Identification of Potential Drug-Drug Interactions in the Pediatric Intensive Care Unit of a Tertiary Care Teaching Hospital of Odisha, India
DOI:
https://doi.org/10.54133/ajms.v10i2.2797Keywords:
Concurrent drugs, Drug interactions , Pediatric intensive care unitsAbstract
Background: To accomplish a specific therapeutic purpose, drugs are frequently used in combination. Concurrent drug use can result in drug-drug interactions (DDIs), which can have negative effects on patients. Information about potential drug-drug interactions (PDDIs) should be made available to healthcare providers. The article reviews our hospital's drug interaction (DI) trend and examines whether it is related to polypharmacy. It also assess the degree of seriousness of potential drug-drug interactions (PDDI). Objective: To evaluate our hospital's drug-drug interaction trend. Methods: In this cross-sectional observational study, we examined the prescriptions of children between the ages of one month and fifteen years who were admitted to the PICU. Using drug interaction checking software, we classified the prescriptions according to the severity (Unknown, minor, moderate, and major), the number of concurrent medications used, and the possible consequences of these PDDIs. Results: We discovered 482 PDDIs out of 101 prescriptions, of which 64.9% were moderate, 19.29% were minor, 12.4% were unknown, and 7.67% were major. The average number of PDDIs per prescription was highest for prescriptions including more than 10 drugs (7.8). Third-generation cephalosporins, ureidopenicillin, carbapenem, and aminoglycosides accounted for 39% of PDDIs, followed by salbutamol (20.12%) and antiepileptic medications (18.67%). Low potassium (11.2%) was the most common possible consequence. Conclusions: The findings of this study may help with the planning and execution of future research as well as the monitoring and prevention of PDDIs associated with adverse events in children in critical care.
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McQuade BM, Campbell A. Drug prescribing: drug-drug interactions. FP Essent. 2021 Sep;508:25–32. PMID: 34491709. DOI: 10.1001/fp.2021.508.25.
Reis AM, Cassiani SH. Adverse drug events in an intensive care unit of a university hospital. Eur J Clin Pharmacol. 2011;67(6):625-632. doi: 10.1007/s00228-010-0987-y. DOI: https://doi.org/10.1007/s00228-010-0987-y
Dai D, Feinstein JA, Morrison W, Zuppa AF, Feudtner C. Epidemiology of polypharmacy and potential drug–drug interactions among pediatric patients in ICUs of US children’s hospitals. Pediatr Critical Care Med. 2016;17(5):e218-228. doi: 10.1097/pcc.0000000000000684. DOI: https://doi.org/10.1097/PCC.0000000000000684
Morales-Ríos O, Jasso-Gutierrez L, Reyes-Lopez A, Garduno-Espinosa J, Muñoz-Hernández O. Potential drug-drug interactions and their risk factors in pediatric patients admitted to the emergency department of a tertiary care hospital in Mexico. PloS One. 2018;13(1):e0190882. doi: 10.1371/journal.pone.0190882. DOI: https://doi.org/10.1371/journal.pone.0190882
Mouly S, Meune C, Bergmann JF. Mini-series: I. Basic science. Uncertainty and inaccuracy of predicting CYP-mediated in vivo drug interactions in the ICU from in vitro models: focus on CYP3A4. Intensive Care Med. 2009;35(3):417-429. doi: 10.1007/s00134-008-1384-1. DOI: https://doi.org/10.1007/s00134-008-1384-1
Askari M, Eslami S, Louws M, Wierenga PC, Dongelmans DA, Kuiper RA, et al. Frequency and nature of drug‐drug interactions in the intensive care unit. Pharmacoepidemiol Drug Saf. 2013;22(4):430-437. doi: 10.1002/pds.3415. DOI: https://doi.org/10.1002/pds.3415
Shabani D, Tahiri Z, Bara P, Hudhra K, Malaj L, Jucja B, et al. Prevalence and correlates of drug-drug interactions in the regional hospital of Gjilan, Kosovo. Materia Socio-Medica. 2014;26(4):268. doi: 10.5455/msm.2014.26.268-271. DOI: https://doi.org/10.5455/msm.2014.26.268-271
Barrett JS, Patel D, Dombrowsky E, Bajaj G, Skolnik JM. Risk assessment of drug interaction potential and concomitant dosing pattern on targeted toxicities in pediatric cancer patients. AAPS J. 2013;15(3):775-786. doi: 10.1208/s12248-013-9489-z. DOI: https://doi.org/10.1208/s12248-013-9489-z
Goodman LS, Gilman AG, Rall TW, Murad F, (Eds.), Goodman and Gilman's the pharmacological basis of therapeutics, (7th ed.), New York: McGraw-Hill; 1996.
Silva DC. Eventos adversos medicamentosos em unidade de terapia intensiva pediátrica (Doctoral dissertation, Universidade de São Paulo). doi: 10.11606/t.5.2012.tde-01032013-141918. DOI: https://doi.org/10.11606/T.5.2012.tde-01032013-141918
Queiroz KCB, Nascimento MFS, Fernandes V, Miotto FA. Drug interactions on the neonatal prescription at ICU-HGU. UNOPAR Cient Ciˆenc Biol Saúde. 2014;16(3):203–207. doi: 10.17921/2447-8938. 2014v16n3p%25p. DOI: https://doi.org/10.17921/2447-8938
Khan LM. Comparative epidemiology of hospital-acquired adverse drug reactions in adults and children and their impact on cost and hospital stay–a systematic review. Eur J Clin Pharmacol. 2013;69(12):1985-1996. doi: 10.1007/s00228-013-1563-z. DOI: https://doi.org/10.1007/s00228-013-1563-z
Fitzmaurice MG, Wong A, Akerberg H, Avramovska S, Smithburger PL, Buckley MS, et al. Evaluation of potential drug–drug interactions in adults in the intensive care unit: a systematic review and meta-analysis. Drug Saf. 2019;42(9):1035-1044. doi: 10.1007/s40264-019-00829-y. DOI: https://doi.org/10.1007/s40264-019-00829-y
Moura C, Prado N, Acurcio F. Potential drug-drug interactions associated with prolonged stays in the intensive care unit: a retrospective cohort study. Clin Drug Investig. 2011;31(5):309-316. doi: 10.2165/11586200-000000000-00000. DOI: https://doi.org/10.1007/BF03256929
Moura CS, Acurcio FA, Belo NO. Drug-drug interactions associated with length of stay and cost of hospitalization. J Pharmacy Pharm Sci. 2009;12(3):266-272. doi: 10.18433/j35c7z. DOI: https://doi.org/10.18433/J35C7Z
Xiong G, Yang Z, Yi J, Wang N, Wang L, Zhu H, et al. DDInter: an online drug–drug interaction database towards improving clinical decision-making and patient safety. Nucleic Acids Res. 2022;50(D1):D1200-1207. doi: 10.1093/nar/gkab880. DOI: https://doi.org/10.1093/nar/gkab880
Hassanzad M, Arenas-Lopez S, Baniasadi S. Potential drug-drug interactions among critically ill pediatric patients in a tertiary pulmonary center. J Clin Pharmacol. 2018;58(2):221-227. doi: 10.1002/jcph.996. DOI: https://doi.org/10.1002/jcph.996
Siddarama R, Bharath Naidu J, Joshisree KP, Sahithi Lakshmi V. Polypharmacy induced drug interactions, adverse drug reactions (ADR) and medication errors in tertiary care South Indian Hospital. Int J Pharmacy Pharm Sci. 2019;11:88-93. doi: 10.22159/ijpps.2019v11i2.29508. DOI: https://doi.org/10.22159/ijpps.2019v11i2.29508
Rao C, Shenoy V, Udaykumar P. Potential drug–drug interactions in the pediatric intensive care unit of a tertiary care hospital. J Pharmacol Pharmacother. 2019;10(2):63-68. doi: 10.4103/jpp.jpp_27_19. DOI: https://doi.org/10.4103/jpp.JPP_27_19
Ismail M, Aziz S, Noor S, Haider I, Shams F, Haq I, et al. Potential drug-drug interactions in pediatric patients admitted to intensive care unit of Khyber Teaching Hospital, Peshawar, Pakistan: A cross-sectional study. J Critic Care. 2017;40:243-250. doi: 10.1016/j.jcrc.2017.04.028. DOI: https://doi.org/10.1016/j.jcrc.2017.04.028
Sherin R, Udaykumar P. Assessment of possible drug interactions in patients with psoriasis and associated comorbid medical conditions: an observational study. Reviews on Recent Clinical Trials. 2016 Jun 1;11(2):128-34. doi.org/10.2174/1574887111666160201122532 DOI: https://doi.org/10.2174/1574887111666160201122532
Dc C. Adverse drug events in hospitalized patients-excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277:301-306. doi: 10.1001/jama.1997.03540280039031. DOI: https://doi.org/10.1001/jama.1997.03540280039031
Lima RE, Cassiani SH. Potential drug interactions in intensive care patients at a teaching hospital. Revista latino-americana de enfermagem. 2009;17:222-227. doi: 10.1590/s0104-11692009000200013. DOI: https://doi.org/10.1590/S0104-11692009000200013
Spriet I, Meersseman W, De Hoon J, Von Winckelmann S, Wilmer A, Willems L. Mini-series: II. Clinical aspects. Clinically relevant CYP450-mediated drug interactions in the ICU. Intens Care Med. 2009;35(4):603-612. doi: 10.1007/s00134-008-1383-2. DOI: https://doi.org/10.1007/s00134-008-1383-2
Nasrollahi S, Meera NK. Prevalence of potential drug-drug interactions in neonatal intensive care unit of a tertiary care hospital: a prospective observational study. Int J Life Sci Pharm Res. 2020;10:P40-45. doi: 10.22376/ijpbs/lpr.2020.10.1.p40-45. DOI: https://doi.org/10.22376/ijpbs/lpr.2020.10.1.P40-45
Langerová P, Prokeš M, Konvalinka M, Fürstová J, Urbánek K. Incidence of potential drug interactions in medication prescriptions for children and adolescents in the University Hospital Olomouc, Czech Republic. Eur J Pediatr. 2013;172(5):631-638. doi: 10.1007/s00431-013-1933-7. DOI: https://doi.org/10.1007/s00431-013-1933-7
da Costa Lima E, Camarinha BD, Bezerra NC, Panisset AG, de Souza RB, Silva MT, et al. Severe potential drug-drug interactions and the increased length of stay of children in intensive care unit. Front Pharmacol. 2020;11:555407. doi: 10.3389/fphar.2020.555407. DOI: https://doi.org/10.3389/fphar.2020.555407
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