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

Abstract

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.

Clinically Significant Cytochrome P450-Mediated Drug-Drug Interactions in Children Admitted to Intensive Care Units

“…ere were several studies on the prevalence, common drug pairs, risk factors, and adverse outcomes of pDDIs in children in ICUs [4,12,14,15,18]. However, the occurrence of CYP-mediated and clinically significant pDDIs and related adverse effects have not been studied to the best of our knowledge.…”

Potential drug interactions analysis of COVID-19 patients at a hospital in West Java

“…Hal ini menunjukkan bahwa semakin lama pasien dirawat inap di rumah sakit, maka semakin besar potensi interaksi obat yang terjadi. Hasil analisis ini sejalan dengan penelitian lain dimana interaksi obat mayor yang terjadi mungkin saja berkontribusi dalam peningkatan waktu rawat inap (Lima et al, 2020). Hal ini dapat menunjukkan bahwa pasien dengan durasi rawat inap lebih lama memiliki risiko potensi interaksi obat yang lebih tinggi karena memungkinkan pasien menerima lebih banyak obat dibandingkan pasien dengan durasi rawat inap lebih cepat (Moura et al, 2009).…”

Novel Method for Early Prediction of Clinically Significant Drug–Drug Interactions with a Machine Learning Algorithm Based on Risk Matrix Analysis in the NICU

“…Undesirable effects that occur in a potential or clinically relevant way with the concurrent use of two or more drugs are drug–drug interaction (DDI) and adverse drug reactions (ADR) [ 1 ]. In the broadest sense, a DDI occurs whenever one drug affects the pharmacokinetics (PK), pharmacodynamics (PD), efficacy, or toxicity of another drug depending on various factors such as drug-related (such as the mechanism of action, route of administration, dose, dose interval, duration of treatment, dosing times) and patient-related (such as diagnosis, polypharmacy, pharmacogenetics, length of hospital stays) [ 2 , 3 , 4 ] factors. DDIs often lead to increased healthcare costs, morbidity, and mortality, originating from 2.5 to 4.4% of ADRs and 3 to 5% of all inpatient medication errors [ 5 , 6 ].…”