Investigating Potential Drug-Drug Interactions in Pediatric and Adolescent Patients Receiving Chemotherapy

Abstract

Introduction Pediatric and adolescent oncology patients admitted to receive chemotherapy are at risk for drug-drug interactions (DDI). While adult literature has quoted this risk to be as high as 95% of encounters, the literature in pediatrics is limited. This is a single-center, retrospective chart review of DDI in hospitalized pediatric oncology patients. Methods All patients admitted to Texas Children's Hospital for chemotherapy were included. Medications ordered during the hospitalization were evaluated by Lexicomp® Drug Interactions Tool. Interactions classified as D or X or interactions rated a C including a chemotherapeutic agent were independently reviewed by three clinicians for clinical relevance. Medications associated with central nervous system (CNS) depression or QTc prolongation were counted separately. Results Of 100 admissions evaluated, 100% had a flagged interaction. There were a total of 12 X-rated interactions, 8 D-rated interactions, and 12 C-rated interactions with a chemotherapeutic agent found to be clinically relevant. Thirty-three percent of admissions had 4 or more QTc prolonging medications ordered. Twenty-four percent of admissions had 3 or more prescribed CNS depressants. In total 49% of admissions were found to have at least 1 clinically-significant DDI. Conclusions This study exemplifies the risk of drug-drug interactions in children and young adults admitted to the hospital for chemotherapy. We demonstrated a high rate of flagged interactions with about half of admissions found to have a potentially clinically-significant DDI. Concomitant use of multiple QTc prolonging and CNS depressant medications was also prevalent, indicating a need to evaluate monitoring practices.

Investigation of polypharmacy and potential drug-drug interactions in a group of hospitalized pediatric patients: a single-center study

“…18 According to recent data, a retrospective data analysis study using the Pediatric Health Information System (PHIS) database, which included data from 498,956 hospitalized children from 43 different hospitals, found that 49% of hospitalizations in hospitalized pediatric patients were associated with ≥1 potential DDI. 19 Similar results were obtained in a study conducted by Daignault et al 20 When we compare the results of our study, we can conclude that they are compatible with the intervals stated in the literature.…”