Epidemiology of potential drug-drug interactions in elderly population admitted to critical care units of Peshawar, Pakistan

Heterogeneity in the identification of potential drug-drug interactions in the intensive care unit: A systematic review, critical appraisal, and reporting recommendations

Patients admitted to the intensive care unit (ICU) are frequently exposed to potential drug‐drug interactions (pDDIs). However, reported frequencies of pDDIs in the ICU vary widely between studies. This can be partly explained by significant variation in their methodological approach. Insight into methodological choices affecting pDDI frequency would allow for improved comparison and synthesis of reported pDDI frequencies. This study aimed to evaluate the association between methodological choices and pDDI frequency and formulate reporting recommendations for pDDI frequency studies in the ICU. The MEDLINE database was searched to identify papers reporting pDDI frequency in ICU patients. For each paper, the pDDI frequency and methodological choices such as pDDI definition and pDDI knowledge base were extracted, and the risk of bias was assessed. Each paper was categorized as reporting a low, medium, or high pDDI frequency. We sought associations between methodological choices and pDDI frequency group. Based on this comparison, reporting recommendations were formulated. Analysis of methodological choices showed significant heterogeneity between studies, and 65% of the studies had a medium to high risk of bias. High risk of bias, small sample size, and use of drug prescriptions instead of administrations were related to a higher pDDI frequency. The findings of this review may support researchers in designing a reliable methodology assessing pDDI frequency in ICU patients. The reporting recommendations may contribute to standardization, comparison, and synthesis of pDDI frequency studies, ultimately improving knowledge about pDDIs in and outside the ICU setting.

Risk factors for potential drug-drug interactions in patients with myasthenia gravis

OBJECTIVES

Our aim was to determine risk factors for and frequency of potential drug-drug interactions (pDDIs) among hospitalized patients with myasthenia gravis (MG).

METHODS

This was a retrospective cross-sectional study of the-first time hospitalized MG patients or patients hospitalized because of the exacerbation of MG at the Neurology Clinic of the Clinical Center of Serbia, Belgrade. Medical records and discharge summaries of hospitalized MG patients over a 10-year period were reviewed. The pDDIs were identified by means of Micromedex, and multivariate regression methods were used to reveal potential predictors of number of pDDIs per patient.

RESULTS

The study included 687 patients with MG. In total, 2041 pDDIs were detected in 608 (88.5%) patients. Among the discovered pDDIs, 329 different pDDIs were observed. The most frequent pDDIs were pyridostigmine-prednisone (487patients/70.9%) and aspirin-prednisone (90 patients/13.1%) classified as moderate, and enalapril-potassium chloride (71patients/10.3%) classified as major pDDI. Five drugs (aspirin, insulin, prednisone, cyclosporine, metformin) were responsible for 22.6% of different pDDIs. Dyspnea, generalized form of MG, diabetes mellitus, hypertension, total number of drugs-used, use of antiplatelets were identified as the relevant risk factors for total number of pDDIs (R2 = 0.626,F = 73.797, p < 0.001), while age of patients and history of cancer were inversely correlated with such an outcome.

CONCLUSION

The frequency of the pDDIs in hospitalized MG patients is high, and adversely influenced by dyspnea, generalized MG, diabetes mellitus, hypertension, total number of drugs-used and use of antiplatelets.

Drug Interactions of Chronic Neuropsychiatric Drugs in Neuro-critical Care

Neuro psychiatric illnesses are commonly recognised these days in the intensive care especially with the increasing aging population and more intensive care admissions. However they are still inadequately diagnosed and treated disease entities as a majority of these patients do not seek the help of specialists psychiatrists Of course the number of drugs used in psychiatry has explosively increased in recent years. As a corollary to this, the phenomenon of drug- drug interaction between psychiatric drugs and other drugs has come to the forefront. Drug- drug interaction (DDI)) is the response (pharmacological or clinical) of altered drug effects or increase in adverse effects when two or more drugs are used simultaneously^1,2 This effect may be different from the usual action of the individual drugs when used alone. Potential drug- drug interaction (PDDI) are those where theoretically there may be an interaction between the drugs but have not clinically occurred.^1,2