A multicentered pharmacoepidemiological approach to evaluate clinically significant potential drug–drug interactions in medical intensive care settings in Pakistan

Background: Iatrogenic injuries due to drug–drug interactions are particularly significant in critical care units because of the severely compromised state of the patient. The risk further increases with the use of multiple drugs, increasing age, and stay of the patient. Objective: The aim was to assess potential drug–drug interactions, evaluate clinically significant potential drug–drug interactions and their predictors in medical intensive care units of tertiary hospitals in Pakistan. Methods: Analysis of patient data collected from medical intensive care units of tertiary hospitals in Pakistan were carried out using Micromedex DrugReax. Various statistical tools were applied to identify the significance of associated predictors. Results: In a total of 830 patients, prevalence of potential drug–drug interactions was found to be 39%. These attributed to 190 drug combinations, of which 15.4% were clinically significant. A significant association of potential drug–drug interactions was present with number of prescribed drugs, age, and gender. In terms of clinically significant potential drug–drug interactions, the association was significant with increasing age. Moreover, one-way analysis of variance revealed a significant difference in the means of potential drug–drug interactions among the four hospitals. Conclusion: A prevalence of 39% potential drug–drug interactions was observed in patients of medical intensive care unit, with 22.8% being clinically significant. These attributed to nine drug pairs and could easily be avoided to reduce the risk of adverse effects from potential drug–drug interactions.

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A multicentered pharmacoepidemiological approach to evaluate clinically significant potential drug–drug interactions in medical intensive care settings in Pakistan

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918824678 ◽

2019 ◽

Vol 26 (2) ◽

pp. 140-140

Author(s):

Faisal Shakeel ◽

Jamshaid Ali Khan ◽

Muhammad Aamir ◽

Syed Muhammad Asim ◽

Irfan Ullah

Keyword(s):

Intensive Care ◽

Drug Interactions ◽

Potential Drug ◽

Significant Potential ◽

Medical Intensive Care ◽

Clinically Significant

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Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan

International Journal of Clinical Pharmacy ◽

10.1007/s11096-016-0340-3 ◽

2016 ◽

Vol 38 (5) ◽

pp. 1052-1056 ◽

Cited By ~ 8

Author(s):

Mohammad Ismail ◽

Farmanullah Khan ◽

Sidra Noor ◽

Iqbal Haider ◽

Inam-ul Haq ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Drug Interactions ◽

Tertiary Care Hospital ◽

Medical Intensive Care Unit ◽

Tertiary Care ◽

Care Hospital ◽

Potential Drug ◽

Medical Intensive Care

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Potential drug–drug interactions in a medical intensive care unit of a university hospital

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1504-147 ◽

2016 ◽

Vol 46 ◽

pp. 812-819 ◽

Cited By ~ 3

Author(s):

Medine GÜLÇEBİ İDRİZ OĞLU ◽

Esra KÜÇÜKİBRAHİMOĞLU ◽

Atila KARAALP ◽

Özlem SARIKAYA ◽

Mahluga DEMIRKAPU ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Drug Interactions ◽

Medical Intensive Care Unit ◽

University Hospital ◽

Potential Drug ◽

Medical Intensive Care

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The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620980640 ◽

2020 ◽

Vol 11 ◽

pp. 204209862098064

Author(s):

Mansoor Masjedi ◽

Mahtabalsadat Mirjalili ◽

Ehsan Mirzaei ◽

Hadis Mirzaee ◽

Afsaneh Vazin

Keyword(s):

Intensive Care ◽

Drug Interactions ◽

Intensive Care Units ◽

Trauma Center ◽

Type A ◽

P Value ◽

Potential Drug ◽

Potential Ddis ◽

Once Daily ◽

Staffing Patterns

Background: Drug–drug interactions (DDIs) have created alarming challenges for public health, especially in those admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and decreases the treatment costs. The effect of academic versus non-academic (therapeutic) intensivist as well as hours of coverage and attendance of intensivist on potential DDIs (pDDIs) was evaluated in six adult trauma ICUs of a level one trauma center. Methods: In this 6-month cross-sectional study, 200 patients were included. The DDIs were classified into five groups, including type A, B, C, D, and X. pDDIs were defined as interactions belonged to C, D and X categories. Patients in six adult ICUs with three different patterns of intensivist staffing models including type A (once-daily therapeutic intensivist visit followed by 24 h on-call), B (twice-daily academic intensivist visit, 8 h of attendance in ICU and 16 h on-call) and C (all criteria just like ICU type B, except for the presence of therapeutic instead of academic intensivist) were screened for pDDIs. Results: In total, 3735 drug orders and 3869 drugs (193 different types) were screened and 1826 pDDIs were identified. Type C, D and X interactions accounted for 60.6%, 35.5%, and 3.9% of all pDDIs, respectively. The mean of pDDI per patient was significantly higher ( p-value < 0.001) in the ICU type A than ICU types C and B. The frequency of pDDIs was the highest in the type A ICUs. A statistically significant relationship was observed between the number of prescribed drugs and ICU length of stay ( p-value < 0.001 and p = 0.009, respectively). Conclusion: Different patterns of intensivist staffing affect pDDIs to varying degrees. In the studied ICUs academic versus therapeutic intensivist, twice versus once-daily visit, and 8 h attendance with16 h on-call versus 24 h on-call were associated with more reductions in pDDIs. Plain language summary The impact of different intensivist staffing patterns in ICUs on the rate of potential drug-drug interactions Drug-drug interactions (DDIs) have created alarming challenges for public health, especially in patients admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and limits the costs. Considering the high incidence of potential DDIs (pDDIs) occurring for critically ill patients and the importance of ADRs caused by pDDIs in ICUs, the effect of the presence of an academic versus therapeutic intensivist, as well as the hour of coverage of intensivist on prevalence of pDDIs was evaluated in six adult trauma ICUs of a level one trauma center in Shiraz, Iran. We also determined the prevalence of pDDIs and their associated risk factors. To the best of our knowledge, this is the first study that has assessed the effect of various ICU physician staffing models on the incidence and pattern of pDDIs.

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Identification of clinically significant drug-drug interactions in cardiac intensive care units of two tertiary care hospitals in Peshawar, Pakistan

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v15i10.31 ◽

2016 ◽

Vol 15 (10) ◽

pp. 2289 ◽

Cited By ~ 2

Author(s):

Faisal Shakeel ◽

Jamshaid Ali Khan ◽

Muhammad Aamir ◽

Rabeea Shareef ◽

Nazia Shah

Keyword(s):

Intensive Care ◽

Drug Interactions ◽

Intensive Care Units ◽

Tertiary Care ◽

Cardiac Intensive Care ◽

Clinically Significant ◽

Tertiary Care Hospitals

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Assessment of the risk of QT-interval prolongation associated with potential drug-drug interactions in patients admitted to Intensive Care Units

Saudi Pharmaceutical Journal ◽

10.1016/j.jsps.2018.11.003 ◽

2019 ◽

Vol 27 (2) ◽

pp. 229-234

Author(s):

Flávia Medeiros Fernandes ◽

Aryelle Mayara da Silva Paulino ◽

Bruna Camelo Sedda ◽

Eliane Pereira da Silva ◽

Rand Randall Martins ◽

...

Keyword(s):

Intensive Care ◽

Drug Interactions ◽

Intensive Care Units ◽

Qt Interval ◽

Potential Drug ◽

Interval Prolongation ◽

Qt Interval Prolongation

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Assessment of Potential Drug-Drug Interactions and its Associated Factors in Medical Intensive Care Unit of a Tertiary Care Hospital in Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v22i4.34186 ◽

2020 ◽

Vol 22 (4) ◽

pp. 228-232

Author(s):

Anup Raj Upreti ◽

D Shrestha ◽

S Thapa ◽

BK Lingden

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Drug Therapy ◽

Drug Interactions ◽

Associated Factors ◽

Medical Intensive Care Unit ◽

Tertiary Care ◽

Care Hospital ◽

Potential Drug ◽

Medical Intensive Care

Drug interaction may cause an increase in the toxicity of a drug, increases the likelihood of adverse drug reactions, or cause a reduction in the efficacy of particular drug therapy, which may worsen the patient’s condition directly or indirectly. This study aims to assess the potential drug-drug interactions (pDDIs) and their associated factors in the Medical Intensive Care Unit (MICU). We carried out a descriptive retrospective study based on the hospital records of 100 MICU patients. Micromedex Interaction application, designed by Truven Health Analytics Inc., was used to screen prescribed medications. We found 219 drug interactions out of 856 drugs prescribed. The average number of drug interactions per patient was 2.19. The frequency of drugs prescribed, the number of days in MICU, and age had a positive correlation with the occurrence of pDDIs. There were 44.7% major pDDIs; pharmacodynamic being the commonest mechanism for it. Most patients in MICU were at the risk of developing pDDIs. A substantial number of interactions had a major severity. Therefore, there is a need for active surveillance for pDDIs to prevent patient harm during particular drug therapy.

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