Optimizing Oncology Drug Interaction Alerts to Improve Patient Safety

Using a targeted approach to alert clinicians about potential oncology drug interactions could be beneficial in some scenarios, according to research presented at the 2023 American Society of Health-System Pharmacists (ASHP) Summer Meetings and Exhibition, held June 10 to 14 in Baltimore, Maryland.¹

Although alerts in electronic health records can help providers proactively identify and prevent drug interactions, excessive use can lead to alert fatigue. In an effort to avoid alert fatigue, only alerts for drug interactions classified as “major—contraindicated” are active at Intermountain Health, an integrated health system in Salt Lake City, Utah.

Investigators conducted a systematic review of oncology drug interactions in order to optimize alerts and improve patient safety. Oncology drugs included in the review were arsenictrioxide, asparaginase, calaspargase pegol, etoposide, methotrexate, pegaspargase, platinumagents, taxanes, and vinca alkaloids.

An Excel spreadsheet was created of drug interactions from the Cerner Multum drug database and the list was narrowed down to include only high-priority medications. The list was reduced further to include 2 classifications: “major—generally avoid” and “major—monitor closely.” A group of oncology physicians, pharmacists, and a medication safety officer then reviewed the findings and made recommendations to a subcommittee for review and approval.

A total of 3 main drug interaction groups were identified after the review. In the first group, 134 interactions between arsenic trioxide and other medications were found. The second group included 122 interactions between the oncology agents and Cytochrome P-450 enzyme inhibitors or P-glycoprotein transporter inhibitors. Lastly, the third group included 30 interactions between methotrexate and nonsteroidal anti-inflammatory drugs, salicylates, and proton-pump inhibitors.

It was recommended to update the database with the interactions in the first and second group of drugs to alert practitioners. In the third group, it was recommended to restrict the drug interaction alerts to intravenous methotrexate orders only to minimize inappropriate alerts for methotrexate used in non-oncology cases.

The group of oncology physicians and pharmacists all agreed with the recommendations, which were then approved by the subcommittee at the health system.

“Based on this review, a targeted approach may be beneficial in some scenarios to ensure that practitioners are alerted to clinically relevant drug-drug interactions, specifically in circumstances of narrow-therapeutic index medications,” the authors concluded.

Reference

1. Vance, B. Optimization of Oncology Drug Interaction Alerts in a Large, Integrated Health System. Presented at: American Society of Health-System Pharmacists Summer Meetings and Exhibition; June 10-14, 2023; Baltimore, MD. Poster 44-M.