clinically significant interactions (contraindications and severe interactions).

 

 

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