Coprescription of terfenadine and erythromycin or ketaconazole: an assessment of potential harm.
OBJECTIVE
In a retrospective study, the authors used a pharmacy claims database to analyze the rate of coprescription of terfenadine and erythromycin or ketaconazole.


METHODS
The investigators reviewed claims filed for these drugs between January 1, 1990, and June 30, 1993. The time period allowed for comparison of coprescription rates before and after the Food and Drug Administration (FDA) required the manufacturer of terfenadine to inform the medical community of potentially serious adverse interactions.


RESULTS
There were 5,802 coprescription events for terfenadine and erythromycin and 150 coprescription events for terfenadine and ketaconazole. Rates per 100,000 terfenadine users demonstrated large declines about 18 months after initial regulatory action. Coprescription events of terfenadine with either erythromycin or ketaconazole continued to occur despite regulatory action.


CONCLUSIONS
Results of this study suggest important roles for the pharmacist as a risk manager, disseminating information about newly published drug interactions. Both health providers and patients are audiences for the pharmacist's drug expertise. The delay in physician reaction to new information from pharmaceutical companies and the federal government suggests an early, strong role for the pharmacist in changing prescribing behavior.
Carlson
A M
AM
Diversified Pharmaceutical Services, Bloomington, Minn., USA.
Morris
L S
LS
D018926:Anti-Allergic Agents / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000935:Antifungal Agents / Q000009:adverse effects*; D016303:Clinical Pharmacy Information Systems; D004347:Drug Interactions; D004917:Erythromycin / Q000009:adverse effects*; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence; D007345:Insurance Claim Review; D007654:Ketoconazole / Q000009:adverse effects*; D012189:Retrospective Studies; D016593:Terfenadine / Q000009:adverse effects*
D018926:Anti-Allergic Agents; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D004917:Erythromycin; D016593:Terfenadine; D007654:Ketoconazole