The assessment of causation for a potential drug interaction requires thoughtful consideration of the properties of both the object and precipitant drugs, patient-specific factors, and the possible contribution of other drugs that the patient may be taking. The Naranjo nomogram was designed to evaluate single-drug adverse events, not drug-drug interactions. Several of the questions on the Naranjo nomogram do not apply to potential drug-drug interactions, while others do not specify object or precipitant drug. Nevertheless, it has been inappropriately used to evaluate drug-drug interactions. The Drug Interaction Probability Scale (DIPS) was developed to provide a guide to evaluating drug interaction causation in a specific patient. It is intended to be used to assist practitioners in the assessment of drug interaction-induced adverse outcomes. The DIPS uses a series of questions relating to the potential drug interaction to estimate a probability score. An accurate assessment using the DIPS requires knowledge of the pharmacologic properties of both the object and precipitant drugs. Inadequate knowledge of either the drugs involved or the basic mechanisms of interaction will be a limitation for some users. The DIPS can also serve as a guide in the preparation of articles describing case reports of drug interactions, as well as in the evaluation of published case reports.

Epidemiologic studies of statin use in relation to prostate cancer risk have been inconclusive. Recent evidence, however, suggests that longer-term use may reduce risk of more advanced disease. The authors conducted a population-based study of 1,001 incident prostate cancer cases diagnosed in 2002-2005 and 942 age-matched controls from King County, Washington, to evaluate risk associated with statin use. Logistic regression was used to generate odds ratios for ever use, current use, and duration of use. No overall association was found between statin use and prostate cancer risk (odds ratio (OR) ¼ 1.0, 95% confidence interval (CI): 0.8, 1.2 for current use; OR ¼ 1.1, 95% CI: 0.7, 1.8 for >10 years' use), even for cases with more advanced disease. Risk related to statin use, however, was modified by body mass index (interaction p ¼ 0.04). Obese men (BMI !30 kg/m 2 ) who used statins had an increased risk (OR ¼ 1.5, 95% CI: 1.0, 2.2) relative to obese nonusers, with a stronger association for longer-term use (OR ¼ 1.8, 95% CI: 1.1, 3.0 for !5 years' use). Although statin use was not associated with overall prostate cancer risk, the finding of an increased risk associated with statin use among obese men, particularly use for extended durations, warrants further investigation. case-control studies; hydroxymethylglutaryl-CoA reductase inhibitors; obesity; odds ratio; prostatic neoplasms Abbreviations: BMI, body mass index; CI, confidence interval; OR, odds ratio; PSA, prostate-specific antigen.Statin drugs are competitive inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, the enzyme that controls conversion of 3-hydroxy-3-methylglutaryl-coenzyme A to mevalonate, an essential precursor of cholesterol (1-3). Statins are used to treat hypercholesterolemia and have been shown to reduce cardiovascular disease incidence and mortality (4-7). Thus, use of statins has increased exponentially in the United States over the last decade (8).Statin use in relation to prostate cancer etiology is of interest because 1) these drugs inhibit the synthesis of cholesterol, a precursor of androgens that also plays a role in cell signaling pathways (9); 2) mevalonate is necessary for the prenylation of proteins involved in signal transduction cascades downstream of membrane receptors that are crucial in cell growth and apoptosis (10, 11); and 3) in experimental models, statins inhibit cell proliferation, inflammation, oxidative stress, angiogenesis, and metastasis (2,3,11,12).Some studies suggest that statins may alter prostate cancer risk. Randomized clinical trials of statin use to prevent cardiovascular disease reported no associations with prostate cancer incidence (13-15), but such trials were limited by the short durations of use and brief follow-up periods (16,17).

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Analysis of prescription claims data from a major PBM found that 374,000 of 46 million plan participants had been exposed to a potential DDI of clinical importance.

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