Explanation of severity levels and documentation levels

Explanation of severity levels

Severe - The interaction between these medications may be life-threatening or may cause permanent damage. These medications are not usually used concurrently; medical intervention may be required.

Moderate - These medications may interact resulting in the potential deterioration of the patient's condition. The patient should be monitored for the possible manifestations of the interaction. Medical intervention or a change in therapy may be required.

Minor - Clinical effects of the interaction are limited and may be bothersome but would not usually require a major change to therapy. The patient should be monitored for the possible manifestations of the interaction.

Caution - The interaction may occur based on the mechanism of action of the co-administered medicines. Be alert for increased or decreased effect, depending on the combination of medicines.

Not clinically significant - The interaction may occur, but the outcome is not clinically significant.

Not established - The interaction may theoretically occur due to its pharmacokinetics and pharmacodynamics. There have not been any established reports of the interaction.

Explanation of documentation levels

Well established - There have been several reports of this interaction. The pharmacological explanation of why the interaction occurs is well documented and understood. There are usually controlled studies that have established that the interaction exists.

Good - Although controlled studies may not have been performed, several case reports have been documented and other data strongly suggests this interaction exists.

Limited - Few reports of this interaction exist. These few reports usually consist of limited case reports where clinically sound justification of the interaction is found.

Not established - The interaction may have occurred with other medicines within the same class, or there is a theoretical possibility that the interaction exists.

More about MIMS DrugAlert

Who we are
Classification of drugs
MIMS DrugAlert Content
How MIMS DrugAlert works
MIMS DrugAlert limitations

Who we are

MIMS DrugAlert is a Decision Support module and has been developed by the MIMS editorial team.

MIMS Integrated is a division of MIMS focusing on providing accurate and reliable medicines information and decision support for use in medicines prescribing, dispensing or administering software.

MIMS DrugAlert draws on an international knowledge base of interactions information and is configured by our editorial team for New Zealand conditions and terminology. .

Classification of drugs

Within MIMS DrugAlert medicines are grouped into Drug Interaction Classes:

It is important to note that not all medicines have been classified into specific classes. Such generics fall into two groups: those that do not have significant adverse interactions and those that have not yet been evaluated for their potential interactions, e.g. newer chemical entities. Thus if no interaction message appears it does not necessarily mean that none applies for the medicine selected. It is the responsibility of the end user to evaluate all information in the clinical setting before making any final prescribing decision.

The information provided by this package should not be substituted for good clinical knowledge and practice.

Although every effort has been made in compiling and checking the information in this database to ensure that it is accurate and up-to-date, the authors, editors, publishers and their servants or agents shall not be responsible for any errors, omissions or inaccuracies in this database, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

MIMS DrugAlert content

Once editors have created the interaction classes and allocated medicines to the classes, interactions are assigned between classes. For example, an interaction could be defined between the Salicylates class and the Heparin and related compounds class.

As part of this interaction, the severity, likelihood, precautions, observations and description are also defined.

References to primary and secondary sources are also included for the benefit of the user.

How MIMS DrugAlert works

The MIMS DrugAlert interactions database can be used to check the documented or theoretical interactions between two or more nominated (selected) medicines. When a brand of medicine containing more than one generic component is selected, each generic component (or its allocated class) is compared against each other generic on an individual (paired) basis.

When more than two medicines are chosen, the database checks the interactions between all possible paired combinations of generics, but it cannot provide information about the overall combination.

MIMS DrugAlert limitations

The following is provided to demonstrate the limitations of computer technology and database applications. Users should be aware of the following limitations, and it should be reinforced that there is no substitute for good clinical knowledge and practice.

The information that is provided by this database can help you in your decision making, but how you apply this information in a clinical setting for an individual patient is still your responsibility.

As described in the 'Disclaimer' the database can only allow the checking of interactions between medicines on a paired basis and the cumulative effects of multiple medicines or the effect of a specific resultant interaction on all other medicines cannot possibly be provided. Therefore, the attending clinician must assess the combined consequences of all the displayed interactions in each patient.

Here are two examples where the database cannot provide all the information required for a final prescribing decision.

In summary, only drug/drug combinations can be checked and not resultant interaction/drug or resultant interaction/resultant interaction combinations.

MIMS DrugAlert and the advice contained herein is updated on a regular basis. This reflects the availability of new case reports and clinical studies published in acknowledged primary and secondary sources.