Improving drug-drug interactions management with digital prescribing tools
Addressing the complex landscape of drug-drug interactions (DDIs) is crucial for ensuring the effectiveness of treatments and the safety of patients. To tackle this challenge, the Liverpool Drug Interactions Group, led by Professor Saye Khoo, has developed specialised online prescribing tools for identifying and managing DDIs in patients with HIV, hepatitis and COVID-19.
Their work began in the 1990s with extensive research, highlighting the prevalence of DDIs affecting a quarter of individuals undergoing HIV treatment. They were pioneers in identifying harmful DDIs in HIV-TB coinfection cases and pinpointing the beneficial interactions of HIV protease inhibitors.
Online prescribing tools
The team first developed an electronic point-of-care HIV drug interaction tool in 2000, providing prescribing support in the form of interaction recommendations on the likelihood of DDIs between HIV drugs and commonly prescribed co-medications.
This involved the collation of all available drug information including University of Liverpool and external DDI studies, published drug labels, and expert predictive pharmacokinetics. With the introduction of direct-acting antivirals for hepatitis C in 2011, they expanded their focus to include hepatitis-specific resources, adapting their tools to address emerging challenges.
Drug interactions research
Engaging in large-scale studies from 2012 to 2018 to characterise the frequency and severity of DDIs worldwide, they uncovered significant DDIs in 18-35% of patients on antiretroviral therapy.
They identified particular risks associated with antibiotics, antifungals, central nervous system drugs, cardiovascular drugs, and corticosteroids.
Amidst the global upheaval caused by the COVID-19 pandemic, the team recognised the urgent need to address potential DDIs arising from the treatment of COVID-19 patients.
Understanding that those most vulnerable to severe outcomes of COVID-19 often have underlying comorbidities requiring additional medication, they swiftly developed a freely available drug interactions online resource tailored to this unprecedented healthcare challenge.
Impact and global reach
Today, their prescribing tools are widely adopted in over 30 countries and translated into multiple languages. They have proven effective, identifying missed DDIs in up to 95% of prescriptions and influencing clinical management in over half of cases.
Together, these tools have garnered significant usage, with an average of 190,000 unique monthly users and more than 12 million checks made in 2023. This global reach underscores the impact and importance of their work in optimising patient care and reducing the risks associated with complex medication interactions in HIV, hepatitis, and COVID-19.
