A study of potential drug-drug interactions among critically ill patients at a tertiary care hospital
Keywords:Potential drug interaction, Intensive care, Drug interaction software, Patient safety
Background: Drug interaction is said to occur when presence of one drug affects the activity of another drug when both are administered together. This action can be synergistic or antagonistic. The objective was to study the prevalence of potential drug-drug interactions (pDDI), their severity, clinical significance, and their association with patient characteristics in intensive care unit (ICU) at a tertiary care hospital.
Methods: A prospective, observational study was conducted in ICU patients for a period of 3 months to assess the pDDI using Medscape drug checker software and Lexi-Comp, inc. version: 2.7.5. drug interact android mobile application.
Results: A total of 183 subjects were included in the study with a prevalence of 76.50% pDDI occurring in patients, majority of which were suffering from cardiovascular conditions (26.23%). In those with hospital stay more than five days, 92% had pDDI. There were 229 potentially interacting drug pairs with corticosteroids, aspirin, beta blockers, and diuretics being commonly involved in pDDI. A total of 2336 interactions were observed with an occurrence rate of 12.76 DDI per patient. Severity was moderate in 64%, interaction mechanism was pharmacodynamic in 72.49% and risk rating category was C in 77.1% of the study population.
Conclusions: The present study showed high concomitant administration of potentially interacting drugs. The prevalence confirmed the association of age and polypharmacy. Vigilant prescribing approach is needed to prevent hazardous outcomes of pDDI.
Hasan SS, Lim KN, Anwar M, Sathvik BS, Ahmadi K, Yuan AW, et al. Impact of pharmacists’ intervention on identification and management of drug-drug interactions in an intensive care setting. Singapore Med J. 2012;53(8):526-31.
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):125-30.
Doubova SV, Morales HR, Arreola LT, Ortega MS. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico city. BMC Health Serv Res. 2007;7:147.
Moyen E, Camire E, Stelfox HT. Clinical review: medication errors in critical care. Crit Care. 2008;12(2):208.
Kumar MA, Nizar A, Shailaja K, Jayasutha J, Ramasamy C. A study on prescribing pattern and potential drug-drug interactions in type 2 diabetes mellitus (inpatients) in a tertiary care teaching hospital. Der Pharmacia Lettre. 2011;3(4):13-9.
Ahmadizar F, Soleymani F, Abdollahi M. Study of drug interactions in prescriptions of general practitioners and specialists in Iran 2007-2009. Iran J Pharm Res. 2011;10(4):921-31.
Nabovati E, Arki HV, Taherzadeh Z, Hasibian MR, Hanna AA, Eslami S, et al. Drug-drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. Daru. 2014;22(1):52.
Bleich GW, Bleich A, Chiamulera P, Sanches AC, Schneider DS, Teixeira JV, et al. Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil. Sao Paulo Med J. 2009;127(4):206-10.
Kothari N, Ganguly B. Potential drug-drug interactions among medications prescribed to hypertensive patients. J Clin Diagn Res. 2014;8(11):1-4.
International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-2015-WHO Version for 2015. Available from: http:// apps.who.int/classifications/icd10/browse/2015/en. Accessed in 20 August 2015.
World Health Organization. The anatomical therapeutic chemical classification system with defined daily doses (ATC/DDD). Available at: http://www.who.int/classifications/atcddd/en/. Accessed on 28 August 2015.
Secoli SR, Figueras A, Lebrao ML, Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly: a population based, cross sectional study. Drugs and Aging. 2010;27(9):759-70.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. British Med J. 2004;329(7456):15-9.
Rafi MS, Naqvi SB, Khan MU, Fayyaz M, Ashraf N, Khan MA, et al. Evaluation of potential drug-drug interactions with antidepressants in two tertiary care hospitals. J Clinic Diagn Res. 2015;9(7):5-8.
Teixeira JV, Crozatti MT, Santos CA, Lieber NS. Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, southern Brazil. Public Lib Sci One. 2012;7(10):1-6.
Bista D, Saha A, Mishra P, Palaian S, Shankar PR. Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal. Pharm Pract (Granada). 2009;7(4):242-7.
Nobili A, Pasina L, Tettamanti M, Lucca U, Riva E, Marzona I. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clinic Pharm Therap. 2009;34(4):377-86.
Ray S, Pramanik J, Bhattacharyya M, Todi S. Prospective observational evaluation of incidences and implications of drug-drug interactions induced adverse drug reactions in critically ill patients. Indian J Pharm Sci. 2010;72(6):787-92.