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The Medical Letter Drug Interactions Program for Windows.

Documentation: Small, 20-page, black-and-white illustrated, stapled pamphlet. How Supplied: One 3.5-in. diskette. Minimum Hardware Requirements: 386-PC with Windows 3.1, 2MB free hard disk space, 4MB RAM. Mouse Support: Yes. Customer Support: None specified. Demonstration Disks: None specified. Money-Back Guarrantee: 30-day return policy. Rating: Marginally acceptable.

A physician or designated staff person can determine drug-drug interactions, particularly for multidrug regimens, more efficiently using software than paper-based methods. (The Journal of Family Practice has reviewed several such programs.) There are new versions from some old players.

The Medical Letter. Drug Interactions Program for Windows (DIP-Win), 1996, is supplied on a single 3.5-in. floppy diskette that loads using a Windows File-Run command. The plain vanilla main screen (Figure) pops up instantly when the DIP-Win icon is double-clicked; graciously, there are no screenfuls of disclaimers or promotion. As the user enters the drug name in the text box, a scrolling list box successively displays matching entries. There is no highlighted bar within the list to indicate current selection prior to the user manually highlighting it. Once the desired entry is visualized in the list, it must be highlighted using a mouse point-and-click, followed by a check on the "Add to Patient List" button. Simply double-clicking adds it to the Patient Drug last." Once the drug list is completed, the user must click on the "Interactions" menu and then on the "Current List" selection; unlike most Windows programs, there is no icon alternative. The only user preference setting is whether literature references are listed for described drug interactions. Patient profiles can be saved, each in its own named file. Interactions evaluations can be easily printed.

As expected, most major drug interactions were identified; however, checking D.H.E. (dihydroergotanline), which must be entered with the periods, and Imitrex shows no incompatibility. Interactions are listed by class, with all penicillins mapped to class, amoxicillin and Amoxil do not even make the scrouing list! For each pair of interacting drugs, the effect and the recommendation for management are listed. The timing of the interaction (eg, immediate, delayed) is not specified. In the comment section, clinical significance is often mentioned but, in my opinion, could be misleading. For "ERYTHROMYCINS, [sic] paired with either "SELDANE (ANTIHISTAMINES, H1-BLOCKERS)" or "KETOCONAZOLE (ANTIFUNGALS, IMIDAZOLES AND TRIAZOLES)," DIP-Win specified." Clinical significance not established." Recognizing the major, potentially fatal interactions among these agents, this may reflect that we have entered an era where, in some drug classes, intra-class variation warrants drug-specific data. DIP-Win warns when two drugs from the same class are entered (eg, Prozac, Zoloft). Users can select any drug from the database to view all of its listed interactions. Except for tyra-mine-containing foods, no foods, no food-drug interaction information is included.

Like its DOS counterpart, DIP-Win has minimal "presentation." There is no icon bar to speed selections, and there are extra keystrokes and switches between keyboard and mouse that could be eliminated. When resized to full screen, only DIP-Wins background increases in size. When a list of interactions is generated, they scroll quickly on the screen, as the list is built before returning the user to the top of the screen. (To avoid this photic-seizure-inducing experience, most Windows programs present the first screenful of information for user perusal while adding material "below" out of the users sight.)

DIP-Win does not have the refined, professional feel and interface of even many $15 Windows programs. DIP-Win is acceptable for personal use with one major caveat. Specifically, users could easily be led down the garden path believing, for example, that erythromycin/ketoconazole or erythromycin/Seldane is an acceptable combination and that the interactions are of "unestablished" clinical significance and could, therefore, be prescribed. NOT!
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Author:Fox, Gary N.
Publication:Journal of Family Practice
Article Type:Evaluation
Date:Oct 1, 1996
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