Important drug classes associated with potential drug-drug interactions in critically ill patients: highlights for cardiothoracic intensivists
Important drug classes associated with potential drug-drug interactions in critically ill patients: highlights for cardiothoracic intensivists
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DOI：
10.1186/s13613-015-0086-4
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发表时间：
2015-11-24
影响因子：
8.1
通讯作者：
Alehashem, Maryam
中科院分区：
文献类型：
--
作者：
Baniasadi, Shadi;Farzanegan, Behrooz;Alehashem, Maryam
背景：重症监护病房(ICU)的患者更容易发生药物-药物相互作用(DDIS)。显示所有交互作用的软件和图表可能不适合临床使用。本研究旨在确定心胸ICU中与临床有意义的DDIS相关的主要药物类别，并对DDIS进行分类，以使心胸重症医生意识到安全用药。方法：这项前瞻性研究在一所大学附属教学医院的心胸ICU进行，历时6个月。临床药理学家使用Lexi-InterAct数据库评估潜在的药物-药物相互作用(PDDI)的存在。根据严重程度和可靠性等级定义具有临床意义的pDDI。结果：在1780个用药中，496个药物导致了主要的(D)和禁忌性(X)的相互作用。9个药物类别负责D和/或X交互作用，可靠性极好(E)和/或良好(G)。抗感染药物(45.87%)是引起临床意义pDDI的主要药物类别，其次为中枢神经系统药物(14.67%)。咪唑类抗真菌药作为相互作用最强的抗菌药物，引起了细胞色素P3A底物的代谢抑制。结论：危重病患者普遍存在潜在的患者安全隐患。目前的研究结果有助于提高临床医生在这一领域的知识和认识，并将pDDIs引起的不良事件降至最低。
Background: Patients in the intensive care unit (ICU) are more prone to drug-drug interactions (DDIs). The software and charts that indicate all interactions may not be proper for clinical usage. This study aimed to identify the main drug classes associated with clinically significant DDIs in cardiothoracic ICU and categorize DDIs to make cardiothoracic intensivists aware of safe medication usage.Methods: This prospective study was conducted over 6 months in a cardiothoracic ICU of a university-affiliated teaching hospital. The presence of potential drug-drug interactions (pDDIs) was assessed by a clinical pharmacologist using Lexi-Interact database. Clinically significant pDDIs were defined according to severity and reliability rating. Interacting drug classes, mechanisms, and recommendations were identified for each interaction.Results: From 1780 administered drugs, 496 lead to major (D) and contraindicated (X) interactions. Nine drug classes were responsible for D and/or X interactions with excellent (E) and/or good (G) reliability. Anti-infective agents (45.87 %) were the main drug classes that caused clinically significant pDDIs followed by central nervous system drugs (14.67 %). Azole antifungals as the most interacting antimicrobial agents precipitated metabolism inhibition of CYP3A substrates.Conclusions: Clinically significant pDDIs as potential patient safety risks were prevalent in critically ill patients. The findings from current study help to improve knowledge and awareness of clinicians in this area and minimize adverse events due to pDDIs.