Mobile Medication Reference Apps May Not Adequately Warn of Medication Dangers

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A study published in the Journal of Medical Toxicology finds that mobile apps that help health care practitioners with prescribing the correct dose of medications may not adequately warn of the dangers of some of these drugs.

American College of Medical Toxicology

When given to the wrong patient or at an incorrect dose the outcome of incorrect prescribing may be death.

A new study published in the Journal of Medical Toxicology (JMT), the official journal of the American College of Medical Toxicology (ACMT), found that the warnings offered by electronic medication reference programs used on smartphones vary significantly and some may not adequately warn prescribers of dangers of medications. In the study, "Electronic Pharmacopeia: A Missed Opportunity for Safe Opioid Prescribing Information?", seven such programs, which are widely used by physicians when looking up the correct dose or other important information about a medication, were analyzed. The researchers found that warnings about dangerous effects of certain medications were not prominently displayed or not provided at all. The research focused on extended-release/long-acting opioids, a class of medications that ranks among the most dangerous particularly when prescribed without great caution. “When given to the wrong patient or at an incorrect dose the outcome of incorrect prescribing may be death,” says study author Jeff Lapoint, DO, suggesting that understanding the safety issues around this class of drugs is critical to prevent harm.

The seven programs were evaluated for their warnings regarding 6 medications. Only two programs contained a warning placed in line with dosing information, requiring that it be viewed. Four offered a warning but placed them in separate sections from the dosing information. One program made no mention of the boxed warning. Boxed warnings, also known as ‘black box warnings’, are alerts that the US FDA may require on package inserts for certain medications to indicate a significant risk of a serious or life-threatening adverse event.

The authors chose to study the opioid class of pain medications because it contains a boxed warning. “Given the fact that FDA thought there were enough risks for a black box warning, it seems that this information should be among the first items ones sees when looking up a drug in a reference, and certainly must be seen at some point in the process,” says Lewis Nelson, MD another study author.

“There are no standards for how to display safety information in these apps, and there are concerns about overly aggressive warnings, but it seems reasonable to expect some sort of warning,” said Dr. Lapoint. He goes on to say that “while authorities disagree about the optimal use of warnings, there are few proven solutions to preventing dangerous prescribing.”

ACMT is a professional, nonprofit association of physicians with recognized expertise in medical toxicology. The College is dedicated to advancing the science and practice of medical toxicology through a variety of activities.

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