PMID- 21999763
OWN - NLM
STAT- MEDLINE
DCOM- 20120208
LR  - 20111017
IS  - 1936-2692 (Electronic)
IS  - 1088-0224 (Linking)
VI  - 17 Suppl 11
DP  - 2011 Sep
TI  - Best practices to reduce the risk of drug-drug interactions: opportunities for 
      managed care.
PG  - S299-304
AB  - Patients with moderate to severe pain often require opioid therapy, and many of 
      these patients have multiple comorbid conditions requiring several medications. 
      Guidelines for opioid use do not properly address their use in patients taking 
      multiple medications, as they focus primarily on patient selection, monitoring 
      the patient for drug abuse, and treatment adherence. Moreover, guidelines discuss 
      very little regarding potential drug-drug interactions (DDIs) with opioids. The 
      problem of polypharmacy is exacerbated by the fact that multiple conditions are 
      often treated by different specialists, many of whom are not in communication 
      with one another. Because opioids have significant central nervous system and 
      gastrointestinal side effects, and may interact with other medications, it is 
      essential that efforts be made to treat the patient's pain while limiting the 
      risk of side effects and DDIs. In many cases, this involves a thorough assessment 
      of the medications the patient is taking and an attempt to reduce the number of 
      medications. In managed care settings, a medication therapy management program is 
      an excellent way to reduce inappropriate polypharmacy, and should result in cost 
      savings. Clinicians should also consider drug-disease interactions and drug-food 
      interactions that may be unique to individual patients. A proper assessment of 
      these interactions may also provide insight into medications that are 
      inappropriate, ineffective, and/or unnecessary in a particular patient.
FAU - Fanciullo, Gilbert J
AU  - Fanciullo GJ
AD  - Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, 
      USA. Tabitha.A.Washington@hitchcock.org
FAU - Washington, Tabitha
AU  - Washington T
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
RN  - 0 (Analgesics, Opioid)
RN  - 9035-51-2 (Cytochrome P-450 Enzyme System)
MH  - Age Factors
MH  - Aged
MH  - Analgesics, Opioid/adverse effects/pharmacokinetics/*therapeutic use
MH  - Chronic Pain/*drug therapy
MH  - Comorbidity
MH  - Confusion
MH  - Cytochrome P-450 Enzyme System/metabolism
MH  - *Drug Interactions
MH  - Drug Monitoring/methods/*standards
MH  - Humans
MH  - Managed Care Programs/*standards
MH  - Patient Care Team
MH  - Polypharmacy
MH  - Practice Guidelines as Topic
EDAT- 2011/10/26 06:00
MHDA- 2012/02/09 06:00
CRDT- 2011/10/18 06:00
PHST- 2011/10/18 06:00 [entrez]
PHST- 2011/10/26 06:00 [pubmed]
PHST- 2012/02/09 06:00 [medline]
AID - 51906 [pii]
PST - ppublish
SO  - Am J Manag Care. 2011 Sep;17 Suppl 11:S299-304.