ASSESSMENT OF PREVALENCE OF POTENTIAL DRUGô€‡§DRUG INTERACTIONS IN MEDICAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL IN INDIA
Background: Critically ill-patients frequently receive multidrug regimens (polypharmacy) with the goal of providing the superlative
pharmacotherapeutic support. Drug-drug interaction (DDI) is a specific type of adverse event, which develops due to multiple regimen therapy, and
that may lead to significant hospitalization and death.
Methods: A retrospective study was conducted for a period of 3 months to assess the prevalence potential DDIs in medical Intensive Care Unit (MICU)
patients of a north Indian tertiary care hospital using Lexi Comp drug interact android mobile application.
Results: A total of 72 patients were identified for this study. 65.27% (47) were males, and 34.72% (25) were females. The average age of the study
population was 52 years, and average length of stay in hospital was found to be 7 days. An average of 17.09 drugs per patient was administered to the
patients during the study period. 90.02% (65) of patients experienced at least one potential DDI. A total of 222 interactions observed during the study
period with an occurrence rate of 3.08 DDI per patient. There were 106 types drug pairs was found to get interacted at least 1 time. Corticosteroids,
anticonvulsants, central nervous system depressants, sympathomimetics and quinolone antibiotics are the main class of drugs mostly interacted in
Conclusion: The study shows that, concomitant administration rate of potentially interacting drugs are very high in MICU. We suggest that, special
safety measures must be followed by physicians, pharmacists, and nurses to prevent and monitor DDIs in all departments of the hospital especially in
intensive care departments. Health providers must be able to identify and classify drug interactions (DIs), and know how to manage them clinically,
that is, how to minimize or more over prevent them. Practice of a computer assisted DI checker before prescribing/administering of the drugs can
avoid DDIs. In settings with multiple drug use like in ICUs, attendance of a pharmacist or clinical pharmacist, taking the responsibility for monitoring
DIs and notifying the physician about potential problems could decrease the harm inpatient and ensure the patient safety.
Keywords: Drug interaction, Intensive care, Patient safety, Rational therapy.
Ann Pharmacother 2006;40(1):116-8.
2. Cremades J, Gonzalo M, Arrebola I. Relationship between drug
interactions and drug-related negative clinical outcomes. Pharm Pract
3. Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized
surveillance of adverse drug events in hospital patients. JAMA
4. Grymonpre RE, Mitenko PA, Sitar DS, Aoki FY, Montgomery PR.
Drug-associated hospital admissions in older medical patients. J Am
Geriatr Soc 1988;36(12):1092-8.
5. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug
events in hospitalized patients. Excess length of stay, extra costs, and
attributable mortality. JAMA 1997;277(4):301-6.
6. Levy M, Kewitz H, Altwein W, Hillebrand J, Eliakim M. Hospital
admissions due to adverse drug reactions: A comparative study from
Jerusalem and Berlin. Eur J Clin Pharmacol 1980;17(1):25-31.
7. Romac DR, Albertson TE. Drug interactions in the intensive care unit.
Clin Chest Med 1999;20(2):385-99, ix.
8. Stockwell DC, Slonim AD. Quality and safety in the intensive care unit.
J Intensive Care Med 2006;21(4):199-210.
9. Rivkin A. Admissions to a medical intensive care unit related to adverse
drug reactions. Am J Health Syst Pharm 2007;64(17):1840-3.10. Fijn R, Van den Bemt PM, Chow M, De Blaey CJ, De Jong-Van den
Berg LT, Brouwers JR. Hospital prescribing errors: Epidemiological
assessment of predictors. Br J Clin Pharmacol 2002;53(3):326-31.
11. Plaza J, Alamo M, Torres P, Fuentes A, LÃ³pez F. Drug interactions and
adverse events induced by drugs used in an intensive care unit. Rev
Med Chil 2010;138:452-60.
12. Available from: https://www.play.google.com/store/apps/
details?id=com.lexi.android&hl=en. (Last accessed February 01, 2013).
13. Lexicomp. Lexi-Interact, 2012. Available from: http://www.uptodate.
com/crlsql/interact/frameset.jsp. [Last accessed on 2012 Apr 18].
14. Spriet I, Meersseman W, de Hoon J, von Winckelmann S, Wilmer A,
Willems L. Mini-series: II. Clinical aspects. Clinically relevant
CYP450-mediated drug interactions in the ICU. Intensive Care Med
15. Hammes JA, Pfuetzenreiter F, Silveira FD, Koenig A, Westphal GA.
Potential drug interactions prevalence in intensive care units. Rev Bras
Ter Intensiva 2008;20(4):349-54.
16. Lima RE, De Bortoli Cassiani SH. Potential drug interactions in
intensive care patients at a teaching hospital. Rev Lat Am Enfermagem
17. Reis AM, Cassiani SH. Prevalence of potential drug interactions in
patients in an intensive care unit of a university hospital in Brazil.
Clinics (Sao Paulo) 2011;66(1):9-15.
18. CaribÃ© RA, Chaves GR, Pocognoni JD, Souza IA. Potential drug
interactions in patients with sepsis admitted to the intensive care unit.
Farm Hosp 2013;37(5):383-7.
19. Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug
interactions and its associated factors in a Brazilian teaching hospital.
J Pharm Pharm Sci 2006;9(3):427-33.
20. Straubhaar B, KrÃ¤henbÃ¼hl S, Schlienger RG. The prevalence of
potential drug-drug interactions in patients with heart failure at hospital
discharge. Drug Saf 2006;29(1):79-90.
21. Sierra P, Castillo J, GÃ³mez M, Sorribes V, Monterde J, CastaÃ±o J.
Potential and real drug interactions in critical care patients. Rev Esp
Anestesiol Reanim 1997;44:383-7.
22. Rafiei H, Esmaeli Abdar M, Amiri M, Ahmadinejad M. The study of
harmful and beneficial drug interactions in intensive care, Kerman,
Iran. J Intensive Care Soc 2013;14(2):155-8.
23. Saaby L, Olesen C, Fedder J, Haunstrup E. Drug-drug interactions in
intensive care patients. Ugeskr Laeger 2009;171(39):2817-22.
24. 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
25. Rafiei H, Arab M, Ranjbar H, Sepehri GR, Arab N, Amiri M. The
prevalence of potential drug interactions in intensive care units. Iran J
Crit Care Nurs 2012;4(4):191-6.
26. Nazari MA, Moghadam N. Evaluation of pharmacokinetic drug
interactions in prescriptions of intensive care unit (ICU) in a teaching
hospital. Iran J Pharm Res 2006;3:215-8.
27. Almeida SM, Gama CS, Akamine N. Prevalence and classification
of drug-drug interactions in intensive care patients. Einstein
28. Haji Aghajani M, Sistanizad M, Abbasinazari M, Abiar Ghamsari M,
Ayazkhoo L, Safi O, et al. Potential drug-drug interactions in post-CCU
of a teaching hospital. Iran J Pharm Res 2013;12(1):243-8.
29. Letsas KP, Efremidis M, Kounas SP, Pappas LK, Gavrielatos G,
Alexanian IP, et al. Clinical characteristics of patients with drug-induced
QT interval prolongation and torsade de pointes: Identification of risk
factors. Clin Res Cardiol 2009;98(4):208-12.
30. Gupta A, Lawrence AT, Krishnan K, Kavinsky CJ, Trohman RG. Current
concepts in the mechanisms and management of drug-induced QT
prolongation and torsade de pointes. Am Heart J 2007;153(6):891- 9.
31. Beitland S, Platou ES, Sunde K. Drug-induced long QT syndrome and
fatal arrhythmias in the intensive care unit. Acta Anaesthesiol Scand
32. Mouly S, Meune C, Bergmann JF. Mini-series: I. Basic science.
Uncertainty and inaccuracy of predicting CYP-mediated in vivo drug
interactions in the ICU from in vitro models: Focus on CYP3A4.
Intensive Care Med 2009;35(3):417-29.
33. Zhou SF, Xue CC, Yu XQ, Li C, Wang G. Clinically important drug
interactions potentially involving mechanism-based inhibition of
cytochrome P450 3A4 and the role of therapeutic drug monitoring.
Ther Drug Monit 2007;29(6):687-710.
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