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Analysis of Potential Drug‐Drug Interactions in Medical Intensive Care Unit Patients
Author(s) -
Uijtendaal Esther V.,
Harssel Lieke L. M.,
Hugenholtz Gerard W. K.,
Kuck Emile M.,
Zwartvan Rijkom Jeannette E. F.,
Cremer Olaf L.,
Egberts Toine C. G.
Publication year - 2014
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1395
Subject(s) - medicine , intensive care unit , observational study , confidence interval , drug , emergency medicine , hypoglycemia , pharmacology , insulin
Objective To describe the frequency and type of potential drug‐drug interactions ( pDDI s) in a general intensive care unit (ICU) and to make recommendations to improve the management of these pDDI s. Design Retrospective observational study. Setting General ICU of a tertiary care hospital. Subjects All patients admitted for more than 24 hours between May 2009 and December 2010 who were prescribed at least one medication. Measurement and Main Results Based on the G‐Standaard, the Dutch national drug database, pDDI s were identified and classified into categories of potential clinical outcome and management advice. In total, 35,784 medication episodes were identified, resulting in 2887 pDDI s (8.1%). These 2887 pDDI s occurred in 1659 patients for a mean frequency of 1.7 (95% confidence interval [CI] 1.6–1.9) pDDI s per patient. Overall, 54% of the patients experienced at least one pDDI with pDDI s present during 27% of all ICU admission days. All pDDI s could be reconstructed using 81 of the 358 (23%) relevant unique pDDI pairs described in the G‐Standaard. The most frequently occurring potential clinical consequence was an increased risk of side effects or toxicity (91% of the pDDI s) such as electrolyte disturbances and masking of hypoglycemia. The most important advised management strategy was monitoring (81%), consisting of monitoring of laboratory values (52%), clinical monitoring of toxicity or effectiveness (48%), or monitoring of physical parameters such as electrocardiogram and blood pressure (11%). Conclusion Potential drug‐drug interactions occur in 54% of all ICU patients, which is two times more than the rate seen in patients on general wards. A limited set of 20 pDDI pairs is responsible for more than 90% of all pDDI s. Therefore, it is worthwhile to develop guidelines for the management of these specific pDDI s. As the vast majority of the interactions can be managed by monitoring, advanced clinical decision support systems linking laboratory data to prescription data may be an effective risk management strategy.