Evaluation of drug information resources for drug-ethanol and drug-tobacco interactions

Robert D. Beckett, Curtis D. Stump, Megan A. Dyer


Objective: The research evaluated point-of-care drug interaction resources for scope, completeness, and consistency in drug-ethanol and drug-tobacco content.

Methods: In a cross-sectional analysis, 2 independent reviewers extracted data for 108 clinically relevant interactions using 7 drug information resources (Clinical Pharmacology Drug Interaction Report, Facts & Comparisons eAnswers, Lexicomp Interactions, Micromedex Drug Interactions, Drug Interactions Analysis and Management, Drug Interaction Facts, and Stockley’s Drug Interactions). Scope (presence of an entry), completeness (content describing mechanism, clinical effects, severity, level of certainty, and course of action for each present interaction; up to 1 point per assessed item for a total possible score of 5 points), and consistency (similarity among resources) were evaluated.

Results: Fifty-three drug-ethanol and 55 drug-tobacco interactions were analyzed. Drug-ethanol interaction entries were most commonly present in Lexicomp (84.9%), Clinical Pharmacology (83.0%), and Stockley’s Drug Interactions (73.6%), compared to other resources (p<0.05). Drug-tobacco interactions were more often covered in Micromedex (56.4%), Stockley’s Drug Interactions (56.4%), Drug Interaction Facts (43.6%), and Clinical Pharmacology (41.8%) (p<0.001). Overall completeness scores were higher for Lexicomp, Micromedex, Drug Interaction Facts, and Facts & Comparisons (median 5/5 points, interquartile range [IQR] 5 to 5, p<0.001) for drug-ethanol and for Micromedex (median 5/5 points, IQR 5 to 5, p<0.05) for drug-tobacco, compared to other resources. Drug Interaction Facts and Micromedex were among the highest scoring resources for both drug-ethanol (73.7%, 68.6%) and drug-tobacco (75.0%, 32.3%) consistency.

Conclusions: Scope and completeness were high for drug-ethanol interactions, but low for drug-tobacco interactions. Consistency was highly variable across both interaction types.


Drug Interactions; Ethanol; Tobacco; Factual Databases; Evaluation Studies

Full Text:



World Health Organization. Global status report on alcohol and health: country profiles [Internet]. Geneva, Switzerland: The Organization [2014; cited Aug 21 2018]. .

Substance Abuse and Mental Health Services Administration. 2015–2016 national surveys on drug use and health: model-based estimated totals (in thousands) (50 states and the District of Columbia) [Internet]. Rockville, MD: The Administration [Feb 2018; cited Aug 21 2018] .

Chan LN, Anderson GD. Pharmacokinetic and pharmacodynamic drug interactions with ethanol (alcohol). Clin Pharmacokinet. 2014 Dec;53(12):1115–36. DOI: http://dx.doi.org/10.1007/s40262-014-0190-x.

Anderson GD, Chan LN. Pharmacokinetic drug interactions with tobacco, cannabinoids and smoking cessation products. Clin Pharmacoknet. 2016 Nov;55(11):1353–68. DOI: http://dx.doi.org/10.1007/s40262-016-0400-9.

Furukawa MF, Spector WD, Rhona Limcangco M, Encinosa WE. Meaningful use of health information technology and declines in in-hospital adverse drug events. J Am Med Inform Assoc. 2017 Jul;24(4):729–36. DOI: http://dx.doi.org/10.1093/jamia/ocw183.

Sarkar U, Lopez A, Maselli JH, Gonzales R. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res. 2011 Oct;46(5):1517–33. DOI: http://dx.doi.org/10.1111/j.1475-6773.2011.01269.x.

Hakkarainen KM, Hedna K, Petzold M, Hagg S. Percentage of patients with preventable adverse drug reactions and preventability of adverse drug reactions – a meta-analysis. PLoS One. 2012 Mar;7(3):e33236. DOI: http://dx.doi.org/10.1371/journal.pone.0033236.

Hersh EV, Pinto A, Moore PA. Adverse drug interactions involving common prescription and over-the-counter analgesic agents. Clin Ther. 2007 Dec;29(11 supp 1):2477–97. DOI: http://dx.doi.org/10.1016/j.clinthera.2007.12.003.

Zevin S, Benowitz NL. Drug interactions with tobacco smoking: an update. Clin Pharmacokinet. 1999 Jun;36(6):425–38. DOI: http://dx.doi.org/10.2165/00003088-199936060-00004.

Patel RI, Beckett RD. Evaluation of resources for analyzing drug interactions. J Med Libr Assoc. 2016 Oct;104(4):290–5. DOI: http://dx.doi.org/10.3163/1536-5050.104.4.007.

Clauson KA, Marsh WA, Polen HH, Seamon MJ, Ortiz BI. Clinical decision support tools: analysis of online drug information databases. BMC Med Inform Decis Mak. 2007 Mar;7:7. DOI: http://dx.doi.org/10.1186/1472-6947-7-7.

Somogyi-Vegh A, Nyaka B, Vida RG, Lovasz A, Botz L. Comprehensive evaluation of drug interaction screening programs: discrepancies and concordances. Orvosi Hetilap. 2015 Mar;156(18):720–30. DOI: http://dx.doi.org/10.1556/OH.2015.30134.

Abarca J, Malone DC, Armstrong EP, Grizzle AJ, Hansten PD, Van Bergen RC, Lipton RB. Concordance of severity ratings provided in four drug interaction compendia. J Am Pharm Assoc. 2004 Mar–Apr;44(2):136–41. DOI: http://dx.doi.org/10.1331/154434504773062582.

Elsevier/Gold Standard. Clinical pharmacology drug interaction report [Internet]. Tampa, FL: Elsevier/Gold Standard [2018; cited 5 Jul 2018]. .

Wolters Kluwer Health. Facts & Comparisons® eAnswers [Internet]. St. Louis, MO: Wolters Kluwer Health [2018; cited 5 Jul 2018]. .

Wolters Kluwer. Lexicomp® interactions [Internet]. Hudson, OH: Wolters Kluwer [2018; cited 5 Jul 2018]. .

Truven Health Analytics. Micromedex® solutions drug interactions [Internet]. Greenwood Village, CO: Truven Health Analytics [2018; cited 27 Sep 2018]. .

Hansten PD, Horn JR. Drug interactions analysis and management. St. Louis, MO: Wolters Kluwer Health; 2014.

Tatro DS, ed. Drug interaction facts 2015. St. Louis, MO: Wolters Kluwer Health; 2014.

Baxter K, Preston CL, eds. Stockley’s drug interactions. 10th ed. London, UK: Pharmaceutical Press; 2013.

Giovenale S, ed. Basic resources for pharmacy education [Internet]. Arlington, VA: American Association of Colleges of Pharmacy [2018; cited 5 Jul 2018]. .

Shields KM, Park SK. Drug information resources. In: Drug information: a guide for pharmacists. New York, NY: McGraw Hill Education; 2018.

Indiana University School of Medicine. Drug interactions: Flockhart table: P450 drug interaction table [Internet]. Indianapolis, IN: The University [2016; cited 5 Jul 2018]. .

Montgomery AE, Beckett RD, Montagano KJ, Kutom S. Evaluation of point-of-care resources for dietary supplement information. J Evid-Based Integ Med. 2018 Jan–Dec;23:251569DX18764844.

Polen HH, Zapantis A, Clauson KA, Jebrock J, Paris M. Ability of online drug databases to assist in clinical decision-making with infectious disease therapies. BMC Infect Dis. 2008 Nov;8:153. DOI: http://dx.doi.org/10.1186/1471-2334-8-153.

Floor-Schreudering A, Geerts AFJ, Aronson JK, Bouvy ML, Ferner RE, De Smet PAGM. Checklist for standardized reporting of drug-drug interaction management guidelines. Eur J Clin Pharmacol. 2014 Mar;70(3):313–8. DOI: http://dx.doi.org/10.1007/s00228-013-1612-7.

Indermitte J, Erba L, Beutler M, Bruppacher R, Haefeli WE, Hersberger KE. Management of potential drug interactions in community pharmacies: a questionnaire-based survey in Switzerland. Eur J Clin Pharmacol. 2007 Mar;63(3):297–305. DOI: http://dx.doi.org/10.1007/s00228-006-0237-5.

IBM Analytics. IBM SPSS statistics. Version 24. Armonk, NY: IBM; 2016.

DOI: https://doi.org/10.5195/jmla.2019.549


  • There are currently no refbacks.

Copyright (c) 2019 Robert D Beckett, Curtis D Stump, Megan A Dyer

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.