title: Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines.
abstract: OBJECTIVE
  To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines.
  
  
  METHODS
  Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions.
  
  
  METHODS
  NICE clinical guidelines for type 2 diabetes, heart failure, and depression
  
  
  METHODS
  Potentially serious drug-disease and drug-drug interactions.
  
  
  RESULTS
  Following recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84%) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions.
  
  
  CONCLUSIONS
  Drug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection.
authors.affiliation: University of Dundee, Mackenzie Building, Dundee DD2 4BF, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Dumbreck
authors.affiliation: University of Dundee, Mackenzie Building, Dundee DD2 4BF, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Flynn
authors.affiliation: Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland, Edinburgh EH12 9EB, UK.
authors.forename: Moray
authors.initials: M
authors.lastname: Nairn
authors.affiliation: Raigmore Hospital, Inverness IV2 3UJ, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Wilson
authors.affiliation: University of Aberdeen, Health Services Research Unit, Foresterhill, Aberdeen AB25 2ZD, UK.
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.affiliation: University of Glasgow, Institute of Health and Wellbeing, Glasgow G12 9LX, UK.
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
authors.affiliation: Centre for Clinical Practice, National Institute for Health and Care Excellence, Manchester M1 4BD.
authors.forename: Phil
authors.initials: P
authors.lastname: Alderson
authors.affiliation: Manchester Centre for Health Economics, Jean McFarlane Building, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Manchester Centre for Health Economics, Jean McFarlane Building, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Payne
authors.affiliation: University of Dundee, Mackenzie Building, Dundee DD2 4BF, UK B.Guthrie@dundee.ac.uk.
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
mesh_terms: D000928:Antidepressive Agents; D015897:Comorbidity; D000075202:Contraindications; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D004347:Drug Interactions; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007004:Hypoglycemic Agents; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D006113:United Kingdom
chemical_list: D000928:Antidepressive Agents; D007004:Hypoglycemic Agents