Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 5 ( May, 2022 ) > List of Articles

Original Article

Comparing Important and Well-documented Potential Drug–Drug Interactions between Emergency, Medical, and Surgical ICUs of a Respiratory Referral Center

Zeinab Hosseinpoor, Behrooz Farzanegan, Shadi Baniasadi

Keywords : Drug–drug interactions, Intensive care unit, Potential drug–drug interaction, Prevalence

Citation Information : Hosseinpoor Z, Farzanegan B, Baniasadi S. Comparing Important and Well-documented Potential Drug–Drug Interactions between Emergency, Medical, and Surgical ICUs of a Respiratory Referral Center. Indian J Crit Care Med 2022; 26 (5):574-578.

DOI: 10.5005/jp-journals-10071-23902

License: CC BY-NC 4.0

Published Online: 20-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Drug–drug interaction (DDI) is one of the major healthcare challenges in intensive care units (ICUs). The prevalence of DDIs and interacting drug pairs may vary between different types of ICUs. This study aimed to compare the frequency and nature of important and well-documented potential DDIs (pDDIs) in three types of ICUs. Materials and methods: A prospective study was conducted in medical (M), surgical (S), and emergency (E) ICUs of a tertiary referral center for respiratory diseases. A pharmacist checked the patients’ files three days in a week for 6 months. The pDDIs were identified using the Lexi-Interact database. Interactions with a severity rating of D (modify regimen) and X (avoid combination) and with a reliability rating of good and excellent were considered important and well-documented. These pDDIs were evaluated in terms of drug combinations, mechanisms of interaction, and clinical management. Results: One hundred eighty-nine patients admitted to MICU, SICU, and EICU were included in the study. The percentage of patients who experienced at least one important and well-documented pDDI was 18.8% in MICU, 11.1% in SICU, and 11.8% in EICU. The most common drug pairs causing important and well-documented interactions were atracurium + hydrocortisone in MICU, meropenem + valproic acid in MICU and EICU, and aspirin + warfarin in SICU. Conclusion: The current study shows different frequency and nature of pDDIs between three types of ICUs. We recommend conducting similar studies in other settings to develop evidence-based guidance on clinically relevant pDDIs in different types of ICUs.


HTML PDF Share
  1. Aljadhey H, Mahmoud MA, Mayet A, Alshaikh M, Ahmed Y, Murray MD, et al. Incidence of adverse drug events in an academic hospital: a prospective cohort study. Int J Qual Health Care 2013;25(6):648–655. DOI: 10.1093/intqhc/mzt075.
  2. Alvim MM, Silva LA, Leite IC, Silvério MS. Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital. Rev Bras Ter Intensiva 2015;27(4):353–359. DOI: 10.5935%2F0103-507X.20150060.
  3. Uijtendaal EV, van Harssel LL, Hugenholtz GW, Kuck EM, Zwart-van Rijkom JE, Cremer OL, et al. Analysis of potential drug-drug interactions in medical intensive care unit patients. Pharmacotherapy 2014;34(3):213–219. DOI: 10.1002/phar.1395.
  4. Ismail M, Khan F, Noor S, Haider I, Haq IU, Ali Z, et al. Potential drug-drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. Int J Clin Pharm 2016;38(5):1052–1056. DOI: 10.1007/s11096-016-0340-3.
  5. 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.
  6. Lima RE, De Bortoli Cassiani SH. Potential drug interactions in intensive care patients at a teaching hospital. Rev Lat Am Enfermagem 2009;17(2):222–227. DOI: 10.1590/S0104-11692009000200013.
  7. Hamidy MY, Fauzia D. Significant drug interactions among intensive care unit patients. Asian J Pharm Clin Res 2017;10(14):35–38. DOI: 10.22159/ajpcr.2017.v10s2.19482.
  8. 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.
  9. Smithburger PL, Kane-Gill SL, Seybert AL. Drug-drug interactions in the medical intensive care unit: an assessment of frequency, severity and the medications involved. Int J Pharm Pract 2012;20(6):402–408. DOI: 10.1111/j.2042-7174.2012.00221.x.
  10. Ziehl EA, Morales FE, Villa LA. Drug-drug interactions in an intensive care unit of a tertiary hospital in southern Chile: evaluating databases agreement. J Pharm Pharmacogn Res 2019;7(3):184–192. https://jppres.com/jppres/drug-drug-interactions-in-an-intensive-care-unit/
  11. Oğlu MG, Küçükibrahimoğlu E, Karaalp A, Sarikaya Ö, Demirkapu M, Onat F, et al. Potential drug-drug interactions in a medical intensive care unit of a university hospital. Turk J Med Sci 2016;46(3):812–819. DOI: 10.3906/sag-1504-147.
  12. Rivkin A, Yin H. Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients. J Crit Care 2011;26(1):104-e1. DOI: 10.1016/j.jcrc.2010.04.014.
  13. International statistical classification of diseases and related health problems. 10th revision. Available from: https://icd.who.int/browse10/2019/en [Accessed January 16, 2021].
  14. Valproic acid – Atracurium. Lexicomp drug interactions. Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2020. Available from: http://online.lexi.com.
  15. Improving point of care decisions – Lexicomp. Available from: http://www.eisi.com.ph/docs/lexi/Lexicomp%20 Online%20Product%20Description.pdf [Accessed January 16, 2021].
  16. Farzanegan B, Alehashem M, Bastani M, Baniasadi S. Potential drug-drug interactions in cardiothoracic intensive care unit of a pulmonary teaching hospital. J Clin Pharmacol 2015;55(2):132–136. DOI: 10.1002/jcph.421.
  17. Smithburger PL, Kane-Gill SL, Seybert AL. Drug-drug interactions in cardiac and cardiothoracic intensive care units: an analysis of patients in an academic medical centre in the US. Drug Saf 2010;33(10):879–888. DOI: 10.2165/11532340-000000000-00000.
  18. Egger SS, Ratz AE, Bravo AE, Hess L, Schlienger RG, Krahenbuhl S. Age-related differences in the prevalence of potential drug-drug interactions in ambulatory dyslipidaemic patients treated with statins. Drugs Aging 2007;24(5):429–440. DOI: 10.2165/00002512-200724050-00006.
  19. 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.
  20. Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther 2008;33(2):141–151. DOI: 10.1111/j.1365-2710.2007.00891.x.
  21. Köhler GI, Bode-Böger SM, Busse R, Hoopmann M, Welte T, Böger RH. Drug-drug interactions in medical patients: effects on in-hospital treatment and relation to multiple drug use. Intern J Clin Pharm Ther 2000;38(11):504–513. DOI: 10.5414/cpp38504.
  22. Renew JR, Ratzlaff R, Hernandez-Torres V, Brull SJ, Prielipp RC. Neuromuscular blockade management in the critically Ill patient. J Intensive Care 2020;37(8):1–5. DOI: 10.1186/s40560-020-00455-2.
  23. Caldwell JE. Muscle relaxants in the intensive care unit. Muscle Relaxants 1995:95–104. DOI: 10.1007/978-4-431-66896-1_13.
  24. Murray MJ, Cowen J, DeBlock H, Erstad B, Gray AW, Tescher AN, et al. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 2002;30(1):142–156. DOI: 10.1097/00003246-200201000-00021.
  25. 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 J Pharm Clin Res 2015;8(1):125–130. https://innovareacademics.in/journals/index.php/ajpcr/article/view/2798
  26. Roberts JA, Kirkpatrick CM, Roberts MS, Robertson TA, Dalley AJ, Lipman J. Meropenem dosing in critically ill patients with sepsis and without renal dysfunction: intermittent bolus vs continuous administration? Monte Carlo dosing simulations and subcutaneous tissue distribution. J Antimicrob Chemother 2009;64(1):142–150. DOI: 10.1093/jac/dkp139.
  27. Park MK, Lim KS, Kim TE, Han HK, Yi SJ, Shin KH, et al. Reduced valproic acid serum concentrations due to drug interactions with carbapenem antibiotics: overview of 6 cases. Ther Drug Monit 2012;34(5):599–603. DOI: 10.1097/FTD.0b013e318260f7b3.
  28. Wu CC, Pai TY, Hsiao FY, Shen LJ, Wu FL. The effect of different carbapenem antibiotics (ertapenem, imipenem/cilastatin, and meropenem) on serum valproic acid concentrations. Ther Drug Monit 2016;38(5):587–592. DOI: 10.1097/FTD.0000000000000316.
  29. Meropenem-Valproic acid. Lexicomp drug interactions. Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2020. Available from: http://online.lexi.com.
  30. Cook D, Attia J, Weaver B, McDonald E, Meade M, Crowther M. Venous thromboembolic disease: an observational study in medical-surgical intensive care unit patients. J Crit Care 2000;15(4):127–132. DOI: 10.1053/jcrc.2000.19224.
  31. Schaefer JK, Li Y, Gu X, Souphis NM, Haymart B, Kline-Rogers E, et al. Association of adding aspirin to warfarin therapy without an apparent indication with bleeding and other adverse events. JAMA Intern Med 2019;179(4):533–541. DOI: 10.1001/jamainternmed.2018.7816.
  32. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37(38):2893–2962. DOI: 10.1093/eurheartj/ehw210.
  33. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland Jr JC, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130(23):2071–2104. DOI: 10.1161/CIR.0000000000000040.
  34. Aspirin – Warfarin. Lexicomp drug interactions. Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2020. Available from: http://online.lexi.com.
  35. Kane-Gill SL, O'Connor MF, Rothschild JM, Selby NM, McLean B, Bonafide CP, et al. Technologic distractions (part 1): summary of approaches to manage alert quantity with intent to reduce alert fatigue and suggestions for alert fatigue metrics. Crit Care Med 2017;45(9):1481–1488. DOI: 10.1097/CCM.0000000000002580.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.