Drug-Drug Interactions Among Hospitalized Children Receiving Chronic Antiepileptic Drug Therapy

Lebowitz, Mollie Blazar; Olson, Karen L.; Burns, Michele M.; Harper, Marvin B.; Bourgeois, Florence T.

doi:10.1542/hpeds.2015-0249

Cited by 16 publications

(18 citation statements)

References 31 publications

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“…So the probability of drug-drug interaction is high in pediatric population. In this study we found 17% prevalence of potential DDI which is within the range of values reported by different authors (from 3.8% to 75%) (Langerova et al, 2014;Yeh et al, 2014;Oshikoya et al, 2013;Fernandez de Palencia Espinosa et al, 2014, Lebowitz et al, 2016Dai et al, 2016). There is wide variability in the potential DDIs prevalence values reported in the literature, which can be explained by a) the included population, b) the study design and c) the software used for the identification of DDI.…”

Section: Resultssupporting

confidence: 85%

Assessment of Interactions of Drugs Prescribed for Pediatric Patients in Bangladesh

Ahmed

Yesmine

Rahman³

et al. 2021

Bangla Pharma J

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Drug-drug interactions (DDIs) represent an important clinical problem. During inpatient admissions, infants, children, and adolescents are typically exposed to different medications, increasing their risk of potential drug-drug interactions (pDDIs). While drug interactions are reported to be common, there are only few publications of the prevalence of such interactions among pediatric patients in Bangladesh. The present study tries to estimates the prevalence and characteristics of pDDI exposure of pediatric patients treated in children’s hospitals. This observational retrospective study was carried out on 155 patients admitted to a children’s hospital located at Dhaka during January 2019 to August 2019. The medications of the patients were analyzed for pDDIs by using Medscape drug interaction checker. The prescriptions were analyzed for demographic characteristics, medical and detailed drug history. Drug-drug interactions (DDIs) were evaluated for total numbers, types and severity of DDIs. Total 155 prescriptions with mean age 2.12±2.08 years were analyzed and a total of 25 pDDIs were recorded. The prevalence of pDDI was 17%, of which 12 (48%) were pharmacodynamic interactions, 10 (40%) were pharmacokinetic interactions and 3 (12%) of unknown mechanism. According to the severity of interaction, 4 (18%) cases were categorized as serious, 15 (55%) cases as moderate and 6 (27%) cases as minor. The occurrence of DDIs were significantly associated (r=0.912, p<0.05) with the number of drugs prescribed. The present study has identified pDDIs and also documented interactions in pediatrics patients. It has highlighted the need for screening prescriptions of pediatric patients for pDDIs and proactive monitoring of patients who have identified risk factors in order to promote detection and prevention of possible adverse drug interactions. Bangladesh Pharmaceutical Journal 24(2): 91-98, 2021

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Section: Resultssupporting

confidence: 85%

Assessment of Interactions of Drugs Prescribed for Pediatric Patients in Bangladesh

Ahmed

Yesmine

Rahman³

et al. 2021

Bangla Pharma J

View full text Add to dashboard Cite

show abstract

“…Appropriate management such as monitoring for efficacy, considering an alternative medication, dose adjustment, and monitoring for toxicity should be recommended by considering patient history and the result of laboratory tests to prevent the consequences of metabolism (induction and/or inhibition) interactions . Administration of an alternative medication can decrease the number of pDDIs in a prescription when a precipitant medication such as phenobarbital or phenytoin interferes with the metabolism of many drugs . Monitoring for efficacy and/or toxicity is an appropriate recommendation when the metabolism of an object medication with a wide therapeutic index has been affected by only 1 precipitant drug, for example, inhibition of dexamethasone metabolism by CYP3A4 inhibitors…”

Section: Discussionmentioning

confidence: 99%

“…25 Administration of an alternative medication can decrease the number of pDDIs in a prescription when a precipitant medication such as phenobarbital or phenytoin interferes with the metabolism of many drugs. 26,27 Monitoring for efficacy and/or toxicity is an appropriate recommendation when the metabolism of an object medication with a wide therapeutic index has been affected by only 1 precipitant drug, for example, inhibition of dexamethasone metabolism by CYP3A4 inhibitors. 28 An additive mechanism usually causes prolongation of the QTc interval in ICU-admitted patients.…”

Section: Discussionmentioning

confidence: 99%

Potential Drug–Drug Interactions Among Critically Ill Pediatric Patients in a Tertiary Pulmonary Center

Hassanzad

Arenas-López

Baniasadi

2017

The Journal of Clinical Pharma

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Patients in the pediatric intensive care unit (PICU) are at increased risk of potential drug-drug interactions (pDDIs) because of the complexity of pharmacotherapy. The current study aimed to assess the rate, pattern, risk factors, and management of pDDIs in the PICU of an academic pulmonary hospital. A prospective observational study was conducted for 6 months. Pharmacotherapy data of PICU-admitted patients were evaluated by a clinical pharmacologist. Interacting drugs, reliability, mechanism, potential outcome, and clinical management of pDDIs were identified using the Lexi-Interact database. Logistic regression was applied to analyze the risk factors that could be associated with the interactions. One hundred and twenty-three medication profiles were evaluated during the study period. Diseases of the respiratory system were the main diagnoses among intensive care unit (ICU)-admitted patients (56.1%). A total of 38.6% of the patients exposed to at least 1 major and/or contraindicated interaction during ICU admission. Most pDDIs occurred through metabolic (35.4%) and additive (34.8%) mechanisms. 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 pharmacologists is recommended to prevent harmful outcomes of DDIs.

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“…Phenobarbital, along with several other first-generation antiepileptic and sedative drugs, is known to cause induction of several different P450 enzymes (Perucca, 2006). Because of this, physicians are currently aware of the risk of DDIs with many common medications in patients prescribed phenobarbital (Lebowitz et al, 2016). However, the current clinical practice only takes the DDIs into consideration when multiple drugs are administrated at the same time.…”

Section: Discussionmentioning

confidence: 99%

Phenobarbital Treatment at a Neonatal Age Results in Decreased Efficacy of Omeprazole in Adult Mice

et al. 2017

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Drug-drug interactions (DDIs) occur when the action of one drug interferes with or alters the activity of another drug taken concomitantly. This can lead to decreased drug efficacy or increased toxicity. Because of DDIs, physicians in the clinical practice attempt to avoid potential interactions when multiple drugs are coadministrated; however, there is still a large knowledge gap in understanding how drugs taken in the past can contribute to DDIs in the future. The goal of this study was to investigate the consequence of neonatal drug exposure on efficacy of other drugs administered up through adult life. We selected a mouse model to test phenobarbital exposure at a neonatal age and its impact on efficacy of omeprazole in adult life. The results of our experiment show an observed decrease in omeprazole's ability to raise gastric pH in adult mice that received single or multiple doses of phenobarbital at a neonatal age. This effect may be associated with the permanent induction of cytochrome P450 enzymes in adult liver after neonatal phenobarbital treatment. Our data indicates that DDIs may result from drugs administered in the past in an animal model and should prompt re-evaluation of how DDIs are viewed and how to avoid long-term DDIs in clinical practice.

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Drug-Drug Interactions Among Hospitalized Children Receiving Chronic Antiepileptic Drug Therapy

Cited by 16 publications

References 31 publications

Assessment of Interactions of Drugs Prescribed for Pediatric Patients in Bangladesh

Assessment of Interactions of Drugs Prescribed for Pediatric Patients in Bangladesh

Potential Drug–Drug Interactions Among Critically Ill Pediatric Patients in a Tertiary Pulmonary Center

Phenobarbital Treatment at a Neonatal Age Results in Decreased Efficacy of Omeprazole in Adult Mice

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