Drug interactions detected using Electronic Care Records Rafferty P, Dinsmore WW, Donnelly CM, Emerson CR, McCarty EJ, Quah SP, McMullan k, Curran S. Department of Genito-Urinary Medicine, RVH, Belfast.

 Background  Method  Results  Conclusions  Recommendations  Questions

Background HIV clinicians are very aware of drug-drug interactions (DDI’s)and how to manage. We were concerned that patients could be harmed from DDI’s. Patient confidentiality and communication with other healthcare professionals is a challenge. SSSTDI 2013 reinforced DDI issue

Background In 2013, Northern Ireland Electronic Care Record (NIECR) was launched.

 Background  Method  Results  Conclusions  Recommendations  Questions

Method All patients on a boosted anti-retroviral regimen containing ritonavir or cobicistat were identified using JAC. GP medication records were accessed via NIECR to undertake an interaction screen. Interaction checks done using Liverpool, eMC and regional Medicines information centre.

 Background  Method  Results  Conclusions  Recommendations  Questions

Results 331 patients were identified as taking a boosted antiretroviral regimen. 317 were accessed via NIECR. 144 (45%) patients were prescribed medication by their GP. 114 (80%) required a dose adjustment of GP medication, monitoring advice or ARV medication change. 56 patients (17.5%) required an immediate clinical intervention.

Results Interventions made by age group

Results 114 interventions 7 x Duplication of prescribing PDE5 inhibitors, hypnotics, tramadol 19 x Inhaled steroids– fluticasone, budesonide Seretide, Flixonase, Symbicort 88 x Dose adjustment or dose reduction

Results Priority interventions  Inhaled Steroids (19)  Quetiapine alert 2014 (4)  Domperidone alert 2014 (4)  NOAC/anti-platelets (4)  Lercanidipine (2)

Results Dose/drug adjustment (88)  Anti-depressants (25)  Statins (14)  Long term NSAID’s (6)  Chelation (4)  Lercanidipine (2)  Others include COC, anti-hypertensive, warfarin, tamoxifen

 Background  Method  Results  Conclusions  Recommendations  Questions

Conclusions DDI’s are very common (8/10) with medicines prescribed by GP’s or other hospital specialities. Medicines contra-indicated with protease inhibitors were prescribed. DDI’s have the potential to cause serious harm to patients.

 Background  Method  Results  Conclusions  Recommendations  Questions

Recommendations Education of Clinicians to check for HIV DDI’s is needed Patients should prompt other practitioners to check for DDI’s. HIV/GUM clinicians should enquire from patients at each review if they have started any new medications, inhalers or patches since their last visit. A medicines reconciliation and interaction check should be completed before commencing or switching a patient’s antiretroviral regime.

 Background  Method  Results  Conclusions  Recommendations  Questions?