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Evaluation of drug-drug interactions in critically ill pediatric patients

Year 2023, Volume: 48 Issue: 3, 987 - 992, 30.09.2023
https://doi.org/10.17826/cumj.1341543

Abstract

Purpose: The aim of this study was to determine the drug-drug interactions that are frequently encountered in critically ill patients and the factors that predict these interactions.
Materials and Methods: All patients who were admitted to the pediatric intensive care unit (13 bed) of a university hospital and used more than one drug in their treatment were included in this prospective and cross-sectional study. Patients' demographics, laboratory findings, and medications included in their treatment were evaluated daily by a clinical pharmacist. The UpToDate® database was used to detect potential drug interactions.
Results: During the study, 797 potential drug-drug interactions were detected in 55 (83.33%) of 66 patients followed. All these interactions were evaluated by the clinical pharmacist and 114 recommendations were made to the physicians following the treatment regarding these potential interactions. Eighty-five (74.56%) of these recommendations were accepted by physicians. Within the scope of the study, each patient was followed up for a median of 9 (2-63) days, and the median value of potential drug interactions detected during this period was calculated as 7 (1-89).
Conclusion: The existence of pDDIs was significantly associated with the number of prescribed medications. Exposure to pDDIs is frequent in critically ill pediatric patients and related to the number of medications. Daily and close cooperation between clinicians and clinical pharmacists is recommended to prevent harmful outcomes of DDIs. In order to minimize this risk, it is recommended to avoid polypharmacy as much as possible and to offer alternatives to inducer and inhibitor drugs in treatment.

References

  • Costa Lima E, Camarinha BD, Bezerra NCF, Panisset AG, Souza, RB etal. Severe potential drug-drug interactions and the increased length of stay of children in intensive care unit. Front Pharmacol. 2020;11:555407.
  • Nguyen JK, Fouts MM, Kotabe SE, Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Psychiatry. 2006;4:36-41.
  • Bhatt-Mehta V. "Potential" drug-drug interactions and the PICU: Should we worry about ICU polypharmacy? Pediatr Crit Care Med. 2016;17:470-2.
  • Sharifi H, Hasanloei MAV, Mahmoudi J. Polypharmacy-induced drug-drug interactions; threats to patient safety. Drug Res. 2014;64:633-7.
  • Ismail M, Aziz S, Noor S, Haider I, Shams F 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 Crit Care. 2017;40:243-50.
  • Kunac DL, Kennedy J, Austin NC, Reith D. incidence, preventability, and impact of adverse drug events (ADEs) and potential ADEs in hospitalized children in New Zealand. Paediatr Drugs. 2009;11:153-60.
  • Silva DCB, Araujo OR, Arduini RG, Alonso CFR, Shibata AO et al. Adverse drug events in a paediatric intensive care unit: a prospective cohort. BMJ Open. 2013;3:e001868.
  • Salem F, Rostami-Hodjegan A, Johnson T. Do children have the same vulnerability to metabolic drug-drug interactions as adults? A critical analysis of the literature. J Clin Pharmacol. 2013;53:559-66.
  • Hassanzad M, Nejad ST, Mahboobipour A, Salem F, Baniasadi S. Potential drug-drug interactions in hospitalized pediatric patients with respiratory disorders: a retrospective review of clinically important interactions. Drug Metab Pers Ther. 2020;35:20190012.
  • Baniasadi S, Hassanzad M, Alehashem M. Potential drug-drug interactions in the pediatric intensive care unit of a pulmonary teaching hospital. Eur Respir J. 2016;48:1301.
  • Choi YH, Lee IH, Yang M, Cho YS, Jo YH etal. Clinical significance of potential drug–drug interactions in a pediatric intensive care unit: A single-center retrospective study. Plos One. 2021;16:e0246754.
  • Malfara M, Pernassi M, Aragon D, Carlotti A. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm. 2018;40:513-9.
  • Krupicka M, Bratton SL, Sonnenthal K, Goldstein B. Impact of a pediatric clinical pharmacist in the pediatric intensive care unit. Crit Care Med. 2002;30:919-21.
  • Lexicomp® Drug Interactions. https://www.uptodate.com/drug-interactions/?source=responsive_home#di-druglist. (accessed Dec 2021).

Durumu kritik olan pediatrik hastalarda ilaç-ilaç etkileşimlerinin değerlendirilmesi

Year 2023, Volume: 48 Issue: 3, 987 - 992, 30.09.2023
https://doi.org/10.17826/cumj.1341543

Abstract

Amaç: Bu çalışmada, kritik çocuk hastalarda sıklıkla karşılaşılan ilaç-ilaç etkileşimlerinin ve bu etkileşimleri tahmin eden faktörlerin tespit edilmesi amaçlanmaktadır.
Gereç ve Yöntem: Prospektif ve kesitsel olan bu çalışmaya bir üniversite hastanesinin çocuk yoğun bakım ünitesine yatışı yapılan ve tedavilerinde birden fazla ilaç kullanılan tüm hastalar dahil edilmiştir. Hastaların demografik özellikleri, laboratuvar bulguları ve tedavilerinde yer alan ilaçlar günlük olarak bir klinik eczacı tarafından değerlendirilmiştir. Potansiyel ilaç etkileşimlerinin tespit edilmesi için UpToDate® veri tabanından yararlanılmıştır.
Bulgular: Çalışma boyunca takip edilen 66 hastanın 55’inde (%83.33) toplam 797 adet potansiyel ilaç-ilaç etkileşimi tespit edilmiştir. Tüm bu etkileşimler klinik eczacı tarafından değerlendirilmiş ve bu potansiyel etkileşimlere yönelik, tedaviyi takip eden hekimlere 114 öneride bulunulmuştur. Bu önerilerin 85’i (%74.56) hekimler tarafından kabul edilmiştir. Çalışma kapsamında her hasta ortanca 9 (2-63) gün takip edilmiş, bu sürede tespit edilen potansiyel ilaç etkileşimlerinin ortanca değeri 7 (1-89) olarak hesaplanmıştır.
Sonuç: Kritik çocuk hastaların tedavilerinde potansiyel ilaç etkileşimi riski yüksektir. Bu riskin azaltılması adına, mümkün olduğu kadar polifarmasiden kaçınılması, tedavide bulunan indüktör ve inhibitör ilaçlara alternatifler sunulması önerilmektedir. Yoğun bakım ünitelerinde uzmanlaşmış eczacıların, multidisipliner ekibe dahil olmasının, potansiyel ilaç etkileşimlerinin yönetimini sağlayarak tedavinin optimizasyonuna katkı sağlayacağı düşünülmektedir.

References

  • Costa Lima E, Camarinha BD, Bezerra NCF, Panisset AG, Souza, RB etal. Severe potential drug-drug interactions and the increased length of stay of children in intensive care unit. Front Pharmacol. 2020;11:555407.
  • Nguyen JK, Fouts MM, Kotabe SE, Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Psychiatry. 2006;4:36-41.
  • Bhatt-Mehta V. "Potential" drug-drug interactions and the PICU: Should we worry about ICU polypharmacy? Pediatr Crit Care Med. 2016;17:470-2.
  • Sharifi H, Hasanloei MAV, Mahmoudi J. Polypharmacy-induced drug-drug interactions; threats to patient safety. Drug Res. 2014;64:633-7.
  • Ismail M, Aziz S, Noor S, Haider I, Shams F 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 Crit Care. 2017;40:243-50.
  • Kunac DL, Kennedy J, Austin NC, Reith D. incidence, preventability, and impact of adverse drug events (ADEs) and potential ADEs in hospitalized children in New Zealand. Paediatr Drugs. 2009;11:153-60.
  • Silva DCB, Araujo OR, Arduini RG, Alonso CFR, Shibata AO et al. Adverse drug events in a paediatric intensive care unit: a prospective cohort. BMJ Open. 2013;3:e001868.
  • Salem F, Rostami-Hodjegan A, Johnson T. Do children have the same vulnerability to metabolic drug-drug interactions as adults? A critical analysis of the literature. J Clin Pharmacol. 2013;53:559-66.
  • Hassanzad M, Nejad ST, Mahboobipour A, Salem F, Baniasadi S. Potential drug-drug interactions in hospitalized pediatric patients with respiratory disorders: a retrospective review of clinically important interactions. Drug Metab Pers Ther. 2020;35:20190012.
  • Baniasadi S, Hassanzad M, Alehashem M. Potential drug-drug interactions in the pediatric intensive care unit of a pulmonary teaching hospital. Eur Respir J. 2016;48:1301.
  • Choi YH, Lee IH, Yang M, Cho YS, Jo YH etal. Clinical significance of potential drug–drug interactions in a pediatric intensive care unit: A single-center retrospective study. Plos One. 2021;16:e0246754.
  • Malfara M, Pernassi M, Aragon D, Carlotti A. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm. 2018;40:513-9.
  • Krupicka M, Bratton SL, Sonnenthal K, Goldstein B. Impact of a pediatric clinical pharmacist in the pediatric intensive care unit. Crit Care Med. 2002;30:919-21.
  • Lexicomp® Drug Interactions. https://www.uptodate.com/drug-interactions/?source=responsive_home#di-druglist. (accessed Dec 2021).
There are 14 citations in total.

Details

Primary Language English
Subjects Pediatric Intensive Care
Journal Section Research
Authors

Nursel Surmelioglu 0000-0001-7758-7100

Hatice Yağmur Soysal 0009-0003-1307-5781

İkbal Türker 0000-0002-6370-676X

Faruk Ekinci 0000-0001-6675-3150

Ozden Ozgur Horoz 0000-0001-7590-650X

Dinçer Yıldızdaş 0000-0003-0739-5108

Early Pub Date September 25, 2023
Publication Date September 30, 2023
Acceptance Date September 11, 2023
Published in Issue Year 2023 Volume: 48 Issue: 3

Cite

MLA Surmelioglu, Nursel et al. “Evaluation of Drug-Drug Interactions in Critically Ill Pediatric Patients”. Cukurova Medical Journal, vol. 48, no. 3, 2023, pp. 987-92, doi:10.17826/cumj.1341543.