CDS Alerts
Clinical decision support alerts requiring your attention
Active Alerts
4
Resolved Today
4
Drug Interactions
1
Dosing Alerts
2
Active Alerts4
Warfarin + Azithromycin: Significant INR elevation risk
Azithromycin inhibits CYP3A4 and may increase warfarin exposure by up to 2-fold. Patient currently on warfarin 5mg/day with INR 2.4.
Recommended Action
Monitor INR closely. Consider reducing warfarin dose by 25–30%. Check INR within 3 days.
Prescribed Penicillin — documented penicillin allergy
Patient has documented anaphylaxis to Penicillin G (2019). Prescription for Amoxicillin-Clavulanate 625mg was placed at 07:45.
Recommended Action
Do not administer. Prescribe alternative such as Azithromycin or Levofloxacin based on indication. Verify allergy documentation.
Tramadol dose exceeds recommended limit for eGFR < 30
Patient eGFR is 28 mL/min (CKD Stage 4). Tramadol 100mg q6h ordered. Maximum recommended dose is 50mg q12h in severe renal impairment.
Recommended Action
Reduce tramadol to 50mg q12h or consider switching to opioid alternative with renal dose adjustment.
Metformin ordered — patient undergoing contrast procedure
Patient is scheduled for contrast-enhanced CT at 14:00 today. Metformin 500mg BD was ordered. Risk of metformin-associated lactic acidosis.
Recommended Action
Hold metformin 48h before and after contrast administration. Restart only after confirming stable renal function.
Resolved4
HbA1c overdue — last measured 6 months ago
Per ADA guidelines, HbA1c should be measured every 3 months for patients on insulin, every 6 months if well-controlled. Last HbA1c: 7.8% (Dec 2025).
Recommended Action
Order HbA1c. Consider ordering lipid panel and urine albumin-creatinine ratio (annual screening).
Critical potassium result: K+ 2.9 mEq/L
Serum potassium reported at 2.9 mEq/L (critical low). Patient is on furosemide 80mg BD. Risk of cardiac arrhythmia.
Recommended Action
Potassium replacement therapy: IV KCl or oral supplement. Monitor ECG. Reassess furosemide dose.
Clopidogrel + Pantoprazole: Reduced antiplatelet efficacy
Omeprazole/pantoprazole inhibits CYP2C19 reducing clopidogrel activation by ~50%. Patient is 2 months post-PCI on DAPT.
Recommended Action
Switch to rabeprazole or famotidine which have less CYP2C19 interaction. Document clinical rationale if PPIs are essential.
Statin therapy not prescribed for high CVD risk patient
Patient has 10-year ASCVD risk of 18% (high risk). No statin prescribed. ACC/AHA guidelines recommend high-intensity statin for 10-year risk ≥10%.
Recommended Action
Initiate high-intensity statin therapy (atorvastatin 40–80 mg). Discuss CVD risk with patient.