Drug Interactions Parameters & Terminologies

Structured Severity Levels

DrugBank classifies interactions using different severities to identify how dangerous a drug interaction could be. The three levels we use are minor, moderate, and major.

• minor: observe and adjust
  These medications may interact in a clinically significant manner, however, the benefit of using these medications usually outweighs any risks. The medications may or may not require dose adjustment and monitoring.
• moderate: adjustment should be considered
  The benefits of continuing the medication should be evaluated on an individual basis. Actions such as observing, changing the dose, or changing the medications may be considered.
• major: combination should be avoided
  This combination may cause more harm than benefit and alternative medications should be considered.

Action

The action is the resulting effect of the drug interaction. For example, clarithromycin increases the risk of specific adverse effects when taken with atorvastatin. This is represented in the action key as increase_specific_adverse_effects.

Evidence Levels

At DrugBank we use 2 evidence levels to indicate evidence types for a given interaction.

• level_1 means that the interaction is mentioned in a drug label (FDA, Health Canada, EMA, etc) and may have been confirmed by clinical studies (cohort, case-control, case study, etc) or post-marketing reports.
• level_2 means that the interaction has been confirmed in at least 1 cohort, case-control, or case study, or by established pharmacokinetic and pharmacodynamic properties. Additionally, it may be mentioned in the drug label as an interaction only occurring in the laboratory setting (known as in vitro studies). Drug labels generally mention that the significance of these laboratory interactions in humans is not clear.

Additional Terminology

Subject Drug

The drug which creates the interaction. The addition of this drug while a patient is taking another drug leads to a drug interaction. Some resources refer to this as the “perpetrator” drug.

Affected Drug

The drug which is affected by the interaction. This drug is referred to as the “victim” drug by some sources.

Subject Category

For interactions based on a drug-category or category-category interaction, the category that the subject drug belongs to is the basis for this interaction. This parameter is only shown when the interaction is created on the basis of a category-category or drug-category interaction. It is the category of drugs that exerts effects on another drug or category of drugs.

Affected Category

For interactions based on a drug-category or category-category interaction, the category that the affected drug belongs to is the basis for this interaction. This parameter is only shown when the interaction is created on the basis of a category-category or drug-category interaction. It is the category of drugs affected by another drug or category of drugs.

Description

This is a simple summary of the drug interaction. The information here is very concise and the target audience is the general public.

Extended Description

This is an in depth summary of the interaction that occurs, describing the effect the subject drug/category has on the affected drug/category. It also describes the scientific reason for the interaction, explaining how and why it occurs. In some cases, the scientific reason for the interaction is unclear, and this is explained.

Management

Depending on the severity of the interaction, the management parameter will help explain how to avoid and/or mitigate the interaction.

References

When turned on, the reference parameter will show sources that were used to add this drug interaction.