How Up-to-Date is Your Drug-Drug Interaction Database?

TO THE EDITOR: Followingthe recent researchreportby Hattonet al.' andcommentary by Shahet aI.2 in TheAnnals,we decided to conducta smallobservational studyto address theconcernpresented by Shahet aI. thatrecommended minimizing the time lag between FoodandDrugAdministration (FDA)-approvedlabeling changes and updates to online knowledge databases," In thepast,updates wereincorporated slowlyinto printeditionsor perhapsmorequicklythroughinterimupdatesby subscription, which had to be integrated into binders by the subscriber. Whereas the aforementioned articles focused on the severity andapplicabilityof drug-druginteractions and the alert fatigue associated withupdating them in a computerized physicianorder entry environment,our studyfocused on the timerequired to update commercially available onlinedatabases accessible to the general healthcareprofessional. On June 8,2011, we weregivenan opportunity to follow the incorporation of.an update to the simvastatin prescribing information into 5 drug-druginteraction databases. The updateincluded new contraindications (eg, concurrent use with gemfibrozil, danazol, cyclosporine, posaconazole) anddoserestrictions withmedications suchas arnlodipine andranolazine (simvastatin not to exceed20 mg daily)and amiodarone, verapamil, and diltiazem (simvastatin not to exceed10mg daily).3 Simvastatinappearedto be an idealmedication for the study,as it is extensively used in the US.4 Databases wereselected basedon onlineaccessibility, perceived popularity, and theirgeneraldrug information use.The databases included in the studywereeithersubscription-based (Thomson Healthcare Series [MM1, Lexi-Complete [LCl, Facts and Comparisons Jeffrey R Strawn MD Assistant Professor ofPsychiatry andPediatrics Department of Psychiatry College of Medicine University ofCincinnati Cincinnati, OH strawnjr@uc.edu