Potential drug-drug interactions in cardiothoracic intensive care unit of a pulmonary teaching hospital

Abstract

Little is known about clinically significant drug-drug interactions (DDIs) in respiratory settings. DDIs are more likely to occur in critically ill patients due to complex pharmacotherapy regimens and organ dysfunctions. The aim of this study was to identify the pattern of potential DDIs (pDDIs) occurring in cardiothoracic intensive care unit (ICU) of a pulmonary hospital. A prospective observational study was conducted for 6 months. All pDDIs for admitted patients in cardiothoracic ICU were identified with Lexi-Interact program and assessed by a clinical pharmacologist. The interacting drugs, reliability, mechanisms, potential outcomes, and clinical management were evaluated for severe and contraindicated interactions. The study included 195 patients. Lung cancer (14.9%) was the most common diagnosis followed by tracheal stenosis (14.3%). The rate of pDDIs was 720.5/100 patients. Interactions were more commonly observed in transplant patients. 17.7% of pDDIs were considered as severe and contraindicated interactions. Metabolism (54.8%) and additive (24.2%) interactions were the most frequent mechanisms leading to pDDIs, and azole antifungals and fluoroquinolones were the main drug classes involved. The pattern of pDDIs in cardiothoracic ICU differs from other ICU settings. Specialized epidemiological knowledge of drug interactions may help clinical practitioners to reduce the risk of adverse drug events.

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

“…Several studies reported the overall prevalence of exposure to pDDIs in adult ICU settings in the range of 44.3% to 87.9% . Our previous study also showed 79.5% of adult patients were exposed to at least 1 pDDI in the cardiothoracic ICU . The occurrence of major and contraindicated pDDIs in pediatric hospitalizations was reported as 46% by Feinstein et al .…”

“…The level of evidence for assignment of reliability to a pDDI was good and excellent for only 21% of the major and contraindicated interactions. In other words, a large number of pDDIs have a theoretical basis for inferring the possibility of an ADE, but these interferences have not been proved in clinical practice . Some DDI software may overestimate pDDIs and cause extra concern about interactions.…”

“…According to the software program, the severity rating of the interactions was categorized on a scale of A (unknown), B (minor), C (moderate), D (major), and X (contraindicated) . The reliability rating was scaled as excellent (E, the interaction has been clearly demonstrated in well‐controlled studies), good (G, the studies strongly suggest that interaction exists; however, the proof of well‐controlled studies is lacking), or fair (F, available evidence is poor, but clinicians suspect interaction on the basis of pharmacologic considerations; or evidence is good for an interaction of pharmacologically similar drug) . Patients’ diagnoses were classified according to the International Classification of Diseases (ICD10)…”

“…In addition, ICU‐admitted patients are at increased risk of DDIs because of the complexity of pharmacotherapy, disease severity, multiple comorbidities, and physiologic dysfunction arising from critical illness . Frequency, mechanisms, clinical significance, and management of pDDIs in the adult ICU setting were identified in our previous study . However, the data cannot be generalized to pediatric patients because they may differ from adults in terms of response to specific drug combinations and the clinical utility of DDI software …”

Critical Care Series

“…1 Because health care costs are not measured in dollars alone, several studies have also demonstrated the impact of adverse events and medication errors in the ICU setting. [2][3][4][5][6] It has been well documented that factors associated with the care of critically ill patients increase the risk of adverse events including, but not limited to, significant polypharmacy with high-risk agents, acute changes in organ function that impact pharmacotherapy, dynamic comorbidities, severe illnesses, and lengthy hospital stays.…”