Clinical relevancy and risks of potential drug–drug interactions in intensive therapy

Rodrigues, Antônio Flavio Aires; Stahlschmidt, Rebeca; Granja, Silvia; Falcão, Antônio Luís Eiras; Moriel, Patrícia; Mazzola, Priscila Gava

doi:10.1016/j.jsps.2014.11.014

Cited by 24 publications

(29 citation statements)

References 16 publications

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“…This correlation illustrates the inherent risk of prescribing a wide range of drugs (Papadopoulos, Smithburger, 2010;Reimche, Forster, Van Walraven, 2011;Kane-Gill et al, 2012). Moderate pDDIs comprise much of interactions found in this study and are also the most frequently reported by other ICU researches (Smithburger, KaneGill, Seybert, 2012;Smithburger et al, 2010;Hammes et al, 2008;Rodrigues et al, 2015). In this study, the interactions classified as contraindicated, major, and moderate by Micromedex TM were clinically relevant.…”

Section: Discussionsupporting

confidence: 69%

“…Other studies, with different designs and sample sizes, have confirmed this alarmingly high number, which included all classes of pDDIs (from contraindicated to minor) (Papadopoulos, Smithburger, 2010;Reimche, Forster, Van Walraven, 2011;Kane-Gill et al, 2012;Arques-Armoiry et al, 2010;Rodrigues et al, 2015). The relationship between the number of prescribed drugs and the number of pDDIs has been reported previously.…”

Section: Discussionsupporting

confidence: 55%

“…Although clinical decision support systems, as Micromedex™, contribute to this discussion, the inherent risk of each pDDI in clinical practice is individually evaluated using the theoretical information along with the specifics of each case. It is not possible to observe complete agreement among classification of severity of pDDI in intensive therapy publishing (Papadopoulos, Smithburger, 2010;Smithburger et al, 2010;Rodrigues et al, 2015).…”

Section: Discussionmentioning

confidence: 93%

“…Other pDDIs with acknowledged adverse events, such as antidiabetic agents, have an important clinical relevancy in an intensive care environment (Vanham et al, 2016). Identifying which pDDIs are clinically relevant and manage their alerts to the multidisciplinary team is essential to improve patient safety (Rodrigues et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Rodrigues

Stahlschmidt

Granja

et al. 2017

Braz. J. Pharm. Sci.

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Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for > 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through Micromedex TM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results.Uniterms: Potential drug-drug interactions. Intensive care unit. Patient safety. University hospitals.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Rodrigues

Stahlschmidt

Granja

et al. 2017

Braz. J. Pharm. Sci.

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“…This observation regarding the influence of ICU management on the incidence of drugdrug interactions correlates well with the observation made by Rodrigues AT et al A highly complex environment of the ICU combined with the need for prescribing multiple drugs can predispose to increased likelihood of pDDIs in the prescriptions of patients managed in the ICU. 16 The length of hospital stay in our study was 4.7±1.8 days. A significant positive linear relationship was found between the length of hospital stay and pDDIs which correlates well with a study done by Moura et al 17 The reason for such an observation can be attributed to increasing drugs per prescription with increased number of days in the hospital.…”

Section: Discussionmentioning

confidence: 55%

Potential drug-drug interactions among hospitalized cardiac patients

Shanbhag

Hema

Sadananda

2016

Int J Basic Clin Pharmacol

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Drug-drug interactions (DDIs) represent a special category of adverse drug reactions in which the effects of one drug influence the effects of the other, thus either limiting effectiveness or inducing toxicity. Overall, 1% of hospital admissions and 16% of admissions due to ADRs can be attributed to DDIs. A higher number of DDIs is also significantly associated with longer hospitalization and higher treatment costs. 1,2 Approximately 37-60% of patients admitted to hospital may have one or more potentially interacting drug combinations at admission. In inpatients, the risk of having potentially interacting drug combinations can additionally increase because new drugs are often added to the existing drug therapy. DDIs are a concern for patients and providers, as polypharmacy is becoming more common in managing complex diseases or comorbidities and the consequences can range from untoward effects to drug-related morbidity and mortality. Healthcare professionals' ability to recognize potential DDIs is important in reducing their potential risks and adverse consequences. 3 Studies have revealed that DDIs are a major clinical problem along with other adverse drug reactions especially in the hospitalized cardiac patients. Cardiovascular patients are more often reported with potential drug-drug interactions (pDDIs) as compared to patients with other diseases. The possible reason behind higher pDDI rate in cardiovascular diseases may include ABSTRACT Background: Drug-drug interactions (DDIs) are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. The objective of our study was to identify potential drug-drug interactions among hospitalized cardiac patients and to identify the risk factors associated with these interactions. Methods: After obtaining approval from Institutional Ethical Committee, a prospective observational study was carried out among 367 hospitalized cardiac patients in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru. Cardiac patients prescribed at least 2 drugs and having hospital stay of more than 24 hour duration were enrolled into the study. The prescriptions were analysed for potential DDIs using MEDSCAPE multidrug interaction checker tool. Descriptive statistics, Student 't' test, ANOVA and Pearson correlation coefficient were used to analyse the results. Results: The incidence of potential DDIs was 98% with 360 prescriptions having at least one potential DDI. A total of 38 potentially interacting drug pairs were identified among which majority were of significant grade while only 3 were serious. Majority of interactions were pharmacodynamic (76.3%) in nature. Aspirin/clopidogrel (71.1%) and pantoprazole/clopidogrel (69.8%) were the most common interacting pairs. Drugs most commonly involved were aspirin, clopidogrel, heparin, pantoprazole and ramipril. Age, female gender, polypharmacy, prolonged hospital stay, stay in ICU and diabetes mellitus were the risk factors found associated...

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Heterogeneity in the Identification of Potential Drug‐Drug Interactions in the Intensive Care Unit: A Systematic Review, Critical Appraisal, and Reporting Recommendations

Bakker

Dongelmans

Nabovati

et al. 2022

The Journal of Clinical Pharma

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Patients admitted to the intensive care unit (ICU) are frequently exposed to potential drug‐drug interactions (pDDIs). However, reported frequencies of pDDIs in the ICU vary widely between studies. This can be partly explained by significant variation in their methodological approach. Insight into methodological choices affecting pDDI frequency would allow for improved comparison and synthesis of reported pDDI frequencies. This study aimed to evaluate the association between methodological choices and pDDI frequency and formulate reporting recommendations for pDDI frequency studies in the ICU. The MEDLINE database was searched to identify papers reporting pDDI frequency in ICU patients. For each paper, the pDDI frequency and methodological choices such as pDDI definition and pDDI knowledge base were extracted, and the risk of bias was assessed. Each paper was categorized as reporting a low, medium, or high pDDI frequency. We sought associations between methodological choices and pDDI frequency group. Based on this comparison, reporting recommendations were formulated. Analysis of methodological choices showed significant heterogeneity between studies, and 65% of the studies had a medium to high risk of bias. High risk of bias, small sample size, and use of drug prescriptions instead of administrations were related to a higher pDDI frequency. The findings of this review may support researchers in designing a reliable methodology assessing pDDI frequency in ICU patients. The reporting recommendations may contribute to standardization, comparison, and synthesis of pDDI frequency studies, ultimately improving knowledge about pDDIs in and outside the ICU setting.

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Clinical relevancy and risks of potential drug–drug interactions in intensive therapy

Cited by 24 publications

References 16 publications

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Potential drug-drug interactions among hospitalized cardiac patients

Heterogeneity in the Identification of Potential Drug‐Drug Interactions in the Intensive Care Unit: A Systematic Review, Critical Appraisal, and Reporting Recommendations

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