Common Mistakes When Testing Drug Interactions

Medication errors are the most common cause of preventable patient harm in hospitals (1) . According to the European Medicines Agency (EMA), medication errors occurring in hospitals account for 50% of all preventable harm in healthcare worldwide  (2) . In addition, medication errors are responsible for 5% to 41.3% of all hospital admissions and 22% of readmissions after discharge (3) . 

The likelihood of medication errors is 30% higher in patients taking five or more medications and 38% higher in patients aged 75 or older.

The World Health Organization (WHO) estimates that medication errors cost around 42 billion US dollars annually worldwide. In Europe, the WHO estimates that one death per million inhabitants is due to medication errors. For a population of 447 million people in the EU, this would mean around 163,000 deaths per year (4) .

Medication errors typically occur when an incorrect medication or dose is administered, an incorrect route of administration, or a medication is given to the wrong patient. 

Anticoagulants, antimicrobials, anticonvulsants and opioids are frequently associated with medication errors. (5)

The Role of Drug Interactions in Medication Errors

Failure to recognize drug interactions plays a significant role in medication errors.

A study by the Drug Commission of the German Medical Association found that failure to consider drug interactions is responsible for 17% of medication errors reported in the spontaneous reporting system (6) . 

Medication errors often have multiple causes—and drug interactions are often classified into other categories. For example, some prescribing or monitoring errors may be due to overlooking potential drug interactions.

How can we prevent drug interactions? The most common mistakes in prescribing medications 

Prescribing medication is a delicate process that requires precision, knowledge, and thorough communication. But in a world where tens of thousands of prescription drugs, over-the-counter medications, and dietary supplements flood the market, avoiding drug interactions is a complex challenge. Failure to effectively address this challenge can result in significant risks to patients, including serious side effects or even drug poisoning. So why do these errors happen, and how can we mitigate them?

Why do errors occur that lead to drug interactions?

The causes of medication prescription errors often lie in a mix of systemic, human and informational gaps. Here are some of the main causes of these errors:

1. The overwhelming variety of medications available
   With an enormous number of prescription drugs and supplements available, it is nearly impossible to keep track of all potential interactions. This complexity increases the likelihood of unintentional errors in prescribing.
   
   
2. Errors in prescribing practice
   Errors can occur due to negligence or unintentional oversights during the prescription phase. Common problems are:  
   
   1. Errors in dose selection: Prescribing an incorrect dose – whether too high or too low – increases the risk of side effects or inadequate effect.  
   2. Transcription errors : Omission of a necessary medication or misinterpretation of a prescription due to illegible handwriting or misunderstanding.  
   3. Oversight : Unintentional omissions or confusions during documentation.
      
      
3. Incomplete patient information
   When prescribers do not have comprehensive knowledge of a patient's medical history, ongoing treatments, or current medications, the risk of harmful interactions increases. 
   
   
4. Inadequate patient education
   Patients play a crucial role in preventing interactions, but many are not sufficiently informed about the potential interactions of their medications with other drugs, over-the-counter preparations, or even foods. This lack of awareness can lead to serious health risks.
   
   
5. Neglecting over-the-counter medications
   The potential interaction of over-the-counter medicines and dietary supplements with prescription drugs is often underestimated. If doctors do not specifically ask about such products, significant risks may go undetected.

med-drugs! helps doctors and pharmacists to quickly and accurately identify potential drug interactions, thus ensuring safer prescribing and dispensing.

How can drug interactions be prevented?

Preventing medication errors requires proactive measures by both prescribers and patients. Here are some practical strategies to minimize the risk of harmful interactions:

1. Using reliable tools to check interactions 
   

   Tools like med-drugs’ Interaction Checker can help healthcare professionals identify potential drug conflicts quickly and effectively.

2. Special caution with drugs with a narrow therapeutic range
   Drugs such as anticoagulants or anticonvulsants, where the range between therapeutic and toxic dose is small, require special attention. These drugs are particularly susceptible to serious interactions.
   
   

3. Consideration of disease-specific interaction risks 

   Patients with conditions such as epilepsy, depression or diabetes are often treated with medications that are particularly susceptible to interactions. Careful selection and monitoring of medications is crucial here.

   
   
4. Ensure comprehensive patient information
   Patient information is a key step in preventing interactions. Patients should be informed...  
   
   1. that it is important to provide a complete list of all medications – including over-the-counter medications and dietary supplements;  
   2. about possible interactions with food, alcohol or other lifestyle habits;
   3. About warning signs of an interaction and when to seek medical help.
5. Stay up to date on recalls and drug information 
   Healthcare providers need to stay informed of the latest pharmaceutical news, including recalls, new drug approvals, and safety alerts. This information can be critical to identifying risks associated with specific medications.
   
   
6.  Obtain Complete Patient Information
   A thorough understanding of the patient's medical history, current medications, and potential risk factors is essential. Taking the time to gather this information can greatly reduce the likelihood of errors.
   
   Prescribing medication is a process that can be affected by many different factors. To avoid unwanted interactions, especially when prescribing multiple medications, use reliable drug interaction checkers - like the one from med-drugs.

The Role of Patient Education in Preventing Drug-Drug Interactions

Patient education plays a critical role in reducing the risk of harmful drug interactions. Many adverse drug interactions occur not because of a prescriber's lack of medical knowledge, but because patients make inadvertent decisions or overlook critical details of their medication regimen. Equipping patients with the knowledge they need to avoid common pitfalls can make a critical difference in keeping them safe.

Key areas of patient education

To effectively educate patients, healthcare providers should address the following common mistakes and how to avoid them:

1. Mixing drugs with harmful interactions
   Patients often underestimate the risk of combining drugs that can have harmful interactions. An example:
   1. Combining antidepressants with methadone or painkillers with certain dietary supplements can lead to serious health consequences.
   2. Even over-the-counter medications such as aspirin can pose significant risks when taken with blood thinners such as Coumadin (warfarin), increasing the likelihood of excessive bleeding. (7)
      
      Healthcare providers should stress the importance of always consulting a doctor before mixing medications, even if they are considered "safe" or "routine."
      
      
2. Combining medications with alcohol
   Alcohol can significantly alter the way the body processes certain medications, which may result in increased side effects or decreased effectiveness. Specific drug categories that pose an increased risk include:
   1. Pain medications (e.g. opioids or paracetamol), which when combined with alcohol can cause liver damage or increased sedation.
   2. Anti-anxiety medications (e.g. benzodiazepines) which, when combined with alcohol, may suppress the central nervous system and increase the risk of respiratory arrest.
      Patients should be specifically informed of the risks associated with alcohol consumption during treatment.
      
      
3. Leaving the doctor's office without sufficient information
   A common problem is a lack of understanding of new prescriptions. Patients should be encouraged to ask their healthcare providers the following questions before leaving the office:
   1. What is this medicine for and how does it work?
   2. Are there any possible interactions with my current medications or supplements
   3. What side effects should I look out for and what should I do if they occur?
   4. Can I take the medication with alcohol or certain foods?
      Health care providers should also give patients written instructions or direct them to reliable sources for more information.
      
      
4. Failure to report all medications and dietary supplements
   Many patients are unaware that healthcare providers need to know about all the medications and dietary supplements they take:
   1. Over-the-counter medications such as painkillers, antacids or allergy medications.
   2. Herbal preparations such as St. John's wort, ginseng or garlic, which can interact with prescription medications.
      
      
5. Ignoring Interactions with Over-the-Counter Drugs and Herbal Supplements
   Many patients believe that over-the-counter drugs and herbal supplements are “safe” and do not need to be considered. However, these products can cause significant interactions:
   1. Antacids can interfere with the absorption of certain antibiotics.
   2. Herbal preparations such as St. John's wort may reduce the effectiveness of antidepressants or birth control pills.
      Patients should be counseled about the importance of discussing any substances they are taking, including those purchased without a prescription.
      
      
6. Failure to comply with dosage and timing guidelines
   Many adverse drug interactions occur simply because patients do not adhere to the prescribed dosage or intake instructions. Examples include:
   1. Taking a double dose to make up for a missed dose, which may result in toxicity.
   2. Skipping doses, which may decrease the effectiveness of treatment and complicate the body's response to other medications.
   3. Taking medication at the wrong time (e.g. with food rather than on an empty stomach), which may affect absorption.

Physicians should emphasize the importance of following instructions carefully and provide tools such as pill planners or apps to help patients keep track.

Sources:

_{https://pubmed.ncbi.nlm.nih.gov/23343656/} 

_{https://ecamet.eu/wp-content/uploads/2022/09/ECAMET-PR-on-medication-errors-and-tracebility-to-coincide-with-WHO-World-patient-safety-day_Final.pdf}

_{https://www.ncbi.nlm.nih.gov/books/NBK519065/}

_{https://eaasm.eu/en-gb/2022/09/13/press-release-medication-errors-the-most-common-adverse-event-in-hospitals-threatens-patient-safety-and-causes-160000-deaths-per-year/}

_{https://resolution.nhs.uk/wp-content/uploads/2022/04/Did-You-Know-General-Practice-Medication-Errors.pdf}

_{https://www.akdae.de/fileadmin/user_upload/akdae/Kommission/Organisation/Aufgaben/Publikationen/PDF/Koeberle2017.pdf}

_{https://www.webmd.com/a-to-z-guides/features/7-dangerous-drug-mistakes}