Evaluation of Polypharmacy and Drug Interactions in the Treatment of Patients with Sepsis
PDF
Cite
Share
Request
Original Research
P: 105-110
September 2021

Evaluation of Polypharmacy and Drug Interactions in the Treatment of Patients with Sepsis

J Turk Soc Intens Care 2021;19(3):105-110
1. Çukurova Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık Anabilim Dalı, Adana, Türkiye
2. Çukurova Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık Anabilim Dalı, Adana, Türkiye
3. Hacettepe Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık Anabilim Dalı, Ankara, Türkiye
4. Hacettepe Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık Anabilim Dalı, Ankara, Türkiye
No information available.
No information available
Received Date: 05.05.2020
Accepted Date: 23.07.2020
Publish Date: 26.08.2021
PDF
Cite
Share
Request

ABSTRACT

Objective:

Comprehensive and supportive therapies of sepsis and septic shock (SSS) cause polypharmacy and increase the risk of drug interactions. This study aimed to evaluate the rate of polypharmacy, potential drug interactions, and clinical pharmacists’ interventions on drug interactions in patients with SSS.

Materials and Methods:

This prospective, cross-sectional study was conducted in the intensive care unit of a university hospital. Drug interactions and clinical pharmacist’s interventions on these interactions were evaluated in patients with SSS.

Results:

The mean number of drugs received by 65 patients (67.7% male) was 8.69±2.12, and 161 drug interactions were recorded. After the assessment of these drug interactions according to their clinical significance, interventions were made in 19 (11.8%) patients. Of these drugs, 78.9% were related to antimicrobials (especially clarithromycin, 31.6%). All interventions were accepted and fully implemented by physicians. The number of drug interactions increased with the increasing frequency of drug use (r=0.475; p<0.05). A clinically significant interaction that required intervention was detected in patients taking seven drugs.

Conclusion:

A positive relationship was found between the number of drugs and the risk of drug interactions. Owing to polypharmacy and drug interactions in patients with SSS, clinicians should be aware of and clinical pharmacists should be involved in drug-interaction management.

Keywords: Sepsis, septic shock, polypharmacy, drug interaction

References

1
Mortazavi SS, Shati M, Keshtkar A, Malakouti SK, Bazargan M, Assari S. Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open 2016;6:e010989.
2
Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002;55:809-17.
3
Çağatay A, Başaran S, Saribuğa A. Sepsis: genel kavramlar ve epidemiyoloji. Turkiye Klinikleri J Emerg Med-Special Topics 2015;1:1-10.
4
Ayhancı T, Altındiş M. Antimikrobiyal peptidlerin sepsis tanısındaki rolü. Journal of BSHR 2019;3:1-7.
5
Cavanaugh JB Jr, Sullivan JB, East N, Nodzon JN. Importance of Pharmacy Involvement in the Treatment of Sepsis. Hosp Pharm 2017;52:191-7.
6
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017;43:304-77.
7
De Paepe P, Belpaire FM, Buylaert WA. Pharmacokinetic and pharmacodynamic considerations when treating patients with sepsis and septic shock. Clin Pharmacokinet 2002;41:1135-51.
8
UpToDate® [Internet].(Wolters Kluwer Health, Massachusetts, ABD), Erişim tarihi: 5 Mart 2018, Erişim adresi: https://www.uptodate.com/contents/search
9
Sehgal V, Bajwa SJ, Consalvo JA, Bajaj A. Clinical conundrums in management of sepsis in the elderly. J Transl Int Med 2015;3:106-12.
10
Garpestad E, Devlin JW. Polypharmacy and Delirium in Critically Ill Older Adults: Recognition and Prevention. Clin Geriatr Med 2017;33:189-203.
11
Reis AM, Cassiani SH. Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. Clinics (Sao Paulo) 2011;66:9-15.
12
Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci 2006;9:427-33.
13
Zhou SF, Xue CC, Yu XQ, Li C, Wang G. Clinically important drug interactions potentially involving mechanism-based inhibition of cytochrome P450 3A4 and the role of therapeutic drug monitoring. Ther Drug Monit 2007;29:687-710.
14
Mann HJ. Drug-associated disease: cytochrome P450 interactions. Crit Care Clin 2006;22:329-45.
15
Mouly S, Meune C, Bergmann JF. Mini-series: I. Basic science. Uncertainty and inaccuracy of predicting CYP-mediated in vivo drug interactions in the ICU from in vitro models: focus on CYP3A4. Intensive Care Med 2009;35:417-29.
16
Kopp BJ, Erstad BL, Allen ME, Theodorou AA, Priestley G. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit Care Med 2006;34:415-25.
17
Stewart RB, Cooper JW. Polypharmacy in the aged. Practical solutions. Drugs Aging 1994;4:449-61.
18
Kara E, Tecen-Yücel K, Özdemir N, İnkaya AÇ, Bayraktar-Ekincioğlu A, Demirkan K, et al. Yoğun bakım hastalarında antibiyotiklerin diğer ilaçlarla etkileşimlerinin değerlendirilmesi. STED/Sürekli Tıp Eğitimi Dergisi 2019;28:404-9.
19
Uijtendaal EV, van Harssel LL, Hugenholtz GW, Kuck EM, Zwart-van Rijkom JE, Cremer OL, et al. Analysis of potential drug-drug interactions in medical intensive care unit patients. Pharmacotherapy 2014;34:213-9.
20
Vieweg WV, Hancox JC, Hasnain M, Koneru JN, Gysel M, Baranchuk A. Clarithromycin, QTc interval prolongation and torsades de pointes: the need to study case reports. Ther Adv Infect Dis 2013;1:121-38.
21
van Haarst AD, van ‘t Klooster GA, van Gerven JM, Schoemaker RC, van Oene JC, Burggraaf J, et al. The influence of cisapride and clarithromycin on QT intervals in healthy volunteers. Clin Pharmacol Ther 1998;64:542-6.
22
Sekkarie MA. Torsades de pointes in two chronic renal failure patients treated with cisapride and clarithromycin. Am J Kidney Dis 1997;30:437-9.
23
Choudhury L, Grais IM, Passman RS. Torsades de pointes due to drug interaction between disopyramide and clarithromycin. Heart Dis 1999;1:206-7.
24
Hayashi Y, Ikeda U, Hashimoto T, Watanabe T, Mitsuhashi T, Shimada K. Torsades de pointes ventricular tachycardia induced by clarithromycin and disopyramide in the presence of hypokalemia. Pacing Clin Electrophysiol 1999;22:672-4.
25
Paar D, Terjung B, Sauerbruch T. Life-threatening interaction between clarithromycin and disopyramide. Lancet 1997;349:326-7.
26
Wang J, Chen Y, Lei W, Chen C, Zhu Y, Su N, et al. Sudden Cardiac Arrest Triggered by Coadministration of Fluconazole and Amiodarone. Cardiology 2017;137:92-5.
27
Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med 2019;7:2050312119835043.
28
Sharma S, Kumar A. Antimicrobial management of sepsis and septic shock. Clin Chest Med 2008;29:677-87.
2024 ©️ Galenos Publishing House