Características de las interacciones farmacológicas en una unidad de cuidados intensivos de pediatría

S, Claudia Santibáñez; E, Jorge Roque; V, Gonzalo Morales; W, Raúl Corrales

doi:10.4067/s0370-41062014000500004

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…The incidence observed in this study (70%) was similar to findings in PICU of United States children hospitals (75%) and another Brazilian PICU (72%) (Lima and Cassiani, 2009;Dai et al, 2016). Other studies found lower frequencies in Indian (63%), Pakistani (59.4%), Mexican (42%), Chilean (41%) PICUs (Santibáñez et al, 2014;Ismail et al, 2017;Rao et al, 2019;Medina-Barajas et al, 2020). An investigation at a Brazilian neonatal intensive care unit found a pDDI prevalence equal to 51% (Queiroz et al, 2014).…”

Section: Discussionsupporting

confidence: 84%

Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit

Lima

Camarinha²,

Bezerra

et al. 2020

Front. Pharmacol.

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Children are exposed to drug-drug interactions (DDI) risks due to their organism’s complexity and the need for several medicines prescriptions in pediatric intensive care units (PICU). This study aimed to assess the prevalence of potential DDIs in a Brazilian PICU. We carried out a cross-sectional study at a pediatric teaching hospital from Rio de Janeiro (Brazil) over one year. Potential DDIs (pDDIs) between prescribed medicines for hospitalized children in PICU (n = 143) were analyzed according to severity using Micromedex®. Sex, age group, number of drugs prescribed, vasoactive amines use (a proxy of clinical complexity), and the PICU length of stay were summarized using descriptive statistics. Association between the PICU length stay, and variables sex, age, clinical condition complexity, number of drugs prescribed, and severity of pDDI were examined by univariate and multiple linear regression. Seventy percent of patients aged three days to 14 years old were exposed at least one potential DDIs during PICU stay. Two hundred eighty-four different types of pDDIs were identified, occurring 1,123 times. Nervous system drugs were implicated in 55% of the interactions, and fentanyl (10%) was most involving in pDDIs. Most pDDIs were classified as higher severity (56.2%), with reasonable documentation (64.6%) and unspecified onset time (63.8%). Worse clinical condition, ten or more drugs prescribed, and most severe pDDIs were associated with a longer PICU length of stay. Multiple linear regression analysis showed an increase of 9.83 days (95% confidence interval: 3.61–16.05; p = 0.002) in the PICU length of stay in children with major or contraindicated pDDIs. The results of this research may support the monitoring and prevention of pDDIs related to adverse events in children in intensive care and the design and conduction of new studies.

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Section: Discussionsupporting

confidence: 84%

Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit

Lima

Camarinha²,

Bezerra

et al. 2020

Front. Pharmacol.

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“…As expected, the result of logistic regression analysis showed that polypharmacy (more than 3 medications per prescription) was a risk factor for the occurrence of pDDIs, which was in agreement with the pilot study of hospitalized pediatric patients conducted by Fabiola Medina-Barajas et al [ 4 ]. Several studies had drawn a consistent conclusion that the increasing amount of medications was a risk factor for presenting drug interactions [ 24 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of potential drug–drug interactions in outpatients of a general hospital in China: a retrospective investigation

et al. 2020

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Background Potential drug-drug interactions are important factors resulting in adverse drug reactions or therapeutic failure. Therefore, potential drug-drug interactions need to be identified to prevent the related risk and improve drug safety. Objective This study was designed to determine the prevalence of potential drug-drug interactions and investigate the association of potential drug-drug interactions with characteristics in outpatient prescriptions. Setting A large-scale general university hospital in Jinshan District of Shanghai, China. Method The retrospective study was conducted on data obtained from prescriptions containing two or more drugs, written for outpatients older than 18 years. They were screened for potential drug-drug interactions using Lexi-Interact in UpToDate, Stockley's Drug Interactions and Medicine Specification in the order of priority. Main outcome measure Drug-drug interactions with C, D, X risk rating and clinical parameters recorded at the prescriptions. Results 16,120 prescriptions were screened for the presence of potential drug-drug interactions and 4882 (30.29%) prescriptions containing 6667 potential drug-drug interactions were identified. Among 6667 potential drug-drug interactions, 90.81% (6054/6667), 8.49% (566/6667), 0.70% (47/6667) potential drug-drug interactions belonged to the risk category of C, D and X, respectively. Male, old age and polypharmacy increased the likelihood of potential drug-drug interactions. The most frequently prescribed drugs responsible for potential drug-drug interactions included pioglitazone, dihydrocodeine, thalidomide, sotalol, amiodarone and amlodipine. The predominant potential adverse outcome of potential drug-drug interactions was the increased central nervous system suppression function with the mechanism of reinforced pharmacological effects. Conclusion This study showed that potentially significant drug-drug interactions in outpatients were prevalent in real-world practice. Considering the risk of potential clinical consequences related to potential drug-drug interactions, it is necessary to implement the computerized surveillance and warning systems with drug-drug interactions databases as well as develop the clinical guidelines regarding the widespread potential drug-drug interactions.

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“…The other drugs are more frequently related to more severe PDI in intensive care in general. ( 6 , 18 )…”

Section: Discussionmentioning

confidence: 99%

“…Likewise other intensive care modalities, drug interactions are a major concern in medical practice, since they may have detrimental consequences for health care. ( 4 , 6 , 7 ) The identification, description and monitoring of potential interactions are, therefore, important in order to minimize pharmacotherapy-related risks. Similar studies may contribute to establishing automated alert systems aimed to the multiprofessional team at ICU, enabling less exposure of patients to severe drug interactions.…”

Section: Discussionmentioning

confidence: 99%

“…( 1 – 3 ) A potential drug-drug interaction (PDI) is defined as the concurrent administration of two potentially interactive drugs, with a prevalence of 46% to 80% among intensive care patients. ( 1 , 4 – 6 ) Because of clinical severity, critically ill patients have a lower capacity for drug elimination, increasing the risk of damage resulting from PDI. ( 3 – 5 , 7 )…”

Section: Introductionmentioning

confidence: 99%

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Drug interactions in maternal intensive care: prevalence, risk factors, and potential risk medications

Pessoa¹,

Clemente²,

Costa³

et al. 2019

Einstein (São Paulo)

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Objective: To characterize severe potential drug interactions in maternal intensive care, and to determine their frequency, risk factors and potential risk medications. Methods: An observational and longitudinal study conducted between December 2014 and December 2015 in a maternal intensive care unit. Clinical data were collected and severe potential drug interactions were identified on pregnant inpatients. The drug interactions were classified by type, prevalence and exposure rate. A multivariate logistic regression model was used to identify the severe potential drug interactions and the related drugs (p<0.05). Results: A total of 95.1% of patients were exposed to, at least, one potential drug interaction; in that, 91.7% 33.9% were related to, respectively, moderate and severe potential drug interactions. The patients were exposed, on average, on 69.2% of days they were in the intensive care unit. The main drugs involved in more severe drug interactions were magnesium sulfate, metoclopramide, propranolol and diazepam. Conclusion: The severe potential drug interactions were observed in almost all patients of the study, and, approximately one third of those interactions were related to greater severity and resulted in exposure during long hospital stay. The higher number of prescribed drugs and its previous use of medications at home increase the occurrence of severe potential drug interactions.

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Características de las interacciones farmacológicas en una unidad de cuidados intensivos de pediatría

Cited by 10 publications

References 12 publications

Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit

Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit

Prevalence of potential drug–drug interactions in outpatients of a general hospital in China: a retrospective investigation

Drug interactions in maternal intensive care: prevalence, risk factors, and potential risk medications

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