Original Article

Potential Drug-Drug Interactions in Critically Ill Medical Patients: A Cross-Sectional Study

Abstract

Background:  Drug interaction commonly occurred in critically ill patients and may increase hospital lengths of stay and total cost. The aim of the present study is to evaluate potential drug-drug interaction in critically ill patients.
Methods: In this cross-sectional study, medical records of critically ill patients admitted to the 16-bed intensive-care units of a teaching hospital were assessed according to the Micromedex® drug interaction and drug interaction fact®. The identified drug-drug interactions were categorized by level of severity. The agreement between two resources was assessed.
Results: Our survey found 915 and 564 paired DDIs according to the Micromedex® and drug interaction fact®, respectively, amongst 120 patients.  The prevalence of potential DDIs (pDDIs) was 87.7% and 91.7% with drug interaction Fact® and Micromedex®, respectively. Approximately, 80% of recruited patients, had at least three pDDIs based on Micromedex®. A significant moderate agreement between two drug interaction compendia was reported. (kappa= 0.41, 95% CI: 0.167-0.649, p<0.001). The serotonin syndrome, increasing the risk of bleeding and hyperkalemia were the major possible consequence of potential DDIs; but none of them occurred.
Conclusions: Most of the observed interactions were mild to moderate in nature. However, major and contraindicated interactions are possible in critically ill patients. Therefore, monitoring of patients with possible major or contraindicated drug interaction is recommended.

 

1. Vonbach P, Dubied A, Krähenbühl S, Beer JH. Prevalence of drug–drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med 2008;19(6):413-20.
2. Moura C, Prado N, Acurcio F. Potential drug-drug interactions associated with prolonged stays in the intensive care unit. Clin Drug Investig 2011;31(5):309-16.
3. van den Bemt PM, Egberts TC, Brouwers JR. Drug-related problems in hospitalised patients. Drug Saf 2000;22(4):321-33.
4. Glintborg B, Andersen SE, Dalhoff K. Drug-drug interactions among recently hospitalised patients–frequent but mostly clinically insignificant. Eur J Clin Pharmacol 2005;61(9):675-81.
5. Mousavi S, Ghanbari G. Potential drug-drug interactions among hospitalized patients in a developing country. Caspian J Intern Med 2017;8(4):282-8.
6. Uijtendaal EV, Harssel LL, Hugenholtz GW, et al. Analysis of Potential Drug‐Drug Interactions in Medical Intensive Care Unit Patients. Pharmacotherapy2014;34(3):213-9.
7. Reis AM, Cassiani SH. Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. Clinics (Sao Paulo) 2011;66: 9-15.
8. Bista D, Saha A, Mishra P, Palaian S, Shankar PR. Pattern of potential drugdrug interactions in the intensive care unit of a teaching hospital in Nepal: a pilot study. JCDR 2009; 3: 1713.
9. Hammes JA, Pfuetzenreiter F, Silveira F, Koenig A, Westphal GA. Potential drug interactions prevalence in intensive care units. Rev Bras TerIntensiva 2008;20: 349-54.
10. Nazari MA, Moqhadam NK. Evaluation of pharmacokinetic drug interactions in prescriptions of intensive care unit in a teaching hospital. Iran J Pharm Res 2006; 3: 215-18.
11. Rafiei H, Arab M, Ranjbar H, et al. The prevalence of potential drug interactions in Intensive Care Units. J Crit Care 2012;4: 191- 6.
12. Lima RE, De Bortoli Cassiani SH. Potential drug interactions in intensive care patients at a teaching hospital. Rev Lat Am Enfermagem 2009;17: 222-7.
13. Kashefi P, Mousavi S, Hosseini A. The Frequency of Drug Interactions in Patients in the Intensive Care Units of Alzahra Hospital, Isfahan, Iran. J Isfahan Med Sch 2017; 35(440): 905-10.
14. Barrons R. Evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm 2004;61(4):380-5.
15. Hasanloei V, Amin M, Hamdolah S, Aysa H. Drug–drug interactions prevalence in intensive care unit patients of a university hospital in Iran. Bulletin of Environment, Pharmacology and Life Sciences 2014;3:87-91.
16. Roblek T, Vaupotic T, Mrhar A, Lainscak M. Drug-drug interaction software in clinical practice: a systematic review. Eur J Clin Pharmacol 2015;71(2):131-42.
17. Wong CM, Ko Y, Chan A. Clinically significant drug–drug interactions between oral anticancer agents and nonanticancer agents: profiling and comparison of two drug compendia. Ann Pharmacother 2008;42(12):1737-48.
18. Patel RI, Beckett RD. Evaluation of resources for analyzing drug interactions. J Med Libr Assoc 2016;104(4):290-295.
19. Janković SM, Pejčić AV, Milosavljević MN, et al. Risk factors for potential drugdrug interactions in intensive care unit patients. J Crit Care 2018;43:1-6.
20. El Samia Mohamed S, Gad Z, El-Nimr N, Abdel Razek A. Prevalence and Pattern of Potential Drug-Drug Interactions in the Critical Care Units of a Tertiary Hospital in Alexandria, Egypt. Adv Pharmacoepidemiol Drug Saf 2013;2:144.
21. Vanham D, Spinewine A, Hantson P, Wittebole X, Wouters D, Sneyers B. Drugdrug interactions in the intensive care unit: Do they really matter? J Crit Care 2017;38:97-103.
22. Ismail M, Khan F, Noor S, Haider I, Haq IU, Ali Z, Shah Z, Hassam M. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. Int J Clin Pharm 2016;38(5):1052-6.
23. Uijtendaal EV, van Harssel LL, Hugenholtz GW, et al. Analysis of potential drugdrug interactions in medical intensive care unit patients. Pharmacotherapy 2014;34(3):213-9.
24. Rodrigues AT, Stahlschmidt R, Granja S, Falcao AL, Moriel P, Mazzola PG. Clinical relevancy and risks of potential drug–drug interactions in intensive therapy. Saudi Pharm J 2015;23(4):366-70.
25. Ayvaz S, Horn J, Hassanzadeh O, et al. Toward a complete dataset of drug–drug interaction information from publicly available sources. J Biomed Inform 2015;55:206-17.
26. Rafiei H, Abdar ME, Amiri M, Ahmadinejad M. The study of harmful and beneficial drug interactions in intensive care, Kerman, Iran. 2013;14(2):155-8.
27. Abideen S, Vivekanandan K, Mishra P. Assessment of prevalence of potential drug-drug interactions in medical intensive care unit of a tertiary care hospital in India. Asian Journal of Pharmaceutical and Clinical Research
2015;8(1):125-130.
28. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American
Stroke Association. Stroke 2018;49(3):e46-e110.
29. Moura C, Prado N, Acurcio F. Potential drug-drug interactions associated with prolonged stays in the intensive care unit. Clin Drug Invest 2011;31(5):309- 16.
30. Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. JPharm Pharm Sci 2006;9(3):427-33.
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IssueVol 6, No 3-4 (Summer 2018) QRcode
SectionOriginal Article(s)
Keywords
Critically Ill Drug Interactions Frequency
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How to Cite
1.
Hosseini E, Shojaei L, Karimpour H, Shahbazi F. Potential Drug-Drug Interactions in Critically Ill Medical Patients: A Cross-Sectional Study. J Pharm Care. 2019;6(3-4):52-57.