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Drug-drug interactions (DDI) are a significant cause of adverse drug events (ADE) in palliative care. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions). It reviews the importance of the interprofessional team in identifying this issue. Objectives: Review the pharmacokinetics and pharmacodynamics of drugs in palliative care. Identify serotonin syndrome using the Hunter criteria. Explain the importance of monitoring for drug-drug interactions in palliative care. Summarize the importance of improving drug-drug interactions education in palliative care. Access free multiple choice questions on this topic.

Drug-drug interactions (DDI) are a frequently encountered phenomenon in palliative care (PC) settings. To optimize management, clinicians should be aware of the pharmacokinetics and pharmacodynamics of the most commonly used drugs in this patient population. Based on a patient’s inherited alleles, age, sex, physiologic status, etc., pharmacotherapy will vary significantly from one patient to the next. Also, clinicians must be familiar with potential drug interactions.[1] Several studies have elucidated the prevalence of DDI in palliative care from 31 to 75% across various health care settings.[2] It is worth mentioning that palliative care medicine involves the concerted efforts of a multidisciplinary team to reduce disease burden for patients living with serious illnesses, whether provided concurrently with curative care or alone for comfort care.

Symptoms commonly encountered in palliative care may include dyspnea, air hunger, constipation, uncontrolled bleeding, excessive respiratory tract secretions, delirium, depression, insomnia, refractory nausea, vomiting, pruritus, urinary retention, and uncontrolled pain require continuous and frequent reassessments as patients transition to comfort-focused care near the end of life. Management of these symptoms will always involve nonpharmacologic therapy in addition to pharmacotherapy, yet knowledge of significant DDI, interpatient variability and drug-nutrient interactions by interprofessional team members is critical for safe and effective care. Existing literature encourages the utilization of mobile and online equianalgesic tables, opioid rotation guidelines, drug interaction checker apps, and clinical decision support (CDS) alerts in electronic medical record systems as they have all been critical in decreasing DDIs and potential adverse drug reactions.[14] Furthermore, increasing drug-drug interaction awareness in prescribers improves deprescribing skills, thus decreasing the frequency of adverse drug events.[15][16][17][18][19] This is where a pharmacist consult is necessary, so a thorough medication reconciliation can take place, looking for interactions, verifying dosing, and communicating with the prescriber as well as the palliative care nursing staff, so that all members of the interprofessional team are on the same page. Advance care planning should be discussed early in the disease process to understand individual patient preferences, needs, and values and to ensure the designation of a surrogate decision-maker. Only through an interprofessional team model involving clinicians, nursing, pharmacy, nursing assistants, other palliative care providers, as well as the patient and their family caregivers, can DDI in palliative cases be avoided. [Level 5] Patients facing serious illness with complex symptom management value medication-specific optimization conversations and medication reviews by members of the interprofessional palliative team. Comprehensive palliative care assessment and goal setting through shared decision-making must align treatment plans with patients’ known goals and values and ensure transparency due to the delicate nature of this particular healthcare setting.[17]