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Editor's Correspondence
April 11, 2011

Hard-Stops for Drug Interactions—Reply

Author Affiliations

Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.110

In reply

Dr Horn is indeed correct that most of the alerts in our study were triggered by warfarin being prescribed to patients who already were receiving trimethoprim-sulfamethoxazole. Some of this was due to warfarin being prescribed 3 times more commonly than trimethoprim-sulfamethoxazole, as noted in our article.1 Dr Horn points out that dose titration of the warfarin might have allowed it to be used safely in patients already receiving trimethoprim-sulfamethoxazole. However, such patients might then be at risk of underanticoagulation when stopping therapy with trimethoprim-sulfamethoxazole, in most cases after being discharged from the hospital.

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