Polymedicine: known and unknown drug interactions.

Abstract

Despite more than 15 years of extensive scrutiny, adverse drug interactions, especially in the elderly, remain a problem for the clinician. A two-pronged approach is suggested to contend with drug interactions: detection or avoidance of known drug interactions; and predictions and characterization of hitherto unknown interactions. The former approach is aided by critical reference sources on the subject and the use of drug interaction screening aids such as drug interactions alert lists or rotating drug discs. Computers are becoming increasingly important not only for the detection of potential drug interactions but also for the delineation of drug therapy options. Ultimately, computers can be used to predict interactions on the basis of physiochemical, pharmacokinetic, and pharmacodynamic data. For the present, extensive epidemiologic research programs can serve to ferret out interactions. Limited accessibility to such program data bases mandates a high index of suspicion in prepared and well-informed observers if the drug interaction problem is to be dealt with.