{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T14:50:27Z","timestamp":1778856627676,"version":"3.51.4"},"reference-count":39,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2011,3,1]],"date-time":"2011-03-01T00:00:00Z","timestamp":1298937600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Risks associated with contraindicated drug-drug interaction alerts (CDDIAs) should always outweigh benefits. Misclassified CDDIAs should be eliminated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To review CDDIAs and determine if they are contraindicated according to Food and Drug Administration-approved product labeling and if there are circumstances in which contraindicated interactions are acceptable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A cross-sectional observational and quality improvement study was conducted over two 1 -year periods. The 20 most common CDDIAs from May 2007 to May 2008 and all CDDIAs from April 2008 to April 2009 were collected at a large teaching hospital. Horizon Meds Manager used First DataBank as the knowledge base for decision support. Interactions were deemed truly contraindicated if listed in the contraindications section of the labeling of at least one of the interacting drugs. Alerts were grouped by drug and pharmacologic class to evaluate the evidence supporting the relevance of these interactions. An expert panel determined when an alert was misclassified. A medical advisory committee determined whether a contraindicated drug-drug combination was acceptable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twelve (60%) of the most common 20 contraindicated interaction pairs from 2007 to 2008 were inappropriately classified. Half of the alerts were not truly contraindicated. The 8 truly contraindicated drug-drug pairs were ketorolac and other nonsteroidal antiinflammatory drugs or oral solid potassium products and anticholinergics. Half of these interactions were subsequently deemed acceptable under specific circumstances. Similar results were found in the second year, with only 55.1% of all CDDIAs being truly contraindicated despite eliminating some of the alerts that were misclassified in the first year. Nearly three fourths of legitimate CDDIAs were deemed acceptable under specific circumstances,<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Most contraindicated drug-drug interaction alerts from a commercial knowledge base were inappropriately categorized and could be downgraded. Some contraindicated drug combinations are permissible under specific circumstances. Alerts suggesting that certain drugs should never be used together, but their use together is sometimes acceptable, contribute to alert fatigue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.1p533","type":"journal-article","created":{"date-parts":[[2011,3,8]],"date-time":"2011-03-08T23:09:07Z","timestamp":1299625747000},"page":"297-308","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Evaluation of Contraindicated Drug-Drug Interaction Alerts in a Hospital Setting"],"prefix":"10.1177","volume":"45","author":[{"given":"Randy C","family":"Hatton","sequence":"first","affiliation":[{"name":"Drug Information and Pharmacy Resource Center, Shands at the University of Florida; College of Pharmacy, University of Florida, Gainesville, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy F","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Shands at the University of Florida; College of Pharmacy, University of Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candice T","family":"Morris","sequence":"additional","affiliation":[{"name":"Drug Information, Department of Pharmacy, Florida Hospital, Orlando, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell P","family":"McKelvey","sequence":"additional","affiliation":[{"name":"Shands Jacksonville; College of Pharmacy, University of Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James R","family":"Lewis","sequence":"additional","affiliation":[{"name":"Memorial Health System, Colorado Springs, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2011,3,8]]},"reference":[{"key":"bibr1-aph.1P533","unstructured":"Specific requirements on content and format of labeling for human prescription drugs: contraindications. Title 21 Code of Federal Regulations, Part.201. Section 57, Subsection (d) April 1,2009."},{"key":"bibr2-aph.1P533","first-page":"1101","volume":"11","author":"Taylor L","year":"2004","journal-title":"Medinfo"},{"key":"bibr3-aph.1P533","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp090181"},{"key":"bibr4-aph.1P533","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M1809"},{"key":"bibr5-aph.1P533","doi-asserted-by":"publisher","DOI":"10.1177\/1460458207079836"},{"key":"bibr6-aph.1P533","volume-title":"K-Dur (potassium chloride) tablet, extended-release","author":"Product information","year":"2004"},{"key":"bibr7-aph.1P533","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2006.10.015"},{"key":"bibr8-aph.1P533","volume-title":"Ketorolac tromethamine tnjection, solution","author":"Product information"},{"key":"bibr9-aph.1P533","unstructured":"US Food and Drug Administration. 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Information for healthcare professionals: ceftriaxone (marketed as Rocephin and generics) [4\/21\/09 update]. http:\/\/www.fda.gov\/Drugs\/DrugSafety\/PostmarketDrugSafetyInformationforPatientsandProviders\/DrugSafetyInformationforHeathcareProfessionals\/ucm084263.htm (accessed 2010 Oct 1)."},{"key":"bibr11-aph.1P533","volume-title":"Zyvox (linezolid injection, tablet, and suspension)","author":"Product information"},{"key":"bibr12-aph.1P533","volume-title":"Zyvox (linezolid injection, tablet, and suspension)","author":"Product information"},{"key":"bibr13-aph.1P533","volume-title":"Vistide (cidofovir injection)","author":"Product information"},{"key":"bibr14-aph.1P533","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2008.01070.x"},{"key":"bibr15-aph.1P533","doi-asserted-by":"publisher","DOI":"10.1086\/518282"},{"key":"bibr16-aph.1P533","author":"Product information","journal-title":"Pfizer Laboratories"},{"key":"bibr17-aph.1P533","author":"Product information","journal-title":"Pfizer Laboratories"},{"key":"bibr18-aph.1P533","volume-title":"Vfend (voriconazole tablet, injection and suspension)","author":"Product information","year":"2010"},{"key":"bibr19-aph.1P533","volume-title":"Rapamune (sirolimus solution and tablet)","author":"Product information"},{"key":"bibr20-aph.1P533","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.6.719"},{"key":"bibr21-aph.1P533","volume-title":"Reyataz (atazanavir sulfate capsule)","author":"Product information"},{"key":"bibr22-aph.1P533","volume-title":"Prezista (darunavir ethanolate tablet)","author":"Product information"},{"key":"bibr23-aph.1P533","volume-title":"Lexiva (fosamprenavir calcium tablet and suspension)","author":"Product information","year":"2010"},{"key":"bibr24-aph.1P533","volume-title":"Crixivan (indinavir sulfate capsule)","author":"Product information"},{"key":"bibr25-aph.1P533","volume-title":"Kaletra (lopinavir and ritonavir capsules and solution)","author":"Product information","year":"2007"},{"key":"bibr26-aph.1P533","volume-title":"Viracept (nelfinavir mesylate tablet and powder)","author":"Product information"},{"key":"bibr27-aph.1P533","volume-title":"Norvir (ritonavir tablet and solution)","author":"Product information"},{"key":"bibr28-aph.1P533","volume-title":"Fortovase (saquinavir capsules)","author":"Product information"},{"key":"bibr29-aph.1P533","volume-title":"Invirase (saquinavir tablets and capsules)","author":"Product information"},{"key":"bibr30-aph.1P533","volume-title":"Atripla (efavirenz, emtricitabine and tenofovir diso-proxil fumarate tablets)","author":"Product information"},{"key":"bibr31-aph.1P533","volume-title":"Aptivus (tipranavir capsules and solution)","author":"Product information","year":"2010"},{"key":"bibr32-aph.1P533","volume-title":"Rescriptor (delavirdine mesylate tablets)","author":"Product information"},{"key":"bibr33-aph.1P533","volume-title":"Sustiva (efavirenz capsules and tablets)","author":"Product information"},{"key":"bibr34-aph.1P533","volume-title":"Sporanox (itraconazole capsules)","author":"Product information","year":"2009"},{"key":"bibr35-aph.1P533","unstructured":"Panel on antiretroviral guidelines for adults and adolescents. 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